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- Title
Impact of comorbidity assessment methods to predict non-cancer mortality risk in cancer patients: a retrospective observational study using the National Health Insurance Service claims-based data in Korea.
- Authors
Lee, Sanghee; Chang, Yoon Jung; Cho, Hyunsoon
- Abstract
<bold>Background: </bold>Cancer patients' prognoses are complicated by comorbidities. Prognostic prediction models with inappropriate comorbidity adjustments yield biased survival estimates. However, an appropriate claims-based comorbidity risk assessment method remains unclear. This study aimed to compare methods used to capture comorbidities from claims data and predict non-cancer mortality risks among cancer patients.<bold>Methods: </bold>Data were obtained from the National Health Insurance Service-National Sample Cohort database in Korea; 2979 cancer patients diagnosed in 2006 were considered. Claims-based Charlson Comorbidity Index was evaluated according to the various assessment methods: different periods in washout window, lookback, and claim types. The prevalence of comorbidities and associated non-cancer mortality risks were compared. The Cox proportional hazards models considering left-truncation were used to estimate the non-cancer mortality risks.<bold>Results: </bold>The prevalence of peptic ulcer, the most common comorbidity, ranged from 1.5 to 31.0%, and the proportion of patients with ≥1 comorbidity ranged from 4.5 to 58.4%, depending on the assessment methods. Outpatient claims captured 96.9% of patients with chronic obstructive pulmonary disease; however, they captured only 65.2% of patients with myocardial infarction. The different assessment methods affected non-cancer mortality risks; for example, the hazard ratios for patients with moderate comorbidity (CCI 3-4) varied from 1.0 (95% CI: 0.6-1.6) to 5.0 (95% CI: 2.7-9.3). Inpatient claims resulted in relatively higher estimates reflective of disease severity.<bold>Conclusions: </bold>The prevalence of comorbidities and associated non-cancer mortality risks varied considerably by the assessment methods. Researchers should understand the complexity of comorbidity assessments in claims-based risk assessment and select an optimal approach.
- Subjects
SOUTH Korea; CANCER-related mortality; NATIONAL health insurance; COMORBIDITY; PROGNOSTIC models; PROPORTIONAL hazards models
- Publication
BMC Medical Research Methodology, 2021, Vol 21, Issue 1, p1
- ISSN
1471-2288
- Publication type
journal article
- DOI
10.1186/s12874-021-01257-2