PHARMACOEPIDEMIOLOGY REPORT Development of a comorbidity index using physician claims data
01 Jan 2000-
TL;DR: This article developed a comorbidity index that incorporates the diagnostic and procedure data contained in Medicare physician (Part B) claims, which significantly contributes to models of 2-year noncancer mortality and treatment received in both patient cohorts.
Abstract: Important comorbidities recorded on outpatient claims in administrative datasets may be missed in analyses when only inpatient care is considered. Using the comorbid conditions identified by Charlson and colleagues, we developed a comorbidity index that incorporates the diagnostic and procedure data contained in Medicare physician (Part B) claims. In the national cohorts of elderly prostate ( n 5 28,868) and breast cancer ( n 5 14,943) patients assessed in this study, less than 10% of patients had comorbid conditions identified when only Medicare hospital (Part A) claims were examined. By incorporating physician claims, the proportion of patients with comorbid conditions increased to 25%. The new physician claims comorbidity index significantly contributes to models of 2-year noncancer mortality and treatment received in both patient cohorts. We demonstrate the utility of a disease-specific index using an alternative method of construction employing study-specific weights. The physician claims index can be used in conjunction with a comorbidity index derived from
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TL;DR: An overview of the SEER-Medicare files is provided for investigators interested in using these data for epidemiologic and health services research and a comparison of selected characteristics of elderly persons residing in the SEer areas to the US total aged is compared.
Abstract: Background. The Surveillance, Epidemiology and End Results (SEER)-Medicare–linked database combines clinical information from population-based cancer registries with claims information from the Medicare program. The use of this database to study cancer screening, treatment, outcomes, and costs has g
1,725 citations
TL;DR: The American Cancer Society, the Centers for Disease Control and Prevention, the National Cancer Institute, and the North American Association of Central Cancer Registries collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States.
Abstract: BACKGROUND: The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updates on cancer incidence and death rates and trends in these outcomes for the United States. This year’s report includes the prevalence of comorbidity at the time of first cancer diagnosis among patients with lung, colorectal, breast, or prostate cancer and survival among cancer patients based on comorbidity level. METHODS: Data on cancer incidence were obtained from the NCI, the CDC, and the NAACCR; and data on mortality were obtained from the CDC. Long-term (1975/1992-2010) and short-term (2001-2010) trends in age-adjusted incidence and death rates for all cancers combined and for the leading cancers among men and women were examined by joinpoint analysis. Through linkage with Medicare claims, the prevalence of comorbidity among cancer patients who were diagnosed between 1992 through 2005 residing in 11 Surveillance, Epidemiology, and End Results (SEER) areas were estimated and compared with the prevalence in a 5% random sample of cancer-free Medicare beneficiaries. Among cancer patients, survival and the probabilities of dying of their cancer and of other causes by comorbidity level, age, and stage were calculated. RESULTS: Death rates continued to decline for all cancers combined for men and women of all major racial and ethnic groups and for most major cancer sites; rates for both sexes combined decreased by 1.5% per year from 2001 through 2010. Overall incidence rates decreased in men and stabilized in women. The prevalence of comorbidity was similar among cancer-free Medicare beneficiaries (31.8%), breast cancer patients (32.2%), and prostate cancer patients (30.5%); highest among lung cancer patients (52.9%); and intermediate among colorectal cancer patients (40.7%). Among all cancer patients and especially for patients diagnosed with local and regional disease, age and comorbidity level were important influences on the probability of dying of other causes and, consequently, on overall survival. For patients diagnosed with distant disease, the probability of dying of cancer was much higher than the probability of dying of other causes, and age and comorbidity had a smaller effect on overall survival. CONCLUSIONS: Cancer death rates in the United States continue to decline. Estimates of survival that include the probability of dying of cancer and other causes stratified by comorbidity level, age, and stage can provide important information to facilitate treatment decisions. Cancer 2013;000:000-000. V C 2013 American Cancer Society.
1,580 citations
TL;DR: In the United States, hip fracture rates and subsequent mortality among persons 65 years and older are declining, and comorbidities among patients with hip fractures have increased.
Abstract: Context Understanding the incidence and subsequent mortality following hip fracture is essential to measuring population health and the value of improvements in health care. Objective To examine trends in hip fracture incidence and resulting mortality over 20 years in the US Medicare population. Design, Setting, and Patients Observational study using data from a 20% sample of Medicare claims from 1985-2005. In patients 65 years or older, we identified 786 717 hip fractures for analysis. Medication data were obtained from 109 805 respondents to the Medicare Current Beneficiary Survey between 1992 and 2005. Main Outcome Measures Age- and sex-specific incidence of hip fracture and age- and risk-adjusted mortality rates. Results Between 1986 and 2005, the annual mean number of hip fractures was 957.3 per 100 000 (95% confidence interval [CI], 921.7-992.9) for women and 414.4 per 100 000 (95% CI, 401.6-427.3) for men. The age-adjusted incidence of hip fracture increased from 1986 to 1995 and then steadily declined from 1995 to 2005. In women, incidence increased 9.0%, from 964.2 per 100 000 (95% CI, 958.3-970.1) in 1986 to 1050.9 (95% CI, 1045.2-1056.7) in 1995, with a subsequent decline of 24.5% to 793.5 (95% CI, 788.7-798.3) in 2005. In men, the increase in incidence from 1986 to 1995 was 16.4%, from 392.4 (95% CI, 387.8-397.0) to 456.6 (95% CI, 452.0-461.3), and the subsequent decrease to 2005 was 19.2%, to 369.0 (95% CI, 365.1-372.8). Age- and risk-adjusted mortality in women declined by 11.9%, 14.9%, and 8.8% for 30-, 180-, and 360-day mortality, respectively. For men, age- and risk-adjusted mortality decreased by 21.8%, 25.4%, and 20.0% for 30-, 180-, and 360-day mortality, respectively. Over time, patients with hip fracture have had an increase in all comorbidities recorded except paralysis. The incidence decrease is coincident with increased use of bisphosphonates. Conclusion In the United States, hip fracture rates and subsequent mortality among persons 65 years and older are declining, and comorbidities among patients with hip fractures have increased.
1,311 citations
TL;DR: It is shown that the value of a given construct lies in its ability to explain a particular phenomenon of interest within the domains of clinical care, epidemiology, or health services planning and financing.
Abstract: Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized. In this article, we review definitions of comorbidity and their relationship to related constructs. We show that the value of a given construct lies in its ability to explain a particular phenomenon of interest within the domains of (1) clinical care, (2) epidemiology, or (3) health services planning and financing. Mechanisms that may underlie the coexistence of 2 or more conditions in a patient (direct causation, associated risk factors, heterogeneity, independence) are examined, and the implications for clinical care considered. We conclude that the more precise use of constructs, as proposed in this article, would lead to improved research into the phenomenon of ill health in clinical care, epidemiology, and health services.
1,310 citations
TL;DR: Androgen-deprivation therapy for prostate cancer increases the risk of fracture and there was a statistically significant relation between the number of doses of gonadotropin-releasing hormone received during the 12 months after diagnosis and the subsequent risk of fractures.
Abstract: Background The use of androgen-deprivation therapy for prostate cancer has increased substantially over the past 15 years. This treatment is associated with a loss of bone-mineral density, but the risk of fracture after androgen-deprivation therapy has not been well studied. Methods We studied the records of 50,613 men who were listed in the linked database of the Surveillance, Epidemiology, and End Results program and Medicare as having received a diagnosis of prostate cancer in the period from 1992 through 1997. The primary outcomes were the occurrence of any fracture and the occurrence of a fracture resulting in hospitalization. Cox proportional-hazards analyses were adjusted for characteristics of the patients and the cancer, other cancer treatment received, and the occurrence of a fracture or the diagnosis of osteoporosis during the 12 months preceding the diagnosis of cancer. Results Of men surviving at least five years after diagnosis, 19.4 percent of those who received androgen-deprivation therapy...
1,208 citations
References
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TL;DR: The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death fromComorbid disease for use in longitudinal studies and further work in larger populations is still required to refine the approach.
39,961 citations
TL;DR: It is concluded that the adapted comorbidity index will be useful in studies of disease outcome and resource use employing administrative databases.
9,805 citations
TL;DR: The present method addresses some of the limitations of previous measures and produces an expanded set of comorbidities that easily is applied without further refinement to administrative data for a wide range of diseases.
Abstract: Objectives.This study attempts to develop a comprehensive set of comorbidity measures for use with large administrative inpatient datasets.Methods.The study involved clinical and empirical review of comorbidity measures, development of a framework that attempts to segregate comorbidities from other
8,138 citations
Book•
01 May 1992
TL;DR: Part 1 General information on cancer staging and end-results reporting: purposes and principles of staging reporting of cancer survival and end results are explained.
Abstract: Part 1 General information on cancer staging and end-results reporting: purposes and principles of staging reporting of cancer survival and end results. Part 2 Staging of cancer at specific anatomic sites: lip and oral cavity, pharynx (including base of tongue, soft palate, and uvula) larynx maxillary sinus salivary glands (including parotid, submandibular, and sublingual), thyroid gland digestive system sites - oesophagus, stomach, small intestine, colon and rectum, anal canal, liver (including intrahepatic bile ducts), gallbladder, extrahepatic bile ducts, ampulla of vater, exocrine thorax - lung, pleural mesothelioma musculoskeletal sites - bone, soft tissue, carcinoma of the skin (excluding eyelid, vulva, and penis), melanoma of the skin (excluding eyelid), breast gynaecologic sites - cervix uteri, corpus uteri, ovary, vagina, vulva genitourinary sites - prostate, testis, penis, urinary bladder, kidney, renal pelvis and ureter, urethra ophthalmic tumours - carcinoma of the eyelid, melanoma of the eyelid, carcinoma of the conjunctiva, melanoma of the conjunctiva, melanoma of the uvea, retinoblastoma, sarcoma of the orbit, carcinoma of the lacrimal gland, brain lymphomas - Hodgkin's disease, non-Hodkin's lymphoma paediatric cancers - nephroblastoma (Wilms' tumour), neuroblastoma, soft-tissue sarcoma - paediatric. Part 3 Personnel of the american joint committee on cancer.
2,464 citations