Investigation of the international comparability of population-based routine hospital data set derived comorbidity scores for patients with lung cancer

Margreet Luchtenborg, Eva J.A. Morris*, Daniela Tataru, Victoria Coupland, Andrew Smith, Roger L. Milne, Luc Te Marvelde, Deborah Baker, Jane Young, Donna Turner, DIane Nishri, Craig Earle, Lorraine Shack, Anna Gavin, Deirdre Fitzpatrick, Conan Donnelly, Yulan Lin, Bjørn Møller, David H. Brewster, Andrew DeasDyfed W. Huws, Ceri White, Janet Warlow, Jem Rashbass, Mick Peake

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


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 data sets 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 data sets were acquired from nine ICBP jurisdictions in Australia, Canada, Norway and the UK providing a study population of 233 981 individuals. For each person in this cohort Charlson, Elixhauser and inpatient bed day Comorbidity Scores were derived relating to the 4-36 months prior to their lung cancer diagnosis. The scores were then compared to assess their validity and 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. Predictive validity was limited and there was evidence that the reliability was questionable. Conclusion The results presented here indicate that interjurisdictional 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.

Original languageEnglish
Pages (from-to)339-349
Number of pages11
Issue number4
Publication statusPublished - Apr 2018

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Publisher Copyright:
© Article author(s) 2018.


  • Clinical epidemiology
  • Lung cancer


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