行政医疗保健数据应用于骨折风险评估。
Administrative healthcare data applied to fracture risk assessment.
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China.
Department of Internal Medicine, University of Manitoba, C5121-409 Tache Ave, Winnipeg, Manitoba, R2H 2A6, Canada.
出版信息
Osteoporos Int. 2019 Mar;30(3):565-571. doi: 10.1007/s00198-018-4780-6. Epub 2018 Dec 15.
UNLABELLED
Fracture risk scores generated from population-based administrative healthcare data showed comparable or better discrimination than the Fracture Risk Assessment Tool (FRAX) scores computed without bone mineral density for predicting incident major osteoporotic fracture. Administrative data may be useful to identify individuals at high fracture risk at the population level.
PURPOSE
To evaluate the discrimination of fracture risk scores defined using inputs available from administrative data for predicting incident major osteoporotic fracture (MOF) and hip fracture (HF) alone.
METHODS
Using the Manitoba Bone Mineral Density (BMD) Database (1997-2013), we identified 61,041 individuals aged 50 years or older with healthcare coverage following their first BMD test. We calculated two-modified FRAX)scores based on administrative data: FRAX-A and FRAX-A. The FRAX-A modification used all FRAX inputs, except for BMD, body mass index, and parental HF, while the FRAX-A modification using all FRAX-A inputs plus a comorbidity score, number of hospitalizations in the 3 years prior to the BMD test, depression diagnosis, and dementia diagnosis. FRAX scores computed with BMD (i.e., FRAX [BMD]) and without BMD (i.e., FRAX [no-BMD]) were the comparators.
RESULTS
During a mean of 7 years of follow-up, we identified 5306 (8.7%) incident MOF and 1532 (2.5%) incident HF. The c-statistic for MOF associated with FRAX-A was lower than FRAX (BMD) (0.655 vs 0.675; P < 0.05) and comparable to FRAX (no-BMD) (0.654; P = 0.07). The c-statistic for MOF using FRAX-A (0.663) was lower than FRAX (BMD) but higher than FRAX (no-BMD) (both P < 0.05). For predicting incident HF, c-statistics associated with FRAX-A (0.762) and FRAX-A (0.767) were lower than FRAX (BMD) (0.789) and FRAX (no-BMD) (0.773; both P < 0.05).
CONCLUSIONS
FRAX-A and FRAX-A showed comparable or better discrimination than FRAX without BMD for predicting incident MOF, but slightly lower discrimination for HF alone.
未标注
基于人群的医疗保健数据生成的骨折风险评分在预测主要骨质疏松性骨折（MOF）和髋部骨折（HF）方面的区分度与不使用骨密度计算的骨折风险评估工具（FRAX）评分相当或更好。行政数据可能有助于在人群水平上识别骨折风险高的个体。
目的
评估使用行政数据中可用的输入定义的骨折风险评分在预测单独发生的主要骨质疏松性骨折（MOF）和髋部骨折（HF）方面的区分度。
方法
使用马尼托巴省骨密度（BMD）数据库（1997-2013 年），我们确定了 61041 名年龄在 50 岁或以上、在首次 BMD 检测后有医疗保健覆盖的个体。我们根据行政数据计算了两种修正的 FRAX 评分：FRAX-A 和 FRAX-A。FRAX-A 修正使用了所有 FRAX 输入，除了 BMD、体重指数和父母 HF，而 FRAX-A 修正使用了所有 FRAX-A 输入加上合并症评分、BMD 检测前 3 年的住院次数、抑郁诊断和痴呆诊断。使用 BMD 计算的 FRAX 评分（即 FRAX[BMD]）和不使用 BMD 计算的 FRAX 评分（即 FRAX[无 BMD]）是比较者。
结果
在平均 7 年的随访期间，我们确定了 5306 例（8.7%）MOF 事件和 1532 例（2.5%）HF 事件。FRAX-A 与 MOF 相关的 C 统计量低于 FRAX（BMD）（0.655 比 0.675；P<0.05），与 FRAX（无 BMD）相当（0.654；P=0.07）。FRAX-A 与 MOF 相关的 C 统计量（0.663）低于 FRAX（BMD），但高于 FRAX（无 BMD）（均 P<0.05）。对于预测 HF 事件，与 FRAX-A（0.762）和 FRAX-A（0.767）相关的 C 统计量低于 FRAX（BMD）（0.789）和 FRAX（无 BMD）（0.773；均 P<0.05）。
结论
FRAX-A 和 FRAX-A 对预测 MOF 事件的区分度与不使用 BMD 的 FRAX 相当或更好，但对 HF 事件的区分度略低。
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