Mesothelioma in occupational cohort studies: methodological considerations

Area of Science:

• Epidemiology
• Public Health
• Oncology

Background:

• Mesothelioma mortality assessment relies on accurate death certificate data.
• Previous methods may have underestimated mesothelioma deaths due to limited coding specificity.

Purpose of the Study:

• To describe effective strategies for the identification and valid assessment of mortality due to mesothelioma.
• To evaluate the accuracy of death certificate data for mesothelioma ascertainment.

Main Methods:

• Manual review of all death certificates mentioning mesothelioma across all International Classification of Diseases (ICD) revisions.
• Comparison of New Jersey death certificate data with histologically confirmed cases from the State Cancer Registry to test ascertainment accuracy.

Main Results:

• A reasonably good agreement was found between death certificate diagnoses and histologically confirmed mesothelioma cases (κ = 0.86).
• A significant proportion of mesothelioma deaths were coded to unspecified anatomical sites, indicating potential undercounting with restricted code review.
• The study validated the accuracy of using death certificates for mesothelioma mortality assessment when a comprehensive review strategy is employed.

Conclusions:

• Ascertainment limited to specific ICD codes for pleura and peritoneum underestimates mesothelioma mortality.
• A comprehensive review of all potentially relevant ICD codes is essential for complete and accurate mesothelioma death ascertainment.
• Improved coding practices and data review strategies are necessary for precise mesothelioma burden estimation.