title: Long-term health experience of jet engine manufacturing workers: IV. A comparison of central nervous system cancer ascertainment using mortality and incidence data.
abstract: OBJECTIVE
  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.
authors.affiliation: Center for Occupational Biostatistics and Epidemiology, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA. jeanine@pitt.edu
authors.forename: Jeanine M
authors.initials: JM
authors.lastname: Buchanich
authors.forename: Ada O
authors.initials: AO
authors.lastname: Youk
authors.forename: Gary M
authors.initials: GM
authors.lastname: Marsh
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Kennedy
authors.forename: Nurtan A
authors.initials: NA
authors.lastname: Esmen
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lacey
authors.forename: Roger
authors.initials: R
authors.lastname: Hancock
authors.forename: Michael A
authors.initials: MA
authors.lastname: Cunningham
authors.forename: Frank S
authors.initials: FS
authors.lastname: Lieberman
authors.forename: Mary Lou
authors.initials: ML
authors.lastname: Fleissner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D015331:Cohort Studies; D003390:Cranial Nerve Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D003644:Death Certificates; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D012042:Registries / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology