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韩国痴呆症合并症指数(KDCI)的开发与验证:一项基于2002年至2013年全国人口的队列研究。

Development and validation of the Korea Dementia Comorbidity Index (KDCI): A nationwide population-based cohort study from 2002 to 2013.

作者信息

Kim Jae-Hyun, Yoo Ki-Bong, Lee Yunhwan

机构信息

Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea; Institute of Health Promotion and Policy, Dankook University, Cheonan, Republic of Korea.

Department of Healthcare Management, Graduate School, Eulji University, Gyeonggi, Republic of Korea.

出版信息

Arch Gerontol Geriatr. 2017 Sep;72:195-200. doi: 10.1016/j.archger.2017.06.001. Epub 2017 Jun 7.

DOI:10.1016/j.archger.2017.06.001
PMID:28709115
Abstract

This study develop and validate a simple and accessible measure of comorbidity, named the Korean Dementia Comorbidity index (KDCI), to assist in predicting the onset of dementia. This study used the National Health Insurance Service-Cohort Sample Database from 2002 to 2013 (n=23,856). Cox proportional hazard model was used to estimate incident dementia (International Classification of Disease, 10th edition (ICD-10) codes: F00-F03, G30, G311), with a hazard ratio higher than 1.05 for each comorbid condition being assigned a score. Scores ranging from 1 to 4 were assigned based on the magnitude of the hazard ratio (HR): 1 (1.050≤HR≤1.099), 2 (1.100≤HR≤1.149), 3 (1.150≤HR≤1.199), and 4 (HR≥1.200) Summated scores of comorbidities for each individual constituted the Korean Dementia Comorbidity Index (KDCI). Five patterns were extracted: (1) disease of the eye and adnexa; (2) endocrine and metabolic disease, and disease of circulatory system; (3) disease of the musculoskeletal system and connective tissue; (4) disease of the respiratory system; and (5) disease of the nervous system, and mental and behavioral disorders through factor analysis. Fitting performance by Akaike information criterion (AIC) of CCI by Charlson, CCI by Quan and KDCI adjusting for age and sex was 29,486, 29,488 and 29,444, respectively. Our analysis results on discriminatory abilities provided evidence that KDCI is superior to other comorbidity indices on incident dementia in terms of comorbidity adjustment. Therefore, KDCI can be a useful tool to identify incident dementia. This has implications for clinical management of patients with multimorbidity as well as risk adjustment for database studies.

摘要

本研究开发并验证了一种简单且易于获取的共病测量方法,即韩国痴呆共病指数(KDCI),以帮助预测痴呆的发病。本研究使用了2002年至2013年的国民健康保险服务队列样本数据库(n = 23,856)。采用Cox比例风险模型估计新发痴呆(国际疾病分类第10版(ICD - 10)编码:F00 - F03、G30、G311),每种共病情况的风险比高于1.05时给予一个分数。根据风险比(HR)的大小分配1至4分:1(1.050≤HR≤1.099)、2(1.100≤HR≤1.149)、3(1.150≤HR≤1.199)和4(HR≥1.200)。每个个体的共病总分构成韩国痴呆共病指数(KDCI)。通过因子分析提取了五种模式:(1)眼及附属器疾病;(2)内分泌和代谢疾病以及循环系统疾病;(3)肌肉骨骼系统和结缔组织疾病;(4)呼吸系统疾病;(5)神经系统疾病以及精神和行为障碍。根据赤池信息准则(AIC),Charlson共病指数(CCI)、Quan共病指数(CCI)以及调整年龄和性别的KDCI的拟合性能分别为29,486、29,488和29,444。我们关于鉴别能力的分析结果表明,在共病调整方面,KDCI在新发痴呆方面优于其他共病指数。因此,KDCI可以成为识别新发痴呆的有用工具。这对患有多种疾病患者的临床管理以及数据库研究的风险调整具有重要意义。

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