Charlson Comorbidity Index Based On Hospital Episode Statistics Performs Adequately In Predicting Mortality, But Its Discriminative Ability Diminishes Over Time

• Published in: Clinical epidemiology Vol. 11; pp. 923 - 932
• Main Authors: Pylväläinen, Juho, Talala, Kirsi, Murtola, Teemu, Taari, Kimmo, Raitanen, Jani, Tammela, Teuvo L, Auvinen, Anssi
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.10.2019; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Cardiovascular disease; Chronic illnesses; Clinical medicine; Comorbidity; Comparative analysis; Confounding (Statistics); confounding factors (Epidemiology); Dementia; Drug Prescriptions /statistics and numerical data; Drugs; Epidemiology; follow-up studies; Heart failure; hospitalization/statistics and numerical data; Hospitals; Insurance; Medical imaging; Medical research; Medical screening; Medicine; Mortality; Original Research; Performance evaluation; Pharmacy; Population; Prognosis; Prostate cancer; Social security; Statistics; Stroke; Studies; Urology; Validity; Websites; Finland; mortality; confounding factors; follow-up studies; hospitalization/statistics and numerical data; comorbidity; drug prescriptions/statistics and numerical data
• ISSN: 1179-1349; 1179-1349
• DOI: 10.2147/CLEP.S218697

To evaluate the performance of Charlson Comorbidity Index (CCI) calculated using hospitalization and medication reimbursement databases in predicting mortality. Information on hospitalizations was obtained from the national Care Register for Health Care (HILMO) and on medication reimbursements and entitlements for special reimbursements for medications from the Social Insurance Institution for 77,440 men aged 56-71 years at baseline. The subjects were followed up for mortality via Statistics Finland with 20,562 deaths during a 13-year follow-up. Compared to a CCI score of 0, the age-adjusted hazard ratio for all-cause mortality associated with HILMO-based CCI scores of 1, 2 and 3 or more were 2.39 (95% CI 2.29-2.49), 2.96 (95% CI 2.81-3.13) and 6.42 (95% CI 5.95-6.93) at 13 years. The C-statistic was 0.72 at 1, 0.68 at 5 and 0.66 at 13 years, with only minor improvement over age alone (0.10, 0.06 and 0.04 accordingly). Addition of medication data did not improve predictive abilities and medication-based CCI performed poorly on its own. The hospitalization-based CCI, as well as that based on both databases, predicts relative mortality adequately, but its discriminative ability diminishes over time. Conditions related to hospitalizations affect survival more than medications.