Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.
Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Gerontol A Biol Sci Med Sci. 2023 Jul 8;78(7):1198-1203. doi: 10.1093/gerona/glad010.
A claims-based frailty index (CFI) allows measurement of frailty on a population scale. Our objective was to examine the association of changes in CFI over 12 months with mortality and Medicare costs.
We used a 5% sample of fee-for-service Medicare beneficiaries. We estimated CFI (range: 0–1: nonfrail (<0.25), mildly frail (0.25–0.34), moderately-to-severely frail (≥0.35) on January 1, 2015 and January 1, 2016. Beneficiaries were categorized as having a large decrease (-<0.045), small decrease (-≤0.045-0.015), stable (±0.015), small increase (>0.015-0.045), or large increase (>0.045). We used Cox proportional hazards model to estimate hazard ratio (HR) for mortality adjusting for age, sex, and 2015 CFI value and compared total Medicare costs from January 1, 2016 to December 31, 2016.
The study population included 995 664 beneficiaries (mean age 77 years, 56.8% female). In nonfrail (n = 906 046), HR (95% confidence interval [CI]) ranged from 0.71 (0.67-0.75) for a large decrease to 2.75 (2.68-2.33) for a large increase. In moderate-to-severely frail beneficiaries (n = 16 527), the corresponding HR (95% CI) ranged from 0.63 (0.57-0.70) to 1.21 (1.06-1.38). The mean total Medicare cost per member per year (standard deviation) was from $12 149 ($83 508) in nonfrail beneficiaries to $61 155 ($345 904) in moderate-to-severely frail beneficiaries.
One-year changes in CFI are associated with elevated mortality risk and health care costs across all levels of frailty.
基于索赔的虚弱指数（CFI）可在人群范围内衡量虚弱程度。我们的目的是研究 12 个月内 CFI 的变化与死亡率和医疗保险费用之间的关联。
我们使用了医疗保险按服务收费计划的 5%抽样。我们于 2015 年 1 月 1 日和 2016 年 1 月 1 日估计了 CFI（范围：0-1：非虚弱（<0.25）、轻度虚弱（0.25-0.34）、中度至重度虚弱（≥0.35）。受益人为具有大的下降（-<0.045）、小的下降（-≤0.045-0.015）、稳定（±0.015）、小的增加（>0.015-0.045）或大的增加（>0.045）。我们使用 Cox 比例风险模型估计死亡率的风险比（HR），并调整年龄、性别和 2015 年 CFI 值，同时比较 2016 年 1 月 1 日至 2016 年 12 月 31 日的医疗保险总费用。
研究人群包括 995664 名受益人（平均年龄 77 岁，56.8%为女性）。在非虚弱人群（n=906046）中，HR（95%置信区间[CI]）范围从大的下降（0.71[0.67-0.75]）到大的增加（2.75[2.68-2.33]）。在中度至重度虚弱的受益人（n=16527）中，相应的 HR（95%CI）范围从 0.63（0.57-0.70）到 1.21（1.06-1.38）。每位成员每年的医疗保险总费用平均值（标准差）从非虚弱受益人的 12149 美元（83508 美元）到中度至重度虚弱受益人的 61155 美元（345904 美元）。
CFI 的一年变化与所有虚弱程度的死亡率风险增加和医疗保健费用增加相关。
