[Evaluation of the cancer co-pay fee exemption data source (048 code) to estimate cancer incidence].
OBJECTIVE
to assess whether the data source of cancer exemption ticket (code 048) correctly estimate the cancer incidence produced by Cancer registries (CR).


METHODS
comparison between incidence estimates produced by cancer exemptions ticket and cases registered by CR.


METHODS
six CRs provided incidence data for one year in the five-year period from 2007 to 2011 and for the previous five years, the exemptions provided for the same year and for the previous five years.


METHODS
incidence distribution by gender, age and tumour site, exemptions 048/incident cancers ratio, and trend estimates.


RESULTS
out of 14,586 patients with 048 exemption, a first group was present in the CR database in the same reference year (No. 8,015) and a second group in the previous 6 months (No. 1,696). Of the remaining 4,875, only 2,771 were prevalent cases and 2,104 were manually re-valued: 514 non-cancer; 710 non-malignant/noninfiltrating tumours, 250 non-residents, 532 unknown, and 98 lost at CR. The exemption/ tumours ratio was 32%in males and 37% in females. Out of 27,632 cancer patients in CR, only 29% had a 048 exemption. Among linked cases, there is a case-mix problem: the exemptions overestimated the weight of some cancer sites (breast, prostate), but underestimate the weight of other sites (stomach, liver, lung) and the burden of tumours in the elderly.The trend estimated from the exemptions underestimates the true incidence of tumours and presents fluctuations, because of local administrative and organisational issues.


CONCLUSIONS
the 048 codes are an accessory source for CRs, but when used as single flow they are not able to estimate the true incidence of tumours and, therefore, do not provide useful information on cancer trends.
Registro tumori di Reggio Emilia, Servizio epidemiologia interaziendale, AUSL Reggio Emilia. mangone.lucia@ausl.re.it.|Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia.
Lucia
L
Mangone
Registro tumori di Reggio Emilia, Servizio epidemiologia interaziendale, AUSL Reggio Emilia.
Ivan
I
Rashid
Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia.|Registro tumori di Reggio Emilia, Servizio epidemiologia interaziendale, AUSL Reggio Emilia.
Massimo
M
Vicentini
Registro tumori ligure, SC epidemiologia clinica, IRCCS AOU San Martino - IST, Genova.
Luigina Ada
LA
Bonelli
Registro tumori di Piacenza, UO epidemiologia e comunicazione del rischio, AUSL Piacenza.
Elisabetta
E
Borciani
Registro tumori ligure, SC epidemiologia clinica, IRCCS AOU San Martino - IST, Genova.
Claudia
C
Casella
Registro tumori integrato Catania- Messina-Siracusa-Enna, Università degli Studi di Catania.
Marine
M
Castaing
Registro tumori di Modena, Direzione sanitaria, AUSL Modena.|Associazione italiana registri tumori (AIRTUM), Firenze.
Claudia
C
Cirilli
Registro tumori di Reggio Emilia, Servizio epidemiologia interaziendale, AUSL Reggio Emilia.
Enza
E
Di Felice
Registro tumori di Modena, Direzione sanitaria, AUSL Modena.
Cristina
C
Marchesi
Registro tumori di Parma, UOC oncologia medica, Azienda ospedaliero universitaria, Parma.
Maria
M
Michiara
Registro tumori integrato Catania- Messina-Siracusa-Enna, Università degli Studi di Catania.
Salvatore
S
Sciacca
Registro tumori di Piacenza, UO epidemiologia e comunicazione del rischio, AUSL Piacenza.
Pietro
P
Seghini
Registro tumori di Parma, UOC oncologia medica, Azienda ospedaliero universitaria, Parma.
Paolo
P
Sgargi
Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia.|Registro tumori di Reggio Emilia, Servizio epidemiologia interaziendale, AUSL Reggio Emilia.
Paolo
P
Giorgi Rossi
D005249:Fees and Charges; D005260:Female; D006078:Government Programs; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008483:Medical Assistance / Q000191:economics; D009369:Neoplasms / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D015995:Prevalence; D036301:Qualitative Research; D012042:Registries; D012959:Socioeconomic Factors; D019464:Tax Exemption / Q000191:economics