| Titre : | Use of comorbidity scores for control of confounding in studies using administrative databases. (2000) |
| Auteurs : | Sebastian SCHNEEWEISS ; Malcolm MACLURE ; Department of Epidemiology. Harvard School of Public Health. Boston. MA. USA |
| Type de document : | Article |
| Dans : | International journal of epidemiology (vol. 29, n° 5, 2000) |
| Pagination : | 891-898 |
| Langues: | Anglais |
| Mots-clés : | Etats Unis ; Amérique ; Homme ; Etat santé ; Epidémiologie ; Méthodologie ; Mortalité ; Analyse donnée ; Amérique du Nord |
| Résumé : | [BDSP. Notice produite par INIST 8QR0xPAb. Diffusion soumise à autorisation]. Background Comorbidity scores are increasingly used to reduce potential confounding in epidemiological research. Our objective was to compare metrical and practical properties of published comorbidity scores for use in epidemiological research with administrative databases. Methods The literature was searched for studies of the validity of comorbidity scores as predictors of mortality and health service use, as measured by change in the area under the receiver operating characteristic (ROC) curve for dichotomous outcomes, and change in R2 for continuous outcomes. Results Six scores were identified, including four versions of the Charlson Index (CI) which use either the three-digit International Classification of Diseases, Ninth Revision (ICD-9) or the full ICD-9-CM (clinical modification) code, and two versions of the Chronic Disease Score (CDS) which used outpatient pharmacy records. Depending on the population and exposure under study, predictive validities varied between c=0.64 and c=0.77 for in-hospital or 30-day mortality. This is only a slight improvement over age adjustment. In one study the simple measure'number of diagnoses'outperformed the CI (c=0.73 versus c=0.65). Proprietary scores like Ambulatory Diagnosis Groups and Patient Management Categories do not necessarily perform better in predicting mortality. Comorbidity indices are susceptible to a variety of coding errors. (...) |
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