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Updated: Apr 29, 2026
Genotypic Inference of HIV-1 Tropism Using Population-based Sequencing of V3
Published on: December 27, 2010
Comparison of comorbidity classification methods for predicting outcomes in a population-based cohort of adults with
Tony Antoniou1, Ryan Ng2, Richard H Glazier3
1Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada; The Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Insights
For human immunodeficiency virus (HIV) patients, the Aggregated Diagnosis Groups (ADGs) and Charlson/Elixhauser indices similarly predict 1-year mortality. However, poor calibration limits clinical use for all models.
Area of Science:
- Medical Informatics
- Public Health
- Epidemiology
Background:
- Comorbidity indices are crucial for predicting outcomes in human immunodeficiency virus (HIV) patients.
- Existing indices like Charlson and Elixhauser are widely used but may not fully capture the complexity of comorbidity in HIV.
- The John's Hopkins' Aggregated Diagnosis Groups (ADGs) offer a potentially more comprehensive approach using integrated health records.
Purpose of the Study:
- To compare the predictive performance of the Aggregated Diagnosis Groups (ADGs) against the Charlson and Elixhauser comorbidity indices.
- To evaluate these indices in predicting mortality and hospital admission in a large cohort of HIV-infected patients.
- To assess the clinical utility of different comorbidity measurement methods in HIV care.
Main Methods:
- A cohort of 14,313 HIV-infected adults in Ontario, Canada, was identified using a validated algorithm.
- The dataset was randomly divided into derivation and validation samples 100 times to ensure robust evaluation.
- Primary outcome: all-cause mortality within 1 year; Secondary outcomes: hospital admission and all-cause mortality within 1-2 years.
Main Results:
- ADGs, Elixhauser, and Charlson indices showed comparable discrimination for 1-year mortality (median c-statistics: 0.785, 0.767, 0.788).
- The ADG method demonstrated superior discrimination for predicting hospital admission compared to Elixhauser and Charlson (median c-statistics: 0.727 vs. 0.678 and 0.668).
- All evaluated methods exhibited poor calibration across all outcome predictions, limiting their precise application.
Conclusions:
- The ADG, Charlson, and Elixhauser methods demonstrate comparable effectiveness in predicting 1-year mortality for HIV patients.
- Predictive accuracy for longer-term outcomes (1-2 years) and hospital admissions varied, with ADGs showing an advantage for the latter.
- Significant calibration issues across all models restrict their reliable use in provider profiling and direct clinical decision-making for HIV management.
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.
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