Measuring the incidence of cancer in elderly Americans using Medicare claims data

The Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute is the most frequently used and best estimate of the incidence of cancer in the United States. Although synthetic estimates based on the SEER information can be used to plan cancer prevention and intervention programs, the evaluation of these action programs and the monitoring of cancer incidence in states or other geographic areas requires information on the population for whom the program is directed.

The age-adjusted incidence of six cancers among persons 65 years of age and older for 1986-1987 living in the five states participating in the SEER program was compared with the incidence derived from hospitalization records contained in the Health Care Financing Administration's (HCFA) administrative data files. Age-adjusted incidence rates for 1990 developed from HCFA data for persons living in the nine SEER program areas were contrasted with the incidence rates for persons living in the rest of the United States and were developed for each of the 50 states and the District of Columbia.

The comparison of the SEER and HCFA overall age-adjusted cancer incidence rates in the elderly for 1986-1987 showed that for four of the six cancers (breast, colon, lung, and corpus uteri) the rates differed by 5% or less. The HCFA derived rates were 6.37% and 7.65% greater than the SEER rates for prostate and esophagus cancer, respectively. The incidence of cancer between 1986 and 1990 was neither uniformly higher nor lower among elderly SEER program area residents compared with residents of the rest of the country. Incidence rates varied greatly among states for each of the cancers.

HCFA administrative data can be used by states or other geographic units to monitor the incidence of cancer in the elderly as well as to plan and evaluate cancer prevention and intervention programs.