Journal
ANNALS OF EPIDEMIOLOGY
Volume 24, Issue 7, Pages 532-537Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.annepidem.2014.04.002
Keywords
Comorbidity; Databases; Factual; Diagnosis-related groups; Risk adjustment; HIV; Predictive value of tests; ROC curve; Logistic models
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Funding
- Institute for Clinical Evaluative Sciences (ICES)
- Ontario Ministry of Health and Long-Term Care
- Canadian Institutes of Health Research
- Ontario HIV Treatment Network
- Heart and Stroke Foundation
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Purpose: We compared the John's Hopkins' Aggregated Diagnosis Groups (ADGs), which are derived using inpatient and outpatient records, with the hospital record-derived Charlson and Elixhauser comorbidity indices for predicting outcomes in human immunodeficiency virus (HIV)-infected patients. Methods: We used a validated algorithm to identify HIV-infected adults (n = 14,313) in Ontario, Canada, and randomly divided the sample into derivation and validation samples 100 times. The primary outcome was all-cause mortality within 1 year, and secondary outcomes included hospital admission and all-cause mortality within 1-2 years. Results: The ADG, Elixhauser, and Charlson methods had comparable discriminative performance for predicting 1-year mortality, with median c-statistics of 0.785, 0.767, and 0.788, respectively, across the 100 validation samples. All methods had lower predictive accuracy for all-cause mortality within 1-2 years. For hospital admission, the ADG method had greater discriminative performance than either the Elixhauser or Charlson methods, with median c-statistics of 0.727, 0.678, and 0.668, respectively. All models displayed poor calibration for each outcome. Conclusions: In patients with HIV, the ADG, Charlson, and Elixhauser methods are comparable for predicting 1-year mortality. However, poor calibration limits the use of these methods for provider profiling and clinical application. (C) 2014 Elsevier Inc. All rights reserved.
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