Determination of county-level prostate carcinoma incidence and detection rates with medicare claims data

BACKGROUND. To the authors' knowledge, national-level population-based data regarding prostate carcinoma incidence and detection currently are not ava ilable. The availability of such data could identify those regions with a d isproportionately high cancer incidence as well as the population-level ass ociation between prostate carcinoma detection and incidence. METHODS. Inpatient, hospital outpatient, and physician/supplier Medicare cl aims from 1991 were used to identify incident cases of prostate carcinoma i n men age greater than or equal to 65 years and to calculate state and coun ty-level incidence rates. The 1991 and 1997 claims data were used to determ ine small area rates of prostate-specific antigen (PSA) testing and prostat e biopsy and to determine their correlation with incidence. RESULTS. The calculated incidence rates for 1997 were 890 per 100,000 and 1 196 per 100,000, respectively, in white males and African-American males an d varied substantially between counties (i.e., 25-75th percentile, 676-1124 per 100,000). Rates of PSA and prostate biopsy increased markedly from 199 1 to 1997 in both white men (1580 per 100,000 to 24,286 per 100,000) and Af rican-American men (1277 per 100,000 to 15,190 per 100,000), and considerab le variation in detection between counties was observed. Counties that had higher rates of prostate biopsy also had higher age-adjusted incidence rate s, and county-level PSA testing was found to be associated with incidence i n African-American patients, but not in white patients. CONCLUSIONS. Medicare claims may provide an alternative source of populatio n-based data, particularly for areas in which registry data are not readily available or are of limited scope. In addition, claims provide otherwise u navailable national data concerning cancer detection. Cancer 2001;92:102-9. (C) 2001 American Cancer Society.