Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Dev Med Child Neurol. 2021 Jul;63(7):853-859. doi: 10.1111/dmcn.14879. Epub 2021 Apr 7.
To validate the Whitney Comorbidity Index (WCI), which was recently developed to monitor disease status for adults with cerebral palsy (CP), and to identify WCI scores associated with an increased mortality risk using a representative sample of adults with CP.
Data from 2016 to 2018 were used from a random 20% sample from the fee-for-service Medicare database for this retrospective cohort study. The WCI was examined as unweighted (WCI ) and weighted (WCI ) among adults at least 18 years old with CP. Cox regression models were developed with mortality as the outcome after adjusting for demographics. A concordance statistic (C-statistic) of at least 0.70 was considered as showing sufficient validity. The hazard ratio of mortality for each WCI score was estimated. Secondary analyses were performed for subgroups with co-occurring epilepsy and/or intellectual disabilities.
For the entire group (n=16 728) and subgroups, the WCI showed sufficient validity (C-statistic 0.73-0.81). For the entire group, the mortality rate was elevated for a score of 1 compared with 0 from the WCI (hazard ratio 3.06; 95% confidence interval [CI] 1.52-6.17) and WCI (hazard ratio 4.08; 95% CI 1.69-9.85), and became larger with each WCI score. Results were similar for the subgroups.
The WCI is a valid marker for health/disease status for adults with CP. Several WCI score thresholds were identified to assist in clinical decision making for preventive medicine and intervention implementation. What this paper adds The Whitney Comorbidity Index (WCI) is valid among 16 728 adults with CP. The WCI is valid for those with co-occurring epilepsy and/or intellectual disabilities. Thresholds of the WCI score were identified to assist clinical decision making.
验证最近开发的用于监测脑瘫（CP）成人疾病状况的惠特尼合并症指数（WCI），并使用 CP 成人的代表性样本确定与死亡率风险增加相关的 WCI 评分。
这项回顾性队列研究使用了 2016 年至 2018 年来自按服务收费的医疗保险数据库的随机 20%样本数据。在至少 18 岁的 CP 成人中，检查了未加权（WCI）和加权（WCI）的 WCI。在调整了人口统计学因素后，使用死亡率作为结果，建立了 Cox 回归模型。至少 0.70 的一致性统计量（C 统计量）被认为具有足够的有效性。估计了每个 WCI 评分的死亡率风险比。对伴有共发性癫痫和/或智力残疾的亚组进行了二次分析。
对于整个组（n=16728）和亚组，WCI 显示出足够的有效性（C 统计量 0.73-0.81）。对于整个组，与 WCI 评分为 0 相比，评分为 1 的死亡率较高（危险比 3.06；95%置信区间[CI]1.52-6.17）和 WCI（危险比 4.08；95%CI 1.69-9.85），并且随着每个 WCI 评分的增加而增加。亚组的结果相似。
WCI 是 CP 成人健康/疾病状况的有效标志物。确定了几个 WCI 评分阈值，以协助预防性医学和干预实施的临床决策。
WCI 在 16728 名 CP 成人中是有效的。WCI 对伴有共发性癫痫和/或智力残疾的患者有效。确定了 WCI 评分的阈值，以协助临床决策。
