Effectiveness of Care: Cancer

2009 National Healthcare Quality and Disparities Reports

The National Healthcare Quality Report (NHQR) is a comprehensive national overview of quality of health care in the United States. It is organized around four dimensions of quality of care: effectiveness, patient safety, timeliness, and patient centeredness.
 

Breast Cancer
Women age 40 and over who received a mammogram in the last 2 years.
Breast cancer diagnosed at advanced stage (regional, distant stage, or local stage with tumor greater than 2 cm) per 100,000 women age 40 and over.
Women with Clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy).
Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis.
Breast cancer deaths per 100,000 female population per year.

Cervical Cancer
Women age 18 and over who received a Pap smear in the last 3 years.
Cervical cancer diagnosed at advanced stage (all invasive tumors) per 100,000 women age 20 and over.

Colorectal Cancer
Composite measure: Adults age 50 and over who received colorectal cancer screening (colonoscopy, sigmoidoscopy, proctoscopy, or (in the last 2 years) fecal occult blood test [FOBT]).
Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy.
Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years.
Colorectal cancer diagnosed at advanced stage (tumors diagnosed at regional or distant stage) per 100,000 population age 50 and over.
Patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined.
Colorectal cancer deaths per 100,000 population per year.

Other Cancers
Cancer deaths per 100,000 population per year.
Prostate cancer deaths per 100,000 male population per year.
Lung cancer deaths per 100,000 population per year.


Breast Cancer

Measure Title

Women age 40 and over who received a mammogram in the last 2 years.

Measure Source

Healthy People 2010.

National Tables

1_1_1.1 Women age 40 and over who received a mammogram in the last 2 years, United States, 1999 and 2005.

1_1_1.2 Women age 40 and over who received a mammogram in the last 2 years, United States, 2005, by:

  • Race
  • Ethnicity
  • Family income

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

Number of women age 40 and over.

National Numerator

Subset of denominator who report receiving a mammogram within the last 2 years.

State Tables

1_1_1.3 Women age 40 and over who received a mammogram in the last 2 years, by State, 2000 and 2006.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-13 in Healthy People 2010 documentation.

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Breast Cancer

Measure Title

Breast cancer diagnosed at advanced stage (regional, distant stage, or local stage with tumor greater than 2 cm) per 100,000 women age 40 and over.

Measure Source

National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results Program (SEER).

Tables

1_1_2.1 Breast cancer diagnosed at advanced stage (regional, distant stage, or local stage with tumor greater than 2 cm) per 100,000 women age 40 and over, United States, 2000 and 2006.

Data Source

NCI, SEER.

Denominator

Women age 40 and over.

Numerator

Women age 40 and over with new breast cancer diagnosed at advanced stage.

Comments

All rates except as noted are per 100,000 females age 40 and over and are age adjusted to the 2000 U.S. standard million population by 5-year age groups.

Advanced stage for this table is defined as localized tumors in excess of 2 cm and regional or distant staged tumors.

Cancer stage historically has been collected using three different staging systems having three different purposes, datasets, and rules. The American Joint Committee on Cancer (AJCC), in collaboration with North American standard setters, has developed a unified data set that will combine and standardize the information needed to assign stage in the AJCC TNM Staging System based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of metastasis; SEER (Extent of Disease, [EOD]); and Summary Stage (SS) 1977 and 2000 systems and to derive the T, N, M stage group, EOD, and SS applicable to each cancer site beginning with cancers diagnosed in 2004.

The 2005 data were adjusted for areas affected by Hurricanes Katrina and Rita. Hurricanes Katrina and Rita had a huge impact on the populations within the Gulf Coast region for the second half of 2005. Katrina also significantly affected the Louisiana Cancer Registry's ability to report data for that time period. In an effort to provide the most accurate and complete data and statistics possible, the SEER Program has made several changes for the releases of data and statistics through 2005.

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Breast Cancer

Measure Title

Women with Clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy).

Measure Source

American College of Surgeons (ACS), Commission on Cancer (CoC), National Cancer Database (NCDB).

Tables

1_1_3.1 Women with Clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy), United States, 1999 and 2006.

1_1_3.2 Women with Clinical Stage I-IIb breast cancer who received axillary node dissection or sentinel lymph node biopsy (SLNB) at the time of surgery (lumpectomy or mastectomy), United States, 2006, by:

  • Race
  • Ethnicity
  • Family income

Data Source

ACS, CoC, NCDB.

Denominator

Women age 18 and over with American Joint Committee on Cancer (AJCC) Stage I or IIA primary invasive epithelial breast cancer that was surgically treated by breast-conserving surgery or mastectomy. Breast cancer diagnoses are known or assumed first or only cancer diagnosis.

Numerator

Subset of denominator who received lymph node surgery (axillary node dissection or sentinel lymph node biopsy) at the time of their breast cancer surgery.

Comments

Includes only women who received all or part of their first course of treatment at a facility with a CoC-approved cancer program. There is not full agreement regarding the appropriate population (denominator) for this measure, addressing lymph node surgery in women with breast cancer. As the measure from the National Quality Forum specifies including only women with Stage I/II cancer, women classified as having Stage III disease during lymph node surgery (based on four or more positive nodes) will be excluded if their stage prior to surgery (i.e., clinical stage) was not recorded. This may artificially lower the rates for this measure.

Family income is based on median ZIP Code income as of the 2000 U.S. Census.

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Breast Cancer

Measure Title

Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis.

Measure Source

American College of Surgeons (ACS), Commission on Cancer (CoC), National Cancer Database (NCDB).

Tables

1_1_4.1 Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis, United States, 1999 and 2006.

1_1_4.2 Women under age 70 treated for breast cancer with breast-conserving surgery who received radiation therapy to the breast within 1 year of diagnosis, United States, 2006, by:

  • Race
  • Ethnicity
  • Family income

Data Source

ACS, CoC, NCDB.

Denominator

Women ages 18-69 with American Joint Committee on Cancer (AJCC) Stage I, II, or III primary invasive epithelial breast cancer that was surgically treated by breast-conserving surgery. Breast cancer diagnoses are known or assumed first or only cancer diagnosis, and patients were know to be alive within 1 year of their diagnosis.

Numerator

Subset of denominator for whom radiation therapy to the breast was initiated within 1 year (365 days) of date of diagnosis

Comments

Breast-conserving surgery is defined for this measure as surgical excision less than mastectomy.

Includes only women who received all or part of their first course of treatment at a facility with a CoC-approved cancer program.

Family income is based on median ZIP Code income as of the 2000 U.S. Census.

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Breast Cancer

Measure Title

Breast cancer deaths per 100,000 female population per year.

Measure Source

Healthy People 2010.

National Tables

1_1_5.1 Breast cancer deaths per 100,000 female population per year, United States, 1999 and 2006.

1_1_5.2 Breast cancer deaths per 100,000 female population per year, United States, 2006, by:

  • Race
  • Ethnicity

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System - Mortality (NVSS-M).

National Denominator

U.S. female resident population.

National Numerator

Number of female deaths per year due to breast cancer (ICD-10-CM code C50).

State Tables

1_1_5.3 Breast cancer deaths per 100,000 female population per year, by State, 1999 and 2006.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population, by State.

State Numerator

Same as National.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-3 in Healthy People 2010 documentation.

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Cervical Cancer

Measure Title

Women age 18 and over who received a Pap smear in the last 3 years.

Measure Source

Healthy People 2010.

National Tables

1_2_1.1 Women age 18 and over who received a Pap smear within the last 3 years, United States, 1999 and 2005.

1_2_1.2 Women age 18 and over who received a Pap smear within the last 3 years, United States, 2005, by:

  • Race
  • Ethnicity
  • Family income

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

U.S. female civilian noninstitutionalized population age 18 and over.

National Numerator

Subset of denominator who report receiving a Pap test within the last 3 years.

State Tables

1_2_1.3 Women age 18 and over who received a Pap smear within the last 3 years, by State, 2000 and 2006.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Same as National.

State Numerator

Subset of denominator who report receiving a Pap test within the last 3 years; respondents who answered "Within the past year," "Within the past 2 years," or "Within the past 3 years" to the question, "How long has it been since you had your last Pap smear?"

Comments

Data include women without a uterine cervix

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-11b in Healthy People 2010 documentation.

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Cervical Cancer

Measure Title

Cervical cancer diagnosed at advanced stage (all invasive tumors) per 100,000 women age 20 and over.

Measure Source

National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results Program (SEER).

Tables

1_2_2.1 Cervical cancer diagnosed at advanced stage (all invasive tumors) per 100,000 women age 20 and over, United States, 2000 and 2006.

Data Source

NCI, SEER.

Denominator

Number of women age 20 and over.

Numerator

Number of women age 20 and over with new cervical cancers diagnosed as invasive in the survey years

Comments

All rates except as noted are per 100,000 females age 20 and over and are age adjusted to the 2000 U.S. standard million population by 5-year age groups.

Invasive cervical cancer is defined for this table as cancer that has spread from the surface of the cervix to tissue deeper in the cervix or to other parts of the body.

Cancer stage historically has been collected using three different staging systems having three different purposes, datasets, and rules. The American Joint Committee on Cancer (AJCC), in collaboration with North American standard setters, has developed a unified data set that will combine and standardize the information needed to assign stage in the AJCC TNM Staging System based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of metastasis; SEER (Extent of Disease, [EOD]); and Summary Stage (SS) 1977 and 2000 systems and to derive the T, N, M stage group, EOD, and SS applicable to each cancer site beginning with cancers diagnosed in 2004.

The 2005 data were adjusted for areas affected by Hurricanes Katrina and Rita. Hurricanes Katrina and Rita had a huge impact on the populations within the Gulf Coast region for the second half of 2005. Katrina also significantly affected the Louisiana Cancer Registry's ability to report data for that time period. In an effort to provide the most accurate and complete data and statistics possible, the SEER Program has made several changes for the releases of data and statistics through 2005.

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Colorectal Cancer

Measure Title

Composite measure: Adults age 50 and over who received colorectal cancer screening (colonoscopy, sigmoidoscopy, proctoscopy, or (in the last 2 years) fecal occult blood test [FOBT]).

Measure Source

Healthy People 2010.

Tables

1_3_1.1 Adults age 50 and over who received colorectal cancer screening (ever received colonoscopy, sigmoidoscopy, proctoscopy, or (in the last 2 years) a fecal occult blood test, United States, 2000 and 2005.

1_3_1.2 Adults age 50 and over who received colorectal cancer screening (ever received colonoscopy, sigmoidoscopy, proctoscopy, or (in the last 2 years) a fecal occult blood test, United States, 2005, by:

  • Race
  • Ethnicity
  • Family income

Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

Denominator

U.S. civilian noninstitutionalized population age 50 and over.

Numerator

Number of adults age 50 and over who report receiving a colonoscopy, sigmoidoscopy, proctoscopy, or fecal occult blood test.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is based on two Healthy People 2010 measures, referred to as 3-12a and 3-12b in Healthy People 2010 documentation.

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Colorectal Cancer

Measure Title

Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy.

Measure Source

Healthy People 2010.

National Tables

1_3_2.1 Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy, United States, 2000 and 2005.

1_3_2.2 Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy, United States, 2005, by:

  • Race
  • Ethnicity
  • Family income

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

Number of civilian noninstitutionalized adults age 50 and over.

National Numerator

Subset of denominator who report ever receiving a sigmoidoscopy or colonoscopy.

State Tables

1_3_2.3 Adults age 50 and over who ever received a colonoscopy, sigmoidoscopy, or proctoscopy, by State, 2001 and 2006.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-12b in Healthy People 2010 documentation.

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Colorectal Cancer

Measure Title

Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years

Measure Source

Healthy People 2010.

National Tables

1_3_3.1 Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years, United States, 2000 and 2005.

1_3_3.2 Adults age 50 and over who received a fecal occult blood test (FOBT) in the last 2 years, United States, 2005, by:

  • Race
  • Ethnicity
  • Family income

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Health Interview Survey (NHIS).

National Denominator

Number of civilian noninstitutionalized adults age 50 and over.

National Numerator

Subset of denominator who report receiving fecal occult blood testing within the preceding 2 years.

State Tables

1_3_3.3 Adults age 50 and over who received a fecal occult blood test in the last 2 years, by State, 2001 and 2006.

State Data Source

CDC, National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Behavioral Risk Factor Surveillance System (BRFSS).

State Denominator

Same as National.

State Numerator

Same as National.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-12a in Healthy People 2010 documentation.

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Colorectal Cancer

Measure Title

Colorectal cancer diagnosed at advanced stage (tumors diagnosed at regional or distant stage) per 100,000 population age 50 and over.

Measure Source

National Cancer Institute (NCI), Surveillance, Epidemiology, and End Results Program (SEER).

Tables

1_3_4.1 Colorectal cancer diagnosed at advanced stage (tumors diagnosed at regional or distant stage) per 100,000 population age 50 and over, United States, 2000 and 2006.

Data Source

NCI, SEER.

Denominator

U.S. population age 50 and over.

Numerator

Number of new colorectal cancers diagnosed in the survey years as regional or distant staged cancers.

Comments

All rates except as noted are per 100,000 men and women age 50 and over and are age adjusted to the 2000 U.S. standard million population by 5-year age groups.

Regional stage is defined as a neoplasm that has extended beyond the limits of the organ of origin, either directly into surrounding organs or tissues or into regional lymph nodes. Distant stage is defined as a neoplasm that has spread to parts of the body remote from the primary tumor, either by direct extension or by discontinuous metastasis.

Cancer stage historically has been collected using three different staging systems having three different purposes, datasets, and rules. The American Joint Committee on Cancer (AJCC), in collaboration with North American standard setters, has developed a unified data set that will combine and standardize the information needed to assign stage in the AJCC TNM Staging System based on the extent of the tumor (T), the extent of spread to the lymph nodes (N), and the presence of metastasis; SEER (Extent of Disease, [EOD]); and Summary Stage (SS) 1977 and 2000 systems and to derive the T, N, M stage group, EOD, and SS applicable to each cancer site beginning with cancers diagnosed in 2004.

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Colorectal Cancer

Measure Title

Patients with colon cancer who received surgical resection of colon cancer that included at least 12 lymph nodes pathologically examined.

Measure Source

American College of Surgeons (ACS), Commission on Cancer (CoC), National Cancer Database (NCDB).

Tables

1_3_5.1 Patients with colon cancer who received recommended treatment: resected colon specimen had at least 12 regional lymph nodes pathologically examined, United States, 2003 and 2006.

1_3_5.2 Patients with colon cancer who received recommended treatment: resected colon specimen had at least 12 regional lymph nodes pathologically examined, United States, 2006, by:

  • Race
  • Ethnicity
  • Family income

Data Source

ACS, CoC, NCDB.

Denominator

Adults age 18 and over with AJCC Stage I, II, or III primary invasive epithelial colon cancer that underwent surgical resection (surgery more than local excision). Colon cancer diagnoses are known or assumed first or only cancer diagnosis

Numerator

Subset of denominator with 12 or more regional lymph nodes pathologically examined.

Comments

Family income is based on median ZIP Code income as of the 2000 U.S. Census.

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Colorectal Cancer

Measure Title

Colorectal cancer deaths per 100,000 population per year.

Measure Source

Healthy People 2010.

National Tables

1_3_6.1 Colorectal cancer deaths per 100,000 population per year, United States, 1999 and 2006

1_3_6.2 Colorectal cancer deaths per 100,000 population per year, United States, 2006, by:

  • Race
  • Ethnicity

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System - Mortality (NVSS-M).

National Denominator

U.S. resident population.

National Numerator

Number of deaths per year due to colorectal cancer (ICD-10-CM codes C18-C21).

State Tables

1_3_6.3 Colorectal cancer deaths per 100,000 population per year, by State, 1999 and 2006.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population, by State.

State Numerator

Same as National.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-5 in Healthy People 2010 documentation.

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Other Cancers

Measure Title

Cancer deaths per 100,000 population per year.

Measure Source

Healthy People 2010.

National Tables

1_4_1.1 All cancer deaths per 100,000 population per year, United States, 1999 and 2006.

1_4_1.2 All cancer deaths per 100,000 population per year, United States, 2006, by:

  • Race
  • Ethnicity

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System - Mortality (NVSS-M).

National Denominator

U.S. resident population.

National Numerator

Number of deaths per year due to cancer (ICD-10-CM codes C00-C97).

State Tables

1_4_1.3 All cancer deaths per 100,000 population per year, by State, 1999 and 2006.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population, by State.

State Numerator

Same as National.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-1 in Healthy People 2010 documentation.

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Other Cancers

Measure Title

Prostate cancer deaths per 100,000 male population per year.

Measure Source

Healthy People 2010.

National Tables

1_4_2.1 Prostate cancer deaths per 100,000 male population per year, United States, 1999 and 2006.

1_4_2.2 Prostate cancer deaths per 100,000 male population per year, United States, 2006, by:

  • Race
  • Ethnicity

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System - Mortality (NVSS-M).

National Denominator

U.S. male resident population.

National Numerator

Number of male deaths per year due to prostate cancer (ICD-10-CM code C61).

State Tables

1_4_2.3 Prostate cancer deaths per 100,000 male population per year, by State, 1999 and 2006.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population, by State.

State Numerator

Same as National.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-7 in Healthy People 2010 documentation.

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Other Cancers

Measure Title

Lung cancer deaths per 100,000 population per year.

Measure Source

Healthy People 2010.

National Tables

1_4_3.1 Lung cancer deaths per 100,000 population per year, United States, 1999 and 2006.

1_4_3.2 Lung cancer deaths per 100,000 population per year, United States, 2006, by:

  • Race
  • Ethnicity

National Data Source

Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), National Vital Statistics System - Mortality (NVSS-M).

National Denominator

U.S. resident population.

National Numerator

Number of deaths per year due to lung cancer (ICD-10-CM codes C33-C34).

State Tables

1_4_3.3 Lung cancer deaths per 100,000 population per year, by State, 1999 and 2006.

State Data Source

CDC, NCHS, NVSS-M.

State Denominator

Population, by State.

State Numerator

Same as National.

Comments

Data are age adjusted to the 2000 standard population. Age-adjusted rates are weighted sums of age-specific rates. For a discussion of age adjustment, see Part A, Section 5, of Tracking Healthy People 2010.

This measure is referred to as measure 3-2 in Healthy People 2010 documentation.

Current as of March 2010
Internet Citation: Effectiveness of Care: Cancer: 2009 National Healthcare Quality and Disparities Reports. March 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr09/measurespec/cancer.html