Sorace James, Rogers Michael, Millman Michael, Rogers Daniel, Price Kyle, Queen Susan, Worrall Chris, Kelman Jeffrey
1 Office of Science and Data Policy , Washington, D.C.
2 Acumen LLC , Burlingame, California.
Popul Health Manag. 2015 Oct;18(5):383-91. doi: 10.1089/pop.2014.0145. Epub 2015 Feb 6.
To quantify heredity's effects on the burden of illness in the Medicare population, this study linked information between participants in a research twin registry to a comprehensive set of Medicare claims. To calculate disease categories, the authors used the Centers for Medicare & Medicaid Services Hierarchical Conditions Categories (HCC) model that was developed to risk adjust Medicare's capitation payments to private health care plans based on the health expenditure risk of their enrollees. Using the Medicare database, 2 sets of unrelated but demographically matched control pairs (MCPs) were generated, one specific for the monozygotic twin population and the second specific for the dizygotic twin population. The concordance and correlation rates of the 70 HCC categories for the 2 twin populations, in comparison to their corresponding MCP, was then calculated using Medicare claims data from 1991 through 2011. When indicated, HCCs for which there was a statistically significant difference between the twin and corresponding MCP control group were analyzed by calculating concordance and correlation rates of the International Classification of Diseases, Ninth Revision codes that compose the HCC. Findings reveal that monozygotic twins share 6.5% more HCC disease categories than their MCP while dizygotic twins share 3.8% more HCC disease categories than their MCP. Atrial fibrillation is a highly heritable disease category, a finding consistent with prior literature describing the heritability of the cardiac arrhythmias. These findings are consistent with qualitative assessments of heredity's role found in previous models of population health, and provide both novel methods and quantitative evidence to support future model development.
为了量化遗传因素对医疗保险人群疾病负担的影响，本研究将一个研究双胞胎登记处参与者的信息与一套完整的医疗保险理赔数据相联系。为了计算疾病类别，作者使用了医疗保险与医疗补助服务中心的分层条件类别（HCC）模型，该模型是为根据参保人的医疗支出风险对医疗保险向私人医疗保健计划支付的人头费进行风险调整而开发的。利用医疗保险数据库，生成了两组不相关但人口统计学特征匹配的对照对（MCP），一组针对同卵双胞胎人群，另一组针对异卵双胞胎人群。然后，使用1991年至2011年的医疗保险理赔数据，计算这两组双胞胎人群70个HCC类别的一致性和相关性比率，并与相应的MCP进行比较。如有需要，通过计算构成HCC的《国际疾病分类》第九版编码的一致性和相关性比率，对双胞胎组与相应MCP对照组之间存在统计学显著差异的HCC进行分析。研究结果显示，同卵双胞胎比其MCP共享的HCC疾病类别多6.5%，而异卵双胞胎比其MCP共享的HCC疾病类别多3.8%。心房颤动是一种高度可遗传的疾病类别，这一发现与先前描述心律失常遗传性的文献一致。这些发现与以往人群健康模型中对遗传作用的定性评估一致，并为支持未来模型开发提供了新方法和定量证据。
