Comorbidity index in central cancer registries: The value of hospital discharge data

Daphne Y. Lichtensztajn, Brenda M. Giddings, Cyllene R. Morris, Arti Parikh-Patel, Kenneth W. Kizer

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Background: The presence of comorbid medical conditions can significantly affect a cancer patient’s treatment options, quality of life, and survival. However, these important data are often lacking from population-based cancer registries. Leveraging routine linkage to hospital discharge data, a comorbidity score was calculated for patients in the California Cancer Registry (CCR) database. Methods: California cancer cases diagnosed between 1991 and 2013 were linked to statewide hospital discharge data. A Deyo and Romano adapted Charlson Comorbidity Index was calculated for each case, and the association of comorbidity score with overall survival was assessed with Kaplan-Meier curves and Cox proportional hazards models. Using a subset of Medicare-enrolled CCR cases, the index was validated against a comorbidity score derived using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data. Results: A comorbidity score was calculated for 71% of CCR cases. The majority (60.2%) had no relevant comorbidities. Increasing comorbidity score was associated with poorer overall survival. In a multivariable model, high comorbidity conferred twice the risk of death compared to no comorbidity (hazard ratio 2.33, 95% CI: 2.32-2.34). In the subset of patients with a SEERMedicare-derived score, the sensitivity of the hospital discharge-based index for detecting any comorbidity was 76.5. The association between overall mortality and comorbidity score was stronger for the hospital discharge-based score than for the SEER-Medicare-derived index, and the predictive ability of the hospital discharge-based score, as measured by Harrell’s C index, was also slightly better for the hospital discharge-based score (C index 0.62 versus 0.59, P<0.001). Conclusions: Despite some limitations, using hospital discharge data to construct a comorbidity index for cancer registries is a feasible and valid method to enhance registry data, which can provide important clinically relevant information for population-based cancer outcomes research.

Original languageEnglish (US)
Pages (from-to)601-609
Number of pages9
JournalClinical Epidemiology
StatePublished - Nov 20 2017


  • Administrative health care data
  • Cancer registry
  • Data linkages
  • Hospital discharge data
  • Population-based
  • Survival
  • Validation

ASJC Scopus subject areas

  • Epidemiology


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