Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data
Performance of comorbidity scores to control for confounding in epidemiologic studies using claims data
复制标题
DOI：
10.1093/aje/154.9.854
复制
发表时间：
2001-11-01
影响因子：
5
通讯作者：
Glynn, RJ
中科院分区：
文献类型：
--
作者：
Schneeweiss, S;Seeger, JD;Glynn, RJ
合并症是流行病学研究中的一个重要混杂因素，作者比较了合并症评分在流行病学研究中的预测性能与管理数据库。研究参与者为加拿大不列颠哥伦比亚省，年龄≥ 65岁的居民，在观察期内至少接受一次血管紧张素转换酶抑制剂或钙通道阻滞剂。在基准年（1995-1996年），对所有141，161名参与者计算了六个分数。终点是12个月随访期间（1996-1997）的死亡和医疗保健利用。通过使用c统计量来测量性能，范围从0.5（用于结果的机会预测）到1.0（用于完美预测）。在控制年龄和性别的逻辑回归模型中，基于国际疾病分类第九修订版（ICD-9）的四个评分通常在预测1年死亡率方面表现更好（c = 0.771，c = 0.768，c = 0.745，c = 0.745）高于基于药物的慢性病评分（CDS）-1和CDS-2（c = 0.738，c = 0.718）。使用不同药物的数量是未来医生就诊（R-2 = 0.121）和支出（R-2 = 0.128）的最佳预测因子，也是死亡率的良好预测因子（c = 0.745）。结合ICD-9和基于药物的评分改善了预测死亡率的c统计量（分别为1.7%和6.2%）。结果的普遍性可能仅限于老年人，主要是白色人群，他们可以平等地获得国家资助的医疗保健。
Comorbidity is an important confounder in epidemiologic studies, The authors compared the predictive performance of comorbidity scores for use in epidemiologic research with administrative databases. Study participants were British Columbia, Canada, residents aged greater than or equal to 65 years who received angiotensin-converting enzyme inhibitors or calcium channel blockers at least once during the observation period. Six scores were computed for all 141,161 participants during the baseline year (1995-1996). Endpoints were death and health care utilization during a 12-month follow-up (1996-1997). Performance was measured by using the c statistic ranging from 0.5 for chance prediction of outcome to 1.0 for perfect prediction. In logistic regression models controlling for age and gender, four scores based on the International Classification of Diseases, Ninth Revision (ICD-9) generally performed better at predicting 1-year mortality (c = 0.771, c = 0.768, c = 0.745, c = 0.745) than medication-based Chronic Disease Score (CDS)-1 and CDS-2 (c = 0.738, c = 0.718). Number of distinct medications used was the best predictor of future physician visits (R-2 = 0.121) and expenditures (R-2 = 0.128) and a good predictor of mortality (c = 0.745). Combining ICD-9 and medication-based scores improved the c statistics (1.7% and 6.2%, respectively) for predicting mortality Generalizability of results may be limited to an elderly, predominantly White population with equal access to state-funded health care.