Title | Controlling for Frailty in Pharmacoepidemiologic Studies of Older Adults: Validation of an Existing Medicare Claims-based Algorithm. |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | Cuthbertson CC, Kucharska-Newton AMaria, Faurot KR, Sturmer T, Funk MJonsson, Palta P, B Windham G, Thai S |
Secondary Authors | Lund JL |
Journal | Epidemiology |
Volume | 29 |
Issue | 4 |
Pagination | 556-561 |
Date Published | 2018 07 |
ISSN | 1531-5487 |
Keywords | Activities of Daily Living, Aged, Aged, 80 and over, Algorithms, Comparative Effectiveness Research, Confounding Factors, Epidemiologic, Female, Frailty, Humans, Insurance Claim Review, Male, Medicare, Pharmacoepidemiology, United States |
Abstract | BACKGROUND: Frailty is a geriatric syndrome characterized by weakness and weight loss and is associated with adverse health outcomes. It is often an unmeasured confounder in pharmacoepidemiologic and comparative effectiveness studies using administrative claims data. METHODS: Among the Atherosclerosis Risk in Communities (ARIC) Study Visit 5 participants (2011-2013; n = 3,146), we conducted a validation study to compare a Medicare claims-based algorithm of dependency in activities of daily living (or dependency) developed as a proxy for frailty with a reference standard measure of phenotypic frailty. We applied the algorithm to the ARIC participants' claims data to generate a predicted probability of dependency. Using the claims-based algorithm, we estimated the C-statistic for predicting phenotypic frailty. We further categorized participants by their predicted probability of dependency ( RESULTS: The claims-based algorithm showed good discrimination of phenotypic frailty (C-statistic = 0.71; 95% confidence interval [CI] = 0.67, 0.74). Participants classified with a high predicted probability of dependency (≥20%) had higher prevalence of falls and difficulty in physical ability, and a greater risk of 1-year all-cause mortality (hazard ratio = 5.7 [95% CI = 2.5, 13]) than participants classified with a low predicted probability ( CONCLUSIONS: The Medicare claims-based algorithm showed good discrimination of phenotypic frailty and high predictive ability with adverse health outcomes. This algorithm can be used in future Medicare claims analyses to reduce confounding by frailty and improve study validity. |
DOI | 10.1097/EDE.0000000000000833 |
Alternate Journal | Epidemiology |
PubMed ID | 29621057 |
PubMed Central ID | PMC5980766 |
Grant List | K12 CA120780 / CA / NCI NIH HHS / United States HHSN268201100012C / HL / NHLBI NIH HHS / United States HHSN268201100009I / HL / NHLBI NIH HHS / United States UL1 TR001111 / TR / NCATS NIH HHS / United States HHSN268201100010C / HL / NHLBI NIH HHS / United States HHSN268201100008C / HL / NHLBI NIH HHS / United States HHSN268201100005G / HL / NHLBI NIH HHS / United States HHSN268201100008I / HL / NHLBI NIH HHS / United States HHSN268201100007C / HL / NHLBI NIH HHS / United States R01 HL118255 / HL / NHLBI NIH HHS / United States HHSN268201100011I / HL / NHLBI NIH HHS / United States HHSN268201100011C / HL / NHLBI NIH HHS / United States R01 AG023178 / AG / NIA NIH HHS / United States HHSN268201100006C / HL / NHLBI NIH HHS / United States HHSN268201100005I / HL / NHLBI NIH HHS / United States R21 HD080214 / HD / NICHD NIH HHS / United States R56 AG023178 / AG / NIA NIH HHS / United States HHSN268201100009C / HL / NHLBI NIH HHS / United States HHSN268201100005C / HL / NHLBI NIH HHS / United States R01 CA174453 / CA / NCI NIH HHS / United States HHSN268201100007I / HL / NHLBI NIH HHS / United States R01 AG056479 / AG / NIA NIH HHS / United States T32 HL007055 / HL / NHLBI NIH HHS / United States K99 AG052830 / AG / NIA NIH HHS / United States |