Sun Jenny W, Bourgeois Florence T, Haneuse Sebastien, Hernández-Díaz Sonia, Landon Joan E, Bateman Brian T, Huybrechts Krista F
Am J Epidemiol. 2021 May 4;190(5):918-927. doi: 10.1093/aje/kwaa244.
Comorbidity scores are widely used to help address confounding bias in nonrandomized studies conducted within health-care databases, but existing scores were developed to predict all-cause mortality in adults and might not be appropriate for use in pediatric studies. We developed and validated a pediatric comorbidity index, using health-care utilization data from the tenth revision of the International Classification of Diseases. Within the MarketScan database of US commercial claims data, pediatric patients (aged ≤18 years) continuously enrolled between October 1, 2015, and September 30, 2017, were identified. Logistic regression was used to predict the 1-year risk of hospitalization based on 27 predefined conditions and empirically identified conditions derived from the most prevalent diagnoses among patients with the outcome. A single numerical index was created by assigning weights to each condition based on its β coefficient. We conducted internal validation of the index and compared its performance with existing adult scores. The pediatric comorbidity index consisted of 24 conditions and achieved a C statistic of 0.718 (95% confidence interval (CI): 0.714, 0.723). The index outperformed existing adult scores in a pediatric population (C statistics ranging from 0.522 to 0.640). The pediatric comorbidity index provides a summary measure of disease burden and can be used for risk adjustment in epidemiologic studies of pediatric patients.
共病评分被广泛用于帮助解决在医疗保健数据库中进行的非随机研究中的混杂偏倚，但现有的评分是为预测成年人的全因死亡率而制定的，可能不适用于儿科研究。我们利用国际疾病分类第十版中的医疗保健利用数据，开发并验证了一种儿科共病指数。在美国商业索赔数据的MarketScan数据库中，识别出2015年10月1日至2017年9月30日期间持续参保的儿科患者（年龄≤18岁）。基于27种预定义疾病和从结局患者中最常见诊断得出的经验性确定疾病，采用逻辑回归来预测1年住院风险。通过根据每个疾病的β系数为其赋予权重，创建了一个单一的数值指数。我们对该指数进行了内部验证，并将其性能与现有的成人评分进行了比较。儿科共病指数由24种疾病组成，C统计量为0.718（95%置信区间（CI）：0.714，0.723）。在儿科人群中，该指数的表现优于现有的成人评分（C统计量范围为0.522至0.640）。儿科共病指数提供了疾病负担的汇总指标，可用于儿科患者流行病学研究中的风险调整。
