Concordance and timing in recording cancer events in primary care, hospital and mortality records for patients with and without psoriasis: A population-based cohort study.

Sreeram V. Ramagopalan,Christopher E. M. Griffiths,Evangelos Kontopantelis,Martin K. Rutter,Rosa Parisi,Alex M. Trafford,Darren M. Ashcroft

doi:10.1371/journal.pone.0254661

Abstract

BackgroundThe association between psoriasis and the risk of cancer has been investigated in numerous studies utilising electronic health records (EHRs), with conflicting results in the extent of the association.ObjectivesTo assess concordance and timing of cancer recording between primary care, hospital and death registration data for people with and without psoriasis.MethodsCohort studies delineated using primary care EHRs from the Clinical Practice Research Datalink (CPRD) GOLD and Aurum databases, with linkage to hospital episode statistics (HES), Office for National Statistics (ONS) mortality data and indices of multiple deprivation (IMD). People with psoriasis were matched to those without psoriasis by age, sex and general practice. Cancer recording between databases was investigated by proportion concordant, that being the presence of cancer record in both source and comparator datasets. Delay in recording cancer diagnoses between CPRD and HES records and predictors of discordance were also assessed.Results58,904 people with psoriasis and 350,592 comparison patients were included using CPRD GOLD; whereas 213,400 people with psoriasis and 1,268,998 comparison patients were included in CPRD Aurum. For all cancer records (excluding keratinocyte), concordance between CPRD and HES was greater than 80%. Concordance for same-site cancer records was markedly lower (<68% GOLD-linked data; <72% Aurum-linked data). Concordance of non-Hodgkin lymphoma and liver cancer recording between CPRD and HES was lower for people with psoriasis compared to those without.ConclusionsConcordance between CPRD and HES is poor when restricted to cancers of the same site, with greater discordance in people with psoriasis for some cancers of specific sites. The use of linked patient-level data is an important step in reducing misclassification of cancer outcomes in epidemiological studies using routinely collected electronic health records.

Highlights

Psoriasis is an immune-mediated inflammatory disease, with substantial regional variation in prevalence across the globe [1]
Concordance between Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES) is poor when restricted to cancers of the same site, with greater discordance in people with psoriasis for some cancers of specific sites
The use of linked patient-level data is an important step in reducing misclassification of cancer outcomes in epidemiological studies using routinely collected electronic health records

Summary

Introduction

Psoriasis is an immune-mediated inflammatory disease, with substantial regional variation in prevalence across the globe [1]. The importance of psoriasis has been highlighted by the World Health Organization (WHO) [3], which acknowledged the burden of the disease to the individual and to society, and the consequence of associated comorbidities. Several explanations have been posited for this variation, including the extent of adjustment for confounding and differing severities of psoriasis in study groups [16] Whilst these explanations may play a role, it is important to consider, given the proportion of studies conducted using EHRs, that some of the variation may come as a result of bias in the ascertainment of cancer outcomes. The association between psoriasis and the risk of cancer has been investigated in numerous studies utilising electronic health records (EHRs), with conflicting results in the extent of the association.

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Conclusion