Impact of comorbidity assessment methods to predict non-cancer mortality risk in cancer patients: a retrospective observational study using the National Health Insurance Service claims-based data in Korea

• Published in: BMC medical research methodology Vol. 21; no. 1; p. 66
• Main Authors: Lee, Sanghee, Chang, Yoon Jung, Cho, Hyunsoon
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09.04.2021; BioMed Central; BMC
• Subjects: Cancer; Cancer patients; Care and treatment; Charlson comorbidity index; Claims data; Comorbidity; Complications and side effects; Demographics; Disease; Estimates; Evaluation; Health insurance; Health risk assessment; Medical diagnosis; Medical prognosis; Medical research; Mortality; Non-cancer; Observational studies; Patients; Population; Prognosis; Research methodology; Ulcers; South Korea; Non-cancer; Claims data; Comorbidity; Mortality; Prognosis prediction; Charlson comorbidity index; Cancer
• ISSN: 1471-2288; 1471-2288
• DOI: 10.1186/s12874-021-01257-2

Cancer patients' prognoses are complicated by comorbidities. Prognostic prediction models with inappropriate comorbidity adjustments yield biased survival estimates. However, an appropriate claims-based comorbidity risk assessment method remains unclear. This study aimed to compare methods used to capture comorbidities from claims data and predict non-cancer mortality risks among cancer patients. Data were obtained from the National Health Insurance Service-National Sample Cohort database in Korea; 2979 cancer patients diagnosed in 2006 were considered. Claims-based Charlson Comorbidity Index was evaluated according to the various assessment methods: different periods in washout window, lookback, and claim types. The prevalence of comorbidities and associated non-cancer mortality risks were compared. The Cox proportional hazards models considering left-truncation were used to estimate the non-cancer mortality risks. The prevalence of peptic ulcer, the most common comorbidity, ranged from 1.5 to 31.0%, and the proportion of patients with ≥1 comorbidity ranged from 4.5 to 58.4%, depending on the assessment methods. Outpatient claims captured 96.9% of patients with chronic obstructive pulmonary disease; however, they captured only 65.2% of patients with myocardial infarction. The different assessment methods affected non-cancer mortality risks; for example, the hazard ratios for patients with moderate comorbidity (CCI 3-4) varied from 1.0 (95% CI: 0.6-1.6) to 5.0 (95% CI: 2.7-9.3). Inpatient claims resulted in relatively higher estimates reflective of disease severity. The prevalence of comorbidities and associated non-cancer mortality risks varied considerably by the assessment methods. Researchers should understand the complexity of comorbidity assessments in claims-based risk assessment and select an optimal approach.