Abstract：
BACKGROUND: Research efforts to characterize and evaluate care delivery and outcomes for older adults with cancer and comorbid dementia are limited by varied methods used to classify Alzheimer\'s disease and related dementias (ADRD). The purpose of this study is to evaluate differences in demographic, clinical, and cancer characteristics of people newly diagnosed with cancer and concomitant dementia comparing two common methods to identify ADRD using administrative claims data.
METHODS: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Our sample included adults aged 66 years and older with a first primary diagnosis of lung or colorectal cancer between 2011 and 2017. For each cancer diagnosis, we constructed analytical cohorts using the Center for Medicare and Medicaid Services\' Chronic Condition Warehouse (CCW) flag and the Bynum-Standard one- and three-year algorithms to capture diagnosed ADRD. We estimated ADRD prevalence using the algorithms and compared Bynum and CCW cohorts on demographic, clinical, and cancer characteristics at cancer diagnosis and survival for lung and colorectal cancer separately.
RESULTS: Among older adults with lung cancer, ADRD prevalence was 4.7% with the one-year Bynum, 6.5% with the three-year Bynum, and 12.5% using the CCW flag. In the colorectal cohort, ADRD prevalence was 5.6% with the one-year Bynum, 7.6% with the three-year Bynum, and 14.1% with the CCW flag. Demographic characteristics were similar across ADRD cohorts. The Bynum cohorts identified higher proportions of individuals with moderate to severe dementia (13.8% and 11.2% versus 7.1% CCW in lung cancer; 13.1% and 10.6% versus 6.8% CCW in colorectal cancer), higher frailty rates (27.4% and 22.7% versus 15.0% CCW in lung cancer; 26.4% and 22.3% versus 14.8% CCW in colorectal cancer). Median survival was lower for the Bynum cohorts compared to the CCW, regardless of cancer type.
CONCLUSIONS: Findings demonstrate that ADRD prevalence and certain clinical characteristics vary based on dementia ascertainment method and observation period used to classify individuals with ADRD. Considering differences in the cohorts of registry cases generated by the identification method used is essential when interpreting findings related to treatment, utilization, and outcomes within and across cancer cohorts.
METHODS: We conducted a retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Our sample included adults aged 66 years and older with a first primary diagnosis of lung or colorectal cancer between 2011 and 2017. For each cancer diagnosis, we constructed analytical cohorts using the Center for Medicare and Medicaid Services\' Chronic Condition Warehouse (CCW) flag and the Bynum-Standard one- and three-year algorithms to capture diagnosed ADRD. We estimated ADRD prevalence using the algorithms and compared Bynum and CCW cohorts on demographic, clinical, and cancer characteristics at cancer diagnosis and survival for lung and colorectal cancer separately.
RESULTS: Among older adults with lung cancer, ADRD prevalence was 4.7% with the one-year Bynum, 6.5% with the three-year Bynum, and 12.5% using the CCW flag. In the colorectal cohort, ADRD prevalence was 5.6% with the one-year Bynum, 7.6% with the three-year Bynum, and 14.1% with the CCW flag. Demographic characteristics were similar across ADRD cohorts. The Bynum cohorts identified higher proportions of individuals with moderate to severe dementia (13.8% and 11.2% versus 7.1% CCW in lung cancer; 13.1% and 10.6% versus 6.8% CCW in colorectal cancer), higher frailty rates (27.4% and 22.7% versus 15.0% CCW in lung cancer; 26.4% and 22.3% versus 14.8% CCW in colorectal cancer). Median survival was lower for the Bynum cohorts compared to the CCW, regardless of cancer type.
CONCLUSIONS: Findings demonstrate that ADRD prevalence and certain clinical characteristics vary based on dementia ascertainment method and observation period used to classify individuals with ADRD. Considering differences in the cohorts of registry cases generated by the identification method used is essential when interpreting findings related to treatment, utilization, and outcomes within and across cancer cohorts.
摘要：
背景：对患有癌症和痴呆合并症的老年人的护理提供和结果进行表征和评估的研究工作受到用于对阿尔茨海默病和相关痴呆（ADRD）进行分类的各种方法的限制。这项研究的目的是评估人口统计学的差异，临床,以及新诊断出患有癌症和伴随痴呆症的患者的癌症特征，比较了使用行政索赔数据识别ADRD的两种常用方法。
方法：我们进行了一项回顾性队列研究，流行病学,和最终结果(SEER)-医疗保险数据。我们的样本包括2011年至2017年间首次诊断为肺癌或结直肠癌的66岁及以上的成年人。对于每个癌症诊断，我们使用MedicareandMedicaidServices中心的慢性病症仓库(CCW)标志和Bynum-Standard1年和3年算法构建分析队列,以捕获诊断的ADRD.我们使用算法估计了ADRD的患病率，并比较了Bynum和CCW人群的人口统计，临床,以及肺癌和结直肠癌的癌症诊断和生存率的癌症特征。
结果：在患有肺癌的老年人中，一年Bynum的ADRD患病率为4.7％，6.5%与三年期拜纳姆，和12.5％使用CCW标志。在结肠直肠队列中，一年Bynum的ADRD患病率为5.6％，7.6%与三年期拜纳姆，和14.1%与CCW标志。整个ADRD队列的人口统计学特征相似。拜纳姆队列发现，患有中度至重度痴呆的个体比例更高（肺癌中13.8%和11.2%对7.1%的CCW；结直肠癌中13.1%和10.6%对6.8%的CCW），较高的衰弱率(肺癌27.4%和22.7%对15.0%CCW;结直肠癌26.4%和22.3%对14.8%CCW).与CCW相比，Bynum队列的中位生存率较低，无论癌症类型。
结论：研究结果表明，ADRD患病率和某些临床特征因痴呆确定方法和用于ADRD个体分类的观察期而异。在解释与治疗相关的发现时，考虑到由使用的识别方法产生的登记病例队列的差异是至关重要的。利用率，以及癌症队列内部和之间的结果。
方法：我们进行了一项回顾性队列研究，流行病学,和最终结果(SEER)-医疗保险数据。我们的样本包括2011年至2017年间首次诊断为肺癌或结直肠癌的66岁及以上的成年人。对于每个癌症诊断，我们使用MedicareandMedicaidServices中心的慢性病症仓库(CCW)标志和Bynum-Standard1年和3年算法构建分析队列,以捕获诊断的ADRD.我们使用算法估计了ADRD的患病率，并比较了Bynum和CCW人群的人口统计，临床,以及肺癌和结直肠癌的癌症诊断和生存率的癌症特征。
结果：在患有肺癌的老年人中，一年Bynum的ADRD患病率为4.7％，6.5%与三年期拜纳姆，和12.5％使用CCW标志。在结肠直肠队列中，一年Bynum的ADRD患病率为5.6％，7.6%与三年期拜纳姆，和14.1%与CCW标志。整个ADRD队列的人口统计学特征相似。拜纳姆队列发现，患有中度至重度痴呆的个体比例更高（肺癌中13.8%和11.2%对7.1%的CCW；结直肠癌中13.1%和10.6%对6.8%的CCW），较高的衰弱率(肺癌27.4%和22.7%对15.0%CCW;结直肠癌26.4%和22.3%对14.8%CCW).与CCW相比，Bynum队列的中位生存率较低，无论癌症类型。
结论：研究结果表明，ADRD患病率和某些临床特征因痴呆确定方法和用于ADRD个体分类的观察期而异。在解释与治疗相关的发现时，考虑到由使用的识别方法产生的登记病例队列的差异是至关重要的。利用率，以及癌症队列内部和之间的结果。
