RESUMO
Objective: The Hungarian Undiagnosed Lung Cancer (HULC) study aimed to explore the potential reasons for missed LC (lung cancer) diagnosis by comparing healthcare and socio-economic data among patients with post-mortem diagnosed LC with those who were diagnosed with LC during their lives. Methods: This nationwide, retrospective study used the databases of the Hungarian Central Statistical Office (HCSO) and National Health Insurance Fund (NHIF) to identify patients who died between January 1, 2019 and December 31, 2019 and were diagnosed with lung cancer post-mortem (population A) or during their lifetime (population B). Patient characteristics, socio-economic factors, and healthcare resource utilization (HCRU) data were compared between the diagnosed and undiagnosed patient population. Results: During the study period, 8,435 patients were identified from the HCSO database with LC as the cause of death, of whom 1,203 (14.24%) had no LC-related ICD (International Classification of Diseases) code records in the NHIF database during their lives (post-mortem diagnosed LC population). Post-mortem diagnosed LC patients were significantly older than patients diagnosed while still alive (mean age 71.20 vs. 68.69 years, p<0.001), with a more pronounced age difference among female patients (difference: 4.57 years, p<0.001), and had significantly fewer GP (General Practitioner) and specialist visits, X-ray and CT scans within 7 to 24 months and 6 months before death, although the differences in GP and specialist visits within 7-24 months did not seem clinically relevant. Patients diagnosed with LC while still alive were more likely to be married (47.62% vs. 33.49%), had higher educational attainment, and had more children, than patients diagnosed with LC post-mortem. Conclusions: Post-mortem diagnosed lung cancer accounts for 14.24% of total lung cancer mortality in Hungary. This study provides valuable insights into patient characteristics, socio-economic factors, and HCRU data potentially associated with a high risk of lung cancer misdiagnosis.
RESUMO
Introduction: In international comparison, Hungary is in the forefront of cancer incidence and mortality statistics. Based on paper-based death certificates, mortality statistics are compiled by the Hungarian Central Statistical Office, while population-based measures of cancer incidences are performed by the Hungarian National Cancer Registry. Objective: Linking the records of these two independent databases can highlight their weaknesses and provide an opportunity to reconcile and verify collected data, which may emphasize the need to expand current data exchange protocols. Method: Based on the Hungarian unique health care insurance ID, the mortality database of the Hungarian Central Statistical Office between 2012 and 2020 was compared with the data of the Hungarian National Cancer Registry from 2001 to 2020. Deaths in 2018, in particular those related to lung cancer, were examined in more depth to demonstrate the biases resulting from erroneous data collection. Results: The mortality database of the Hungarian Central Statistical Office contained 32 586 cases with an underlying cause of death of malignant neoplasm for 2018, of which 29 970 were identified in the Hungarian National Cancer Registry. Out of the 8716 deaths coded to lung cancer, 7957 corresponding individuals were also found in the Registry. From the matches, 7381 cases were marked with lung cancer in the Hungarian National Cancer Registry. For the remaining 576 cases, the Registry recorded different types of cancers, of which in 69 cases with lung metastasis. Discussion: The differences between the two databases may be caused by methodological differences in data collection, incomplete, inaccurate reporting and differences in processing algorithms. Nevertheless, the majority of the data in the examined databases were found to be appropriate for epidemiological studies. Conclusion: Based on the outcomes of the present analysis, a revision of the data transfer between the two institutions is in order. The introduction of electronic Death certificate recording and validity checks are expected to improve the reliability of ID numbers and may shorten data processing times.
