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The interpretation of time trends

C S Muir1, J F Fraumeni, R Doll

  • 1Information and Statistics Division, Cancer Registration in Scotland, Edinburgh.

Cancer Surveys
|January 1, 1994
PubMed
Summary

Comparing cancer incidence and mortality over time requires consistent International Classification of Diseases (ICD) revisions. Careful consideration of data biases and errors is crucial for valid trend analysis, especially for rare cancers.

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Area of Science:

  • Epidemiology and Public Health
  • Cancer Research
  • Health Statistics

Background:

  • Valid comparison of cancer incidence and mortality over time depends on the comparability of International Statistical Classification of Diseases, Injuries and Causes of Death (ICD) revisions.
  • Decennial revisions of the ICD face challenges in balancing user needs, incorporating scientific advances, and maintaining time-series continuity.
  • Previous ICD revisions have sometimes compromised the continuity of time-series data, posing challenges for historical trend analysis.

Purpose of the Study:

  • To outline the requirements for valid temporal comparisons of cancer incidence and mortality data.
  • To discuss the challenges and considerations in maintaining data comparability across different ICD revisions.
  • To emphasize the importance of addressing potential biases and errors in cancer trend analysis.

Main Methods:

  • Review of the principles and requirements for valid epidemiological time-series analysis.
  • Discussion of the impact of International Statistical Classification of Diseases, Injuries and Causes of Death (ICD) revisions on data comparability.
  • Consideration of potential sources of bias and error, including underregistration and small sample sizes for rare conditions.

Main Results:

  • Despite challenges with ICD revisions, cancer incidence and mortality time trends can be validly compared when potential biases are systematically addressed.
  • Large datasets (e.g., over a million person-years) with low underregistration are likely to reflect reality.
  • Attention to detail is needed for rare cancer sites and histological types due to potential for artifact and greater standard errors.

Conclusions:

  • Temporal comparisons of cancer incidence and mortality are feasible and valuable if investigators are vigilant about data quality and potential biases.
  • Investigating apparent anomalies by consulting local registries and involving experts (epidemiologists, pathologists, clinicians) can clarify trends.
  • Future research should increasingly focus on detailed subsite and histological data, moving beyond three-digit ICD codes for more precise trend analysis.

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