Operational Definitions of Colorectal Cancer in the Korean National Health Insurance Database

OBJECTIVES: We reviewed the operational definitions of colorectal cancer (CRC) from studies using the Korean National Health Insurance Service (NHIS) and compared CRC incidence derived from the commonly used operational definitions in the literature with the statistics reported by the Korea Central Cancer Registry (KCCR). METHODS: We searched the MEDLINE and KoreaMed databases to identify studies containing operational definitions of CRC, published until January 15, 2021. All pertinent data concerning the study period, the utilized database, and the outcome variable were extracted. Within the NHIS-National Sample Cohort, age-standardized incidence rates (ASRs) of CRC were calculated for each operational definition found in the literature between 2005 and 2019. These rates were then compared with ASRs from the KCCR. RESULTS: From the 62 eligible studies, 9 operational definitions for CRC were identified. The most commonly used operational definition was “C18–C20” (n=20), followed by “C18–C20 with claim code for treatment” (n=3) and “C18–C20 with V193 (code for registered cancer patients’ payment deduction)” (n=3). The ASRs reported using these operational definitions were lower than the ASRs from KCCR, except for “C18–C20 used as the main diagnosis.” The smallest difference in ASRs was observed for “C18–C20,” followed by “C18–C20 with V193,” and “C18–C20 with claim code for hospitalization or code for treatment.” CONCLUSIONS: In defining CRC patients utilizing the NHIS database, the ASR derived through the operational definition of “C18–C20 as the main diagnosis” was comparable to the ASR from the KCCR. Depending on the study hypothesis, operational definitions using treatment codes may be utilized.