X-Message-Number: 27622
Date: Wed, 15 Feb 2006 20:35:55 -0800 (PST)
From: Doug Skrecky <>
Subject: Prognostic Index for 4-Year Mortality

JAMA. February 15, 2006;295(7):801-808

Development and Validation of a Prognostic Index for 4-Year
Mortality in Older Adults
Sei J. Lee, MD; Karla Lindquist, MS; Mark R. Segal, PhD;
Kenneth E. Covinsky, MD, MPH

Context  Both comorbid conditions and functional measures predict
mortality in older adults, but few prognostic indexes combine both
classes of predictors. Combining easily obtained measures into an
accurate predictive model could be useful to clinicians advising
patients, as well as policy makers and epidemiologists interested
in risk adjustment.

Objective  To develop and validate a prognostic index for 4-year
mortality using information that can be obtained from patient report.

Design, Setting, and Participants  Using the 1998 wave of the
Health and Retirement Study (HRS), a population-based study of
community-dwelling US adults older than 50 years, we developed the
prognostic index from 11 701 individuals and validated the index
with 8009. Individuals were asked about their demographic
characteristics, whether they had specific diseases, and whether
they had difficulty with a series of functional measures. We
identified variables independently associated with mortality and
weighted the variables to create a risk index.

Main Outcome Measure  Death by December 31, 2002.

Results  The overall response rate was 81%. During the 4-year
follow-up, there were 1361 deaths (12%) in the development cohort
and 1072 deaths (13%) in the validation cohort. Twelve independent
predictors of mortality were identified: 2 demographic variables
(age: 60-64 years, 1 point; 65-69 years, 2 points; 70-74 years,
3 points; 75-79 years, 4 points; 80-84 years, 5 points, >85 years,
7 points and male sex, 2 points), 6 comorbid conditions (diabetes,
1 point; cancer, 2 points; lung disease, 2 points; heart failure,
2 points; current tobacco use, 2 points; and body mass index <25,
1 point), and difficulty with 4 functional variables (bathing,
2 points; walking several blocks, 2 points; managing money,
2 points, and pushing large objects, 1 point. Scores on the
risk index were strongly associated with 4-year mortality in the
validation cohort, with 0 to 5 points predicting a less than
4% risk, 6 to 9 points predicting a 15% risk, 10 to 13 points
predicting a 42% risk, and 14 or more points predicting a 64% risk.
The risk index showed excellent discrimination with a cstatistic
of 0.84 in the development cohort and 0.82 in the validation cohort.

Conclusion  This prognostic index, incorporating age, sex,
self-reported comorbid conditions, and functional measures,
accurately stratifies community-dwelling older adults into groups
at varying risk of mortality.

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