Towards international standardisation of the comorbidity index from hospital data in lung cancer patients

Introduction: The International Cancer Benchmarking Partnership (ICBP) identified significant international differences in lung cancer survival. Differing levels of comorbid disease across ICBP countries has been suggested as a potential explanation of this variation but, to date, no studies have quantified its impact. This study investigated whether comparable, robust comorbidity scores can be derived from the different routine population-based cancer datasets available in the ICBP jurisdictions and, if so, use them to quantify international variation in comorbidity and determine its influence on outcome. Methods: Linked population-based lung cancer registry and hospital discharge datasets were acquired from nine ICBP jurisdictions in Australia, Canada, Norway and the United Kingdom (UK) providing a study population of 233,981 individuals. For each person in this cohort Charlson, Elixhauser and in-patient bed day comorbidity scores were derived relating to the four to 36 months prior to their lung cancer diagnosis. The scores were then compared to assess validity and to determine their feasibility of use in international survival comparisons. Results: It was feasible to generate the three comorbidity scores for each jurisdiction, which were found to have good content, face and concurrent validity between them. Predictive validity was limited and there was evidence that the reliability was questionable. Conclusion: The results presented here indicate that inter-jurisdictional comparability of recorded comorbidity was limited due to probable differences in coding and hospital admission practices in each area. Before the contribution of comorbidity on international differences in cancer survival can be investigated an internationally harmonised comorbidity index is required.