Newschaffer C J, Bush T L, Penberthy L T
Saint Louis University School of Public Health, Department of Community Health, Missouri 63108, USA.
J Clin Epidemiol. 1997 Jun;50(6):725-33. doi: 10.1016/s0895-4356(97)00050-4.
The inter-rater reliability, cross-source (Medicare claims versus medical record) agreement, and ability to predict all-cause mortality of three aggregate comorbidity indices were evaluated in a group of 404 elderly, incident breast cancer cases identified from the Virginia Cancer Registry and linked to Medicare administrative data files. Comorbidity was based on both medical records and Medicare claims data using indices from Charlson et al (1987), Satariano and Ragland (1994), and Kaplan and Feinstein (1974). Inter-rater agreement was good for all indices (kappas > or = 0.80). Agreement between comorbidity indices measured by claims and medical records was considerably poorer (kappas between 0.30 and 0.40). However, claims-based and medical records-based comorbidity indices were similarly associated with mortality. For the Charlson index, the index best predicting survival, the adjusted relative risk for an increase from a lower to higher comorbidity category was 1.48 (95% confidence interval 1.23, 1.78) based on medical records compared to 1.53 (95% confidence interval 1.23, 1.93) based on Medicare claims. The claims-based Charlson index score still appeared to be associated with survival (relative risk = 1.30; 95% confidence interval = 1.00, 1.70) after controlling for the medical records-based score. This suggests that both comorbidity data sources add valuable prognostic information and, conversely, that the use of either source alone will result in some misclassification of comorbidity.
在一组从弗吉尼亚癌症登记处识别出并与医疗保险管理数据文件相链接的404例老年初发乳腺癌病例中，对三种综合合并症指数的评分者间信度、跨来源（医疗保险理赔数据与病历）一致性以及预测全因死亡率的能力进行了评估。合并症基于病历和医疗保险理赔数据，采用了Charlson等人（1987年）、Satariano和Ragland（1994年）以及Kaplan和Feinstein（1974年）的指数。所有指数的评分者间一致性良好（卡帕值≥0.80）。通过理赔数据和病历测量的合并症指数之间的一致性要差得多（卡帕值在0.30至0.40之间）。然而，基于理赔数据和基于病历的合并症指数与死亡率的关联相似。对于预测生存情况最佳的Charlson指数，基于病历，从较低合并症类别增加到较高合并症类别的调整后相对风险为1.48（95%置信区间1.23，1.78），而基于医疗保险理赔数据的为1.53（95%置信区间1.23，1.93）。在控制了基于病历的评分后，基于理赔数据的Charlson指数评分似乎仍与生存相关（相对风险 = 1.30；95%置信区间 = 1.00，1.70）。这表明两种合并症数据来源都增加了有价值的预后信息，相反，单独使用任何一种来源都会导致合并症的一些错误分类。
