A Case-Study of Pancreatic Cancer in Michigan: Challenges in Reconstructing Residential Histories

Transcription

1 A Case-Study of Pancreatic Cancer in Michigan: Challenges in Reconstructing Residential Histories Melissa Slotnick Research Associate BioMedware, Inc.

2 Background Pancreatic Cancer Relatively rare, but low survival rates (median survival = 4 months) 4 th leading cause of cancer deaths in U.S. Recent evidence suggests there may be a long lag-time (10-15 years) between the initial genetic change and metastatic disease development Risk factors: smoking, family history/genetic predisposition, longterm diabetes, diet/obesity Rates higher in males ( male-female rate ratio) American black populations ( black-white rate ratio) Rates increase rapidly with age in U.S. 90% of patients are over 50 years old Age 50-54: 9.8 per 100,000 per year Age 70-74: 57 per 100,000 per year

3 Background Pancreatic Cancer Cluster Analyses County-level clustering techniques demonstrated significant clustering Wayne and Macomb counties White males Pancreatic cancer mortality County-level data Can we further assess clustering throughout the state on a case-level for incident cases? Jacquez GM. Cluster morphology analysis. Spat Spatio-tempor Epidemiol (2009), doi: /j.sste

4 Application of Pancreatic Cancer Data Study Goals Incorporate state-wide incidence data, Evaluate global space-time clustering of the entire pancreatic cancer dataset Evaluate where and when local space-time clusters occur, and which cases comprise the clusters Evaluate the role of hepatitis-b in clustering (original study goal)

5 Pancreatic Cancer in Michigan Available Data Pancreatic Cancer Cases Michigan Department of Community Health (MDCH), State Cancer Surveillance Program Incident cases, case-level data (n=25,291) Diagnosed in years Entire state of Michigan Geocoded address at diagnosis Age, race, sex, stage, grade, date of diagnosis, survival Residential History Data Commercially available from LexisNexis (Accurint) Linked to cancer cases Up to 16 previous addresses provided per cancer case

6 Michigan Population Density

7 Pancreatic Cancer Incidence in Southeast MI Numbers of Invasive Cancers of the Pancreas and Age-Specific Incidence Rates (per 100,000) by County of Residence Michigan Residents, County of < Residence Number Rate Number Rate Number Rate Number Rate Total Macomb Oakland Washtenaw Wayne Michigan Source : Michigan Resident Cancer Incidence File. Includes cases diagnosed in and processed by the Michigan Department of Community Health, Division for Vital Records and Health Statistics by December 29, % of cases diagnosed in Michigan in resided in 4 counties in the Detroit metropolitan area Rates increase with age

8 Age-Adjusted Pancreatic Cancer Incidence Rates per 100,000 by Michigan County, Houghton Marquette Berrien Wayne Source : Michigan Resident Cancer Incidence File. Includes cases diagnosed in and processed by the Michigan Department of Community Health, Division for Vital Records and Health Statistics by December 30, Age-adjusted rates are computed by the direct method, and are age-adjusted to the 2000 U.S. standard population. Rates are per 100,000 population in the specified group.

9 Michigan Pancreatic Cancer Cases Descriptive Statistics Distribution by Age, Race, and Gender for All Pancreatic Cancer Cases Diagnosed in Years , State of Michigan Age at Diagnosis TOTAL (%) Race Gender White Black Other Unknown Male Female All (%) (83.4) 3914 (15.5) < (6.7) (25.4) (44.8) (23.0) Unknown

10 Michigan Pancreatic Cancer Cases Descriptive Statistics Stage Distribution for Pancreatic Cases Diagnosed in Years , State of Michigan Stage Number of Cases (%) In Situ 67 (0.3) Localized 2259 (8.9) Regional 6270 (24.8) Distant (40.9) Invasive - Stage Unknown 6344 (25.1) In situ: Abnormal cells are present only in the layer of cells in which they developed. Localized: Cancer is limited to the organ in which it began, without evidence of spread. Regional: Cancer has spread beyond the primary site to nearby lymph nodes or organs and tissues. Distant: Cancer has spread from the primary site to distant organs or distant lymph nodes. Unknown: There is not enough information to determine the stage.

11 Linking Pancreatic Cancer and Hepatitis B Data HepB Data (Michigan Disease Surveillance System) 11,000+ records, ~8500 people Dates back to 1992 (MI law required HepB reporting) Average age for HepB cases, 39.9 years Data linkage completed at MDCH Only 14 pancreatic cancer cases matched to HepB cases

12 Linking Pancreatic Cancer and HepB Data Number of Hepatitis B Cases by Diagnosis Year Diagnosis Year Age of Dx * Total 0-9 3(0) 44(0) 65(0) 65(0) 177(0) (0) 134(0) 156(0) 193(0) 487(0) (0) 414(1) 481(0) 827(0) 1729(1) (0) 478(0) 566(0) 1158(0) 2206(0) (0) 305(1) 505(0) 1156(0) 1967(1) (0) 123(0) 207(1) 773(5) 1103(6) (0) 83(0) 108(2) 277(2) 468(4) (0) 47(0) 67(1) 143(0) 257(1) (0) 14(1) 19(0) 38(0) 71(1) (0) 2(0) 1(0) 3(0) 6(0) Total 19(0) 1644(3) 2175(4) 4633(7) 8471(14) Will be evaluating timing of exposure issue by overlaying percent of cases at years of diagnosis Plan B: Evaluate local and global space-time clustering of ~25,000 pancreatic cancer cases

13 Residential History Data Residential history data commercially available from different vendors LexisNexis - Accurint Provides up to 16 past residences for 14 cents per case Pools more than 10,000 data sources Protective about revealing details of linking procedures and data sources Requested details on how data sources might have changed over time All data linkage completed at MDCH

14 Previous Accuracy Assessment of Residential History Data Compared addresses from written survey data to addresses provided by LexisNexis 946 bladder cancer cases and matched controls, SE Michigan Most recent 3 addresses from LexisNexis Lifetime residential histories from survey Calculated 5 different metrics to quantify how well the addresses matched Metric Title Description 1 City Match LN matches survey city only 2 Street Match LN matches survey city and street 3 Detailed Match LN matches survey city, street, and address number 4 Years at Address Distribution of years listed for LN and survey addresses 5 Survey Years Survey years correctly accounted for by Metrics 2 and 3 Jacquez GM, Slotnick MJ, Meliker JR, AvRuskin G, Copeland G, Nriagu J. Accuracy of Commercially Available Residential Histories for Epidemiologic Studies. American Journal of Epidemiology, (in press).

15 Results: Address Accuracy Assessment Percent of LexisNexis Addresses (n=2388) Matched to Survey Data Metric Metric Title Total Match Percent Match Count 1 1 City Match % 2 Street Match % 3 Detailed Match % 1 Sum of points, not total count (partial matches=0.5, complete matches=1.0 point)

16 Limitations: Address Accuracy Assessment Temporal mismatch for address dates Average number of years at each address 13.5 years reported by participants 8.5 years reported by LexisNexis data Almost half of the LexisNexis addresses reported living at the address for one year or less (93% had the same start and end date) Comparison population Geographically stable (20% of person-years spent outside of study area) Average age 65 years Recall error in survey data Results are for three most recent addresses

17 Linking Pancreatic Cancer Cases to Residential History Data 25,291 Pancreatic cancer cases were linked to Accurint (LexisNexis) data

18 Linking Pancreatic Cancer Cases to Residential History Data

19 Linking Pancreatic Cancer Cases to Residential History Data

20 Linking Pancreatic Cancer Cases to Residential History Data Average number of addresses per case increased from 1 for those diagnosed in 1985 to 3 for those diagnosed in 2007 Real or artificial change? Both?

21 Quality of Residential History Data Changes in technology have likely affected quality of source databases over time for commercially-available data Is there a way to consistently quantify this deficit and incorporate into analyses?

22 Future work Assessing quality of residential history data Pancreatic Cancer Cases Quantify false positive matches, manual look-up of subset Evaluate accuracy of first reported LexisNexis address via comparison with address of diagnosis (from MDCH) Work to obtain further information on source data from Accurint Overall accuracy assessment of commercial data Additional evaluation using a large, prospective study for comparison group Compare multiple vendors Evaluate how well time stamps overlap To what extent can commercial data be used to supplement Incorporating pancreatic cancer data into software Geocoding expected to be complete in several weeks Final dataset available in December

23 Thank you! Acknowledgements: MDCH, Division of Vital Records Glenn Copeland, State Registrar National Cancer Institute

24 EXTRA SLIDES

25 Number of Years at Residence LexisNexis Data* (Three Residences) Raw Addresses Aggregated Addresses Raw Survey Data (All Residences) Raw Survey Data (Last Three Addresses) Raw LexisNexis Data (>1 year)* Average Median th Percentile th Percentile Minimum <1 <1 <1 <1 1.0 Maximum % of address with <1 year 46.4 n/a Omitted residence time Total # of addresses (n) n/a