Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea.
National Cancer Survivorship Center, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
BMC Med Res Methodol. 2021 Apr 9;21(1):66. doi: 10.1186/s12874-021-01257-2.
Cancer patients' prognoses are complicated by comorbidities. Prognostic prediction models with inappropriate comorbidity adjustments yield biased survival estimates. However, an appropriate claims-based comorbidity risk assessment method remains unclear. This study aimed to compare methods used to capture comorbidities from claims data and predict non-cancer mortality risks among cancer patients.
Data were obtained from the National Health Insurance Service-National Sample Cohort database in Korea; 2979 cancer patients diagnosed in 2006 were considered. Claims-based Charlson Comorbidity Index was evaluated according to the various assessment methods: different periods in washout window, lookback, and claim types. The prevalence of comorbidities and associated non-cancer mortality risks were compared. The Cox proportional hazards models considering left-truncation were used to estimate the non-cancer mortality risks.
The prevalence of peptic ulcer, the most common comorbidity, ranged from 1.5 to 31.0%, and the proportion of patients with ≥1 comorbidity ranged from 4.5 to 58.4%, depending on the assessment methods. Outpatient claims captured 96.9% of patients with chronic obstructive pulmonary disease; however, they captured only 65.2% of patients with myocardial infarction. The different assessment methods affected non-cancer mortality risks; for example, the hazard ratios for patients with moderate comorbidity (CCI 3-4) varied from 1.0 (95% CI: 0.6-1.6) to 5.0 (95% CI: 2.7-9.3). Inpatient claims resulted in relatively higher estimates reflective of disease severity.
The prevalence of comorbidities and associated non-cancer mortality risks varied considerably by the assessment methods. Researchers should understand the complexity of comorbidity assessments in claims-based risk assessment and select an optimal approach.
癌症患者的预后受到合并症的影响。未对合并症进行适当调整的预后预测模型会导致生存估计出现偏差。然而，一种合适的基于索赔的合并症风险评估方法仍不清楚。本研究旨在比较从索赔数据中捕获合并症并预测癌症患者非癌症死亡率风险的方法。
数据来自韩国国家健康保险服务-国家样本队列数据库；考虑了 2006 年诊断出的 2979 例癌症患者。根据各种评估方法评估基于索赔的 Charlson 合并症指数：洗脱窗口、回顾和索赔类型的不同时期。比较了合并症的患病率和相关的非癌症死亡率风险。考虑到左截断的 Cox 比例风险模型用于估计非癌症死亡率风险。
最常见的合并症消化性溃疡的患病率为 1.5%至 31.0%，≥1 种合并症的患者比例为 4.5%至 58.4%，具体取决于评估方法。门诊索赔涵盖了 96.9%的慢性阻塞性肺疾病患者；然而，它们仅涵盖了 65.2%的心肌梗死患者。不同的评估方法影响了非癌症死亡率风险；例如，中度合并症（CCI 3-4）患者的风险比从 1.0（95%CI：0.6-1.6）到 5.0（95%CI：2.7-9.3）不等。住院索赔导致相对较高的估计值，反映了疾病的严重程度。
合并症的患病率和相关的非癌症死亡率风险因评估方法而异。研究人员应了解索赔风险评估中合并症评估的复杂性，并选择最佳方法。
