5 years ago

The new Measuring Multimorbidity index predicted mortality better than Charlson and Elixhauser indices amongst the general population

To develop and validate an updated morbidity index for short-term mortality risk, using chronic conditions identified from routine hospital admission ICD-10 data. Study Design and Setting Retrospective cohort study of all adult New Zealand (NZ) residents at 1st Jan 2012. Participants Adult NZ residents aged 18 and over, defined by enrolment with a Primary Healthcare Organisation or accessing public healthcare in preceding year. Data were split into two datasets for index development (70%, n=2,331,645) and validation (30%, n=1,000,166). Results The M3 index was constructed using log hazard ratios for one-year mortality modelled from presence of 61 chronic conditions. Validation results were improved for the M3 index for predicting one-year mortality compared to Charlson and Elixhauser on the c-statistic (M3: 0.931, Charlson 0.921, Elixhauser 0.922; difference M3 vs Charlson = 0.010, 95% CI 0.008, 0.012; M3 vs Elixhauser = 0.009, 95% CI 0.007, 0.012) and integrated discriminative improvement (IDI: M3 vs Charlson=0.024, 95% CI 0.021, 0.026; M3 vs Elixhauser=0.024, 95% CI 0.022, 0.027). Conclusion The M3 index had improved predictive performance for one-year mortality risk over Charlson and Elixhauser indices, allowing better adjustment for mortality risk from chronic conditions. This provides an important tool for population-level analyses of health outcomes.

Publisher URL: www.sciencedirect.com/science

DOI: S0895435617304419

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