Long-Term Health Experience of Jet Engine Manufacturing Workers: IV. A Comparison of Central Nervous System Cancer Ascertainment Using Mortality and Incidence Data

Buchanich, Jeanine M.; Youk, Ada O.; Marsh, Gary M.; Kennedy, Kathleen J.; Esmen, Nurtan A.; Lacey, Steven E.; Hancock, Roger; Cunningham, Michael A.; Lieberman, Frank S.; Fleissner, Mary Lou

doi:10.1016/j.annepidem.2010.06.008

« Previous Next »Annals of Epidemiology
Volume 20, Issue 10 , Pages 759-765, October 2010

Long-Term Health Experience of Jet Engine Manufacturing Workers: IV. A Comparison of Central Nervous System Cancer Ascertainment Using Mortality and Incidence Data

Jeanine M. Buchanich, PhD
- Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
- Address correspondence to: Jeanine M. Buchanich, PhD, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261. Tel.: 412–624–3032; Fax: 412–624–9969.
Ada O. Youk, PhD
- Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Gary M. Marsh, PhD
- Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Kathleen J. Kennedy, MS
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL
Nurtan A. Esmen, PhD
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL
Steven E. Lacey, PhD
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL
Roger Hancock, MCE
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL
Michael A. Cunningham, MS
- Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
Frank S. Lieberman, MD
- Department of Neuro-Oncology, University of Pittsburgh Medical Center (UPMC), University of Pittsburgh Cancer Institute, Pittsburgh, PA
Mary Lou Fleissner, DrPH
- Connecticut Department of Public Health, Hartford, CT

Received 29 October 2009; accepted 17 June 2010.

Purpose

To compare ascertainment of central nervous system (CNS) neoplasms with the use of mortality and incidence data as part of an occupational epidemiology study.

Methods

Deaths were identified by matching the cohort of 223,894 jet engine manufacturing employees to the U.S. Social Security Administration death files and the National Death Index. Incident cancer cases were identified by matching the cohort to 19 state cancer registries.

Results

We identified 718 cases overall: 59% by the use of both mortality and cancer incidence tracing; 24% by the use of only mortality tracing, and 17% by the use of only cancer incidence tracing. Compared with state cancer registries, death certificates missed 38% of the malignant, more than six times the benign and nearly 1.5 times the unspecified CNS cases. The positive predictive value of death certificates, with cancer registry as gold standard, was 6% for unspecified, 35% for benign, and 86% for malignant histologies.

Conclusions

Death certificates seriously underascertained benign and unspecified CNS tumors; analyses determined with mortality data would not accurately capture the true extent of disease among the cohort. Most state cancer registries have only collected nonmalignant CNS tumor information since 2004, which currently limits the usefulness of state cancer registries as a source of nonmalignant CNS tumor identification. Underascertainment of CNS deaths could seriously affect interpretation of results, more so if examining nonmalignant CNS.

Key Words: Brain Cancer, Cancer Incidence, Central Nervous System Neoplasms, Death Certificates, Methodology, Mortality

Selected Abbreviations and Acronyms: NDI, National Death Index, CNS, central nervous system, CT, Connecticut, ICD, International Classification of Diseases, UCOD, underlying cause of death, CCOD, contributory cause of death, CBTRUS, Central Brain Tumor Registry of the United States, PPV, positive predictive value