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Validation study of Charlson Comorbidity Index in predicting mortality in Chinese older adults
Tuen-Ching Chan1, James Ka-Hay Luk, Leung-Wing Chu
1Department of Medicine and Geriatrics, Fung Yiu King Hospital, Hong Kong SAR, China; Division of Geriatric Medicine, Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Insights
The Charlson Comorbidity Index (CCI) effectively predicts 1-year mortality in Chinese older adults, showing a clear dose-response relationship. Comprehensive health assessments are also crucial for older adults.
Area of Science:
- Gerontology
- Public Health
- Epidemiology
Background:
- The Charlson Comorbidity Index (CCI) is widely used to predict mortality.
- However, its validation in Chinese older adults is lacking.
- This study addresses the need for localized validation of the CCI.
Purpose of the Study:
- To validate the Charlson Comorbidity Index (CCI) for predicting 1-year mortality in Chinese older adults.
- To assess the dose-response relationship between CCI scores and mortality risk.
Main Methods:
- Retrospective cohort study (2004-2013) of patients from a Hong Kong geriatric day hospital.
- Comorbidity quantified using CCI, with patients grouped by score (CCI-0 to CCI ≥ 5).
- 1-year mortality was the primary outcome measure, with demographic and functional data collected.
Main Results:
- A significant dose-response relationship was observed between CCI scores and 1-year mortality (P < 0.001).
- Higher CCI scores correlated with increased hazard ratios for mortality.
- The area under the receiver operating characteristic curve for CCI was 0.68, indicating moderate predictive accuracy.
Conclusions:
- The CCI is a valid tool for predicting 1-year mortality in Chinese older adults.
- A significant dose-response relationship exists between CCI and mortality risk.
- Functional, nutritional, and social assessments are vital for a holistic health evaluation.
Aim:
The Charlson Comorbidity Index (CCI) is commonly studied for predicting mortality, but there is no validation study of it in Chinese older adults. The objective of the present study was to validate the use of CCI in Chinese older adults for predicting mortality.
Method:
We carried out a retrospective cohort study from 2004 to 2013 for patients discharged from a geriatric day hospital in Hong Kong. Comorbidity was quantified using CCI, and patients were divided into six groups according to their score of CCI: CCI-0, CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5. Other data collected included demographics, and functional, nutritional, cognitive and social assessment. The outcome measure was 1-year mortality.
Results:
At 1-year follow up, 3.8% (n = 17), 5.9% (n = 37), 9.2% (n = 35), 12.9% (n = 20), 16.9% (n = 23) and 19.3% (n = 60) of CCI-0, CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5 died, respectively (P < 0.001). Multivariate analysis showed that CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5 have a hazard ratio (HR) of 1.34 (confidence interval [CI] 1.04-2.12), 2.18 (CI 1.03-4.61), 3.44 (CI 1.52-7.81), 3.74 (CI 1.35-10.39) and 4.63 (CI 2.28-9.43), respectively, compared with CCI-0. The area under the curve of the receiver operating characteristic curves of CCI in predicting 1-year mortality for older adults was 0.68 (CI 0.64-0.72).
Conclusion:
There is a significant dose-response relationship in the hazard ratio between CCI and 1-year mortality in Chinese older adults, but involvements of functional, nutritional and social assessments are important for comprehensive quantification of health status in older adults.
