Kristensen Kasper Bruun, Lund Lars Christian, Jensen Peter Bjødstrup, Broe Anne, Rotbain Emelie, Damkier Per, Pottegård Anton, Andersen Jacob Harbo, Højlund Mikkel, Olesen Morten, Rasmussen Lotte, Hansen Morten Rix, Ernst Martin Thomsen, Wesselhoeft Rikke, Henriksen Daniel Pilsgaard, Reilev Mette, Bliddal Mette, Hallas Jesper
Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark.
Department of Hematology, Odense University Hospital, Odense, Denmark.
Clin Epidemiol. 2022 Apr 27;14:567-579. doi: 10.2147/CLEP.S353398. eCollection 2022.
To develop the Nordic Multimorbidity Index (NMI), a multimorbidity measure specifically suited to the Nordic health and administrative registry data based on current diagnosis, treatment, and coding practices.
The NMI was developed to predict 5-year mortality in a population-based cohort of randomly sampled Danish residents aged ≥40 years (n = 425,087) followed from 2013 to 2018. Included predictors were selected from hospital diagnoses and filled drug prescriptions based on a combination of subject matter knowledge and a data-driven approach using backwards elimination. The performance of the NMI was assessed in a temporal validation cohort of Danish residents followed from 2007 to 2012 and in six cohorts of new users of selected drugs. The discriminative performance of the NMI, Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) was assessed using the c-statistic from logistic regression models with 5-year mortality as dependent variable and the multimorbidity index score, age, and sex as independent variables.
The NMI included 50 predictors. In the temporal validation cohort, the c-statistic of the NMI (0.887, 95% CI 0.883-0.890) exceeded that of the CCI (0.871, 95% CI 0.868-0.874) and ECI (0.866, 95% CI 0.863-0.870). In all new user cohorts, the NMI outperformed the other indices with c-statistics ranging from 0.781 (95% CI 0.779-0.784) to 0.838 (95% CI 0.834-0.842).
The NMI predicted 5-year mortality in a general Danish population and six cohorts of new users of selected drugs and was superior to the CCI and ECI. The NMI could be preferred over these indices to quantify the level of multimorbidity for, eg, descriptive purposes or confounding control. The NMI should be validated in other patient populations and other Nordic countries.
开发北欧多重疾病指数（NMI），这是一种基于当前诊断、治疗和编码实践，特别适用于北欧健康和行政登记数据的多重疾病测量方法。
开发NMI以预测2013年至2018年期间对年龄≥40岁的丹麦居民进行随机抽样的基于人群队列中的5年死亡率（n = 425,087）。纳入的预测因素是根据主题知识和使用向后消除法的数据驱动方法，从医院诊断和填写的药物处方中选择的。在2007年至2012年随访的丹麦居民的时间验证队列以及六个选定药物新用户队列中评估NMI的性能。使用以5年死亡率为因变量、多重疾病指数得分、年龄和性别为自变量的逻辑回归模型的c统计量，评估NMI、查尔森合并症指数（CCI）和埃利克斯豪泽合并症指数（ECI）的判别性能。
NMI包括50个预测因素。在时间验证队列中，NMI的c统计量（0.887，95%CI 0.883 - 0.890）超过了CCI（0.871，95%CI 0.868 - 0.874）和ECI（0.866，95%CI 0.863 - 0.870）。在所有新用户队列中，NMI的表现优于其他指数，c统计量范围为0.781（95%CI 0.779 - 0.784）至0.838（95%CI 0.834 - 0.842）。
NMI预测了丹麦普通人群和六个选定药物新用户队列中的5年死亡率，并且优于CCI和ECI。在例如描述目的或混杂控制等方面，与这些指数相比，NMI可能更受青睐以量化多重疾病水平。NMI应在其他患者群体和其他北欧国家进行验证。
