Key result
Incorporating claims-based markers of disease severity into multimorbidity indices yielded minimal gains in c-statistics (<0.001 to 0.007) for predicting ADL decline, hospitalization, and death.
Why the study?
Claims-based measures of multimorbidity are limited in their ability to predict future outcomes, raising the question of whether markers of disease severity could improve assessments of multimorbid burden.
Does the inclusion of claims-based markers of disease severity improve the ability of multimorbidity indices to predict ADL decline, hospitalization, and death in older adults?
Cohort (n=5,102)
Does the inclusion of claims-based markers of disease severity improve the ability of multimorbidity indices to predict ADL decline, hospitalization, and death in older adults?
Effect estimate: c-statistic gain of <0.001 to 0.007
Adding claims-based markers of disease severity to multimorbidity indices does not meaningfully improve their ability to predict functional decline, hospitalization, or mortality in older adults.
Adding claims-based severity markers yields negligible predictive gains; leaves open whether richer data sources improve multimorbidity indices.
BACKGROUND: Claims-based measures of multimorbidity, which evaluate the presence of a defined list of diseases, are limited in their ability to predict future outcomes. We evaluated whether claims-based markers of disease severity could improve assessments of multimorbid burden. METHODS: We developed 7 dichotomous markers of disease severity which could be applied to a range of diseases using claims data. These markers were based on the number of disease-associated outpatient visits, emergency department visits, and hospitalizations made by an individual over a defined interval; whether an individual with a given disease had outpatient visits to a specialist who typically treats that disease; and ICD-9 codes which connote more versus less advanced or symptomatic manifestations of a disease. Using Medicare claims linked with Health and Retirement Study data, we tested whether including these markers improved ability to predict ADL decline, IADL decline, hospitalization, and death compared to equivalent models which only included the presence or absence of diseases. RESULTS: Of 5012 subjects, median age was 76 years and 58% were female. For a majority of diseases tested individually, adding each of the 7 severity markers yielded minimal increase in c-statistic (≤0.002) for outcomes of ADL decline and mortality compared to models considering only the presence versus absence of disease. Gains in predictive power were more substantial for a small number of individual diseases. Inclusion of the most promising marker in multi-disease multimorbidity indices yielded minimal gains in c-statistics (<0.001-0.007) for predicting ADL decline, IADL decline, hospitalization, and death compared to indices without these markers. CONCLUSIONS: Claims-based markers of disease severity did not contribute meaningfully to the ability of multimorbidity indices to predict ADL decline, mortality, and other important outcomes.
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Rizzo et al. (2022) conducted a cohort in Multimorbidity (n=5,102). Claims-based markers of disease severity vs. Multimorbidity indices considering only the presence or absence of diseases was evaluated on Predictive power (c-statistic) for ADL decline, IADL decline, hospitalization, and death (c-statistic gain of <0.001 to 0.007). Incorporating claims-based markers of disease severity into multimorbidity indices yielded minimal gains in c-statistics (<0.001 to 0.007) for predicting ADL decline, hospitalization, and death.
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