Duchesneau Emilie D, Stürmer Til, Reeder-Hayes Katherine, Kim Dae Hyun, Edwards Jessie K, Faurot Keturah R, Lund Jennifer L
Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Pharmacoepidemiol Drug Saf. 2025 Feb;34(2):e70103. doi: 10.1002/pds.70103.
Frailty is an important prognostic indicator in older women with breast cancer. The Faurot frailty index, a validated claims-based frailty proxy measure, uses healthcare billing codes during a user-specified ascertainment window to predict frailty. We assessed how the duration of frailty ascertainment affected the ability of the Faurot frailty index to predict one-year mortality in women with stage I-II breast cancer.
We included 128 857 women (66+ years) with stage I-III breast cancer in the SEER-Medicare database (2003-2019). The Faurot frailty index was calculated using 3-, 6-, 8-, and 12-month ascertainment windows prior to diagnosis or using all-available lookback. Associations between the Faurot frailty index using each window and one-year all-cause mortality were estimated using Kaplan-Meier curves. Discrimination of one-year mortality risk was assessed using C-statistics.
Five percent of women died during the year following diagnosis. Higher Faurot scores were associated with increased mortality risk for all frailty ascertainment windows. Differences in one-year mortality risk for women with high vs. low Faurot frailty scores were reduced when using all-available lookback (16% vs. 2%, difference = 15%, 95% CI 0.14-0.15) compared to shorter windows (e.g., 8 months: 25% vs. 2%, difference = 23%, 95% CI 0.22-0.24). C-statistics ranged from 0.758 (all-available lookback) to 0.770 (12 months) and were robust in subgroups defined by age, race, ethnicity, region, stage, and cancer subtype.
The Faurot frailty index performed well across 3- to 12-month frailty ascertainment windows in women with breast cancer. Researchers should employ this index to address confounding by frailty in studies of cancer populations.
衰弱是老年乳腺癌女性的一项重要预后指标。Faurot衰弱指数是一种经过验证的基于索赔的衰弱替代指标，它在用户指定的确定窗口期间使用医疗保健计费代码来预测衰弱。我们评估了衰弱确定的持续时间如何影响Faurot衰弱指数预测I-II期乳腺癌女性一年死亡率的能力。
我们纳入了SEER - 医疗保险数据库（2003 - 2019年）中128857名年龄在66岁及以上的I - III期乳腺癌女性。Faurot衰弱指数是在诊断前使用3个月、6个月、8个月和12个月的确定窗口或使用所有可用的回顾期来计算的。使用Kaplan - Meier曲线估计每个窗口的Faurot衰弱指数与一年全因死亡率之间的关联。使用C统计量评估一年死亡风险的辨别力。
5%的女性在诊断后的一年内死亡。对于所有衰弱确定窗口，较高的Faurot分数与死亡风险增加相关。与较短的窗口（例如8个月：25%对2%，差异 = 23%，95%CI 0.22 - 0.24）相比，使用所有可用回顾期时，Faurot衰弱分数高与低的女性之间一年死亡风险的差异减小（16%对2%，差异 = 15%，95%CI 0.14 - 0.15）。C统计量范围从0.758（所有可用回顾期）到0.770（12个月），并且在按年龄、种族、民族、地区、分期和癌症亚型定义的亚组中具有稳健性。
Faurot衰弱指数在乳腺癌女性3至12个月的衰弱确定窗口中表现良好。研究人员应采用该指数来解决癌症人群研究中因衰弱导致的混杂问题。
