Development and validation of a prognostic index for 4-year mortality in older adults
Development and validation of a prognostic index for 4-year mortality in older adults
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DOI：
10.1001/jama.295.7.801
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发表时间：
2006-02-15
影响因子：
120.7
通讯作者：
Covinsky, KE
中科院分区：
文献类型：
--
作者：
Lee, SJ;Lindquist, K;Covinsky, KE
合并症和功能指标都能预测老年人的死亡率，但很少有预后指标能将这两类预测指标结合起来。将容易获得的测量方法结合到一个准确的预测模型中，对于向患者提供建议的临床医生，以及对风险调整感兴趣的政策制定者和流行病学家都是有用的。目的利用从患者报告中获得的信息，建立并验证一种预测4年死亡率的预后指标。利用1998年健康与退休研究（HRS），一项针对50岁以上美国社区居民的基于人群的研究，我们从11701个人中开发了预后指数，并以8009人验证了该指数。个人被问及他们的人口特征，他们是否患有特定疾病，以及他们是否在一系列功能测量方面有困难。我们确定了与死亡率相关的独立变量，并对这些变量进行加权以创建风险指数。主要结果测量截至2002年12月31日死亡人数。结果总有效率为81%。在4年随访期间，发展组有1361例死亡（12%），验证组有1072例死亡（13%）。确定了12个独立的死亡率预测因素：2个人口统计学变量（年龄：60-64岁，1分；65-69岁，2分；70-74岁，3分；75-79岁，4分；80-84岁，5分，bb0 - 85岁，7分，男性，2分），6个合并症(糖尿病，1分；癌症，2分；肺病，2分；心力衰竭，2分；目前吸烟，2分；和体重指数
Context Both comorbid conditions and functional measures predict mortality in older adults, but few prognostic indexes combine both classes of predictors. Combining easily obtained measures into an accurate predictive model could be useful to clinicians advising patients, as well as policy makers and epidemiologists interested in risk adjustment.Objective To develop and validate a prognostic index for 4-year mortality using information that can be obtained from patient report.Design, Setting, and Participants Using the 1998 wave of the Health and Retirement Study (HRS), a population-based study of community-dwelling US adults older than 50 years, we developed the prognostic index from 11 701 individuals and validated the index with 8009. Individuals were asked about their demographic characteristics, whether they had specific diseases, and whether they had difficulty with a series of functional measures. We identified variables independently associated with mortality and weighted the variables to create a risk index.Main Outcome Measure Death by December 31, 2002.Results The overall response rate was 81%. During the 4-year follow-up, there were 1361 deaths (12%) in the development cohort and 1072 deaths (13%) in the validation cohort. Twelve independent predictors of mortality were identified: 2 demographic variables (age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years, 3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years, 7 points and male sex, 2 points), 6 comorbid conditions (diabetes, 1 point; cancer, 2 points; lung disease, 2 points; heart failure, 2 points; current tobacco use, 2 points; and body mass index