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Background <p>Various comorbidity indices have been validated for individual health outcomes. However, systematic concurrent comparisons of multiple outcome measures in a single study remain relatively underrepresented but needed for practical decision support.</p> Aims <p>To compare the performance of the Charlson Comorbidity Index (CCI) and Rx-Risk Comorbidity Index (Rx-Risk).</p> Methods <p>Baseline and six-month follow-up data from <i>n</i> = 221 patients recruited in <i>n</i> = 70 practices were used. CCI and Rx-Risk scores were calculated using documented diagnoses and prescribed medications. Outcomes assessed were health-related quality of life (HRQoL, EQ-5D-5&#xa0;L), functional impairment (B-ADL), cognitive decline (MMSE), and healthcare utilization (physician visits, hospitalizations). Indices performance was evaluated regarding agreement (Cohens Kappa (<i>k</i>)), known-groups validity (ANOVA, t-test), convergent validity (correlation coefficient (<i>r</i><sub><i>s</i></sub>)) and predictive ability (R², Akaike information criterion (AIC)).</p> Results <p>Patients were, on average, 80 years old, mostly female (55%), with 12 diagnoses and seven medications. Agreement between both indices was poor for all conditions except diabetes (<i>k</i> = 0.645) and chronic airway diseases (<i>k</i> = 0.486). Rx-Risk differed more in known groups, especially for HRQoL and hospitalizations, and showed stronger correlations with the EQ-5D index (<i>r</i><sub><i>s</i></sub>, -0.215 vs. -0.134) and risk of hospitalization (<i>r</i><sub><i>s</i></sub>, 0.145 vs. 0.128) than CCI. Rx-Risk, again, performed better in predicting the change of EQ-5D index (R², 30 vs. 28%) and all EQ-5D dimensions, functional (R², 55 vs. 52%) and cognitive decline (R², 47 vs. 46%) and physician consultations (AIC, 649.2 vs. 651.0), except for hospitalization (AIC, 149.2 vs. 147.1).</p> Conclusions <p>Rx-Risk demonstrated slightly superior validity and predictive ability for HRQoL and healthcare utilization, making it a promising option for studies focused on these outcomes. However, limitations regarding functional and cognitive impairment suggest alternative instruments are needed.</p>

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A head-to-head comparison of the validity and predictive ability for health outcomes of diagnosis versus medication-based comorbidity indices

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月27日

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  • Moritz Platen,
  • Maresa Buchholz,
  • Anika Rädke,
  • Fabian Kleinke,
  • Annelie Scharf,
  • Michelle Pfaff,
  • Audrey Iskandar,
  • Neeltje van den Berg,
  • Wolfgang Hoffmann,
  • Bernhard Michalowsky

摘要

Background

Various comorbidity indices have been validated for individual health outcomes. However, systematic concurrent comparisons of multiple outcome measures in a single study remain relatively underrepresented but needed for practical decision support.

Aims

To compare the performance of the Charlson Comorbidity Index (CCI) and Rx-Risk Comorbidity Index (Rx-Risk).

Methods

Baseline and six-month follow-up data from n = 221 patients recruited in n = 70 practices were used. CCI and Rx-Risk scores were calculated using documented diagnoses and prescribed medications. Outcomes assessed were health-related quality of life (HRQoL, EQ-5D-5 L), functional impairment (B-ADL), cognitive decline (MMSE), and healthcare utilization (physician visits, hospitalizations). Indices performance was evaluated regarding agreement (Cohens Kappa (k)), known-groups validity (ANOVA, t-test), convergent validity (correlation coefficient (rs)) and predictive ability (R², Akaike information criterion (AIC)).

Results

Patients were, on average, 80 years old, mostly female (55%), with 12 diagnoses and seven medications. Agreement between both indices was poor for all conditions except diabetes (k = 0.645) and chronic airway diseases (k = 0.486). Rx-Risk differed more in known groups, especially for HRQoL and hospitalizations, and showed stronger correlations with the EQ-5D index (rs, -0.215 vs. -0.134) and risk of hospitalization (rs, 0.145 vs. 0.128) than CCI. Rx-Risk, again, performed better in predicting the change of EQ-5D index (R², 30 vs. 28%) and all EQ-5D dimensions, functional (R², 55 vs. 52%) and cognitive decline (R², 47 vs. 46%) and physician consultations (AIC, 649.2 vs. 651.0), except for hospitalization (AIC, 149.2 vs. 147.1).

Conclusions

Rx-Risk demonstrated slightly superior validity and predictive ability for HRQoL and healthcare utilization, making it a promising option for studies focused on these outcomes. However, limitations regarding functional and cognitive impairment suggest alternative instruments are needed.