Machine learning models of healthcare expenditures predicting mortality: A cohort study of spousal bereaved Danish individuals

BackgroundThe ability to accurately predict survival in older adults is crucial as it guides clinical decision making. The added value of using health care usage for predicting mortality remains unexplored. The aim of this study was to investigate if temporal patterns of healthcare expenditures, can improve the predictive performance for mortality, in spousal bereaved older adults, next to other widely used sociodemographic variables. MethodsThis is a population-based cohort study of 48,944 Danish citizens 65 years of age and older suffering bereavement within 2013-2016. Individuals were followed from date of spousal loss until death from all causes or 31(st) of December 2016, whichever came first. Healthcare expenditures were available on weekly basis for each person during the follow-up and used as predictors for mortality risk in Extreme Gradient Boosting models. The extent to which medical spending trajectories improved mortality predictions compared to models with sociodemographics, was assessed with respect to discrimination (AUC), overall prediction error (Brier score), calibration, and clinical benefit (decision curve analysis). ResultsThe AUC of age and sex for mortality the year after spousal loss was 70.8% [95% CI 68.8, 72.8]. The addition of sociodemographic variables led to an increase of AUC ranging from 0.9% to 3.1% but did not significantly reduce the overall prediction error. The AUC of the model combining the variables above plus medical spending usage was 80.8% [79.3, 82.4] also exhibiting smaller Brier score and better calibration. Overall, patterns of healthcare expenditures improved mortality predictions the most, also exhibiting the highest clinical benefit among the rest of the models. ConclusionTemporal patterns of medical spending have the potential to significantly improve our assessment on who is at high risk of dying after suffering spousal loss. The proposed methodology can assist in a more efficient risk profiling and prognosis of bereaved individuals.

Automated summary

This study investigated whether the temporal patterns of healthcare expenditures can improve predictive performance for mortality in bereaved older adults. The study found that the patterns of healthcare expenditures significantly improved mortality predictions and had greater clinical significance compared to other sociodemographic variables.