Multimorbidity and Mental Health‐Related Quality of Life and Risk of Completed Suicide

Luster

Chan

et al. 2020

BMC Health Serv Res

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Background: Quantifying the burden of multimorbidity for healthcare research using administrative data has been constrained. Existing measures incompletely capture chronic conditions of relevance and are narrowly focused on risk-adjustment for mortality, healthcare cost or utilization. Moreover, the measures have not undergone a rigorous review for how accurately the components, specifically the International Classification of Diseases, Ninth Revision (ICD-9) codes, represent the chronic conditions that comprise the measures. We performed a comprehensive, structured literature review of research studies on the accuracy of ICD-9 codes validated using external sources across an inventory of 81 chronic conditions. The conditions as a weighted measure set have previously been demonstrated to impact not only mortality but also physical and mental health-related quality of life. Methods: For each of 81 conditions we performed a structured literature search with the goal to identify 1) studies that externally validate ICD-9 codes mapped to each chronic condition against an external source of data, and 2) the accuracy of ICD-9 codes reported in the identified validation studies. The primary measure of accuracy was the positive predictive value (PPV). We also reported negative predictive value (NPV), sensitivity, specificity, and kappa statistics when available. We searched PubMed and Google Scholar for studies published before June 2019. Results: We identified studies with validation statistics of ICD-9 codes for 51 (64%) of 81 conditions. Most of the studies (47/51 or 92%) used medical chart review as the external reference standard. Of the validated using medical chart review, the median (range) of mean PPVs was 85% (39-100%) and NPVs was 91% (41-100%). Most conditions had at least one validation study reporting PPV ≥70%. Conclusions: To help facilitate the use of patient-centered measures of multimorbidity in administrative data, this review provides the accuracy of ICD-9 codes for chronic conditions that impact a universally valued patientcentered outcome: health-related quality of life. These findings will assist health services studies that measure chronic disease burden and risk-adjust for comorbidity and multimorbidity using patient-centered outcomes in administrative data.

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confidence: 99%

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Comprehensive review of ICD-9 code accuracies to measure multimorbidity in administrative data

Luster

Chan

et al. 2020

BMC Health Serv Res

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“…Multimorbidity is associated with higher rates of adverse outcomes including worse physical functioning, health-related quality of life, disability, and mortality (6)(7)(8)(9). However, less is known about its association with cognitive functioning and rate of cognitive decline over time as multimorbidity persists or worsens.…”

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confidence: 99%

Multimorbidity and Cognitive Decline Over 14 Years in Older Americans

The Journals of Gerontology: Series A

Levine

Zahodne

et al. 2019

Background Multimorbidity is associated with greater disability and accelerated declines in physical functioning over time in older adults. However, less is known about its effect on cognitive decline. Methods Participants without dementia from the Health and Retirement Study were interviewed about physician-diagnosed conditions, from which their multimorbidity-weighted index (MWI) that weights diseases to physical functioning was computed. We used linear mixed-effects models to examine the predictor MWI with the modified Telephone Interview for Cognitive Status (TICSm, global cognition), 10-word immediate recall and delayed recall, and serial 7s outcomes biennially after adjusting for baseline cognition and covariates. Results Fourteen thousand two hundred sixty-five participants, 60% female, contributed 73,700 observations. Participants had a mean ± SD age 67 ± 9.3 years and MWI 4.4 ± 3.9 at baseline. Each point increase in MWI was associated with declines in global cognition (0.04, 95% CI: 0.03–0.04 TICSm), immediate recall (0.01, 95% CI: 0.01–0.02 words), delayed recall (0.01, 95% CI: 0.01–0.02 words), and working memory (0.01, 95% CI: 0.01–0.02 serial 7s; all p < .001). Multimorbidity was associated with faster declines in global cognition (0.003 points/year faster, 95% CI: 0.002–0.004), immediate recall (0.001 words/year faster, 95% CI: 0.001–0.002), and working memory (0.006 incorrect serial 7s/year faster, 95% CI: 0.004–0.009; all p < .001), but not delayed recall compared with premorbid slopes. Conclusions Multimorbidity using a validated index weighted to physical functioning was associated with acute decline in cognition and accelerated and persistent cognitive decline over 14 years. This study supports an ongoing geriatric syndrome of coexisting physical and cognitive impairment in adults with multimorbidity. Clinicians should monitor and address both domains in older multimorbid adults.

“…Importantly, MWI captured both the low and high extremes of multimorbidity better than other measures of multimorbidity and provided a better model fit and generally stronger associations with mortality and future physical functioning . MWI is also associated with physical and cognitive performance, limitations performing both basic and instrumental activities of daily living, HRQOL, and future physical functioning and mortality using a joint analysis …”

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confidence: 99%

Multimorbidity in Medicare Beneficiaries: Performance of an ICD‐Coded Multimorbidity‐Weighted Index

J American Geriatrics Society

Ratz

Mukamal

2020

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OBJECTIVES: Most older adults have multimorbidity that impairs physical functioning, but it is difficult to quantify using claims data. We previously developed and validated a multimorbidity-weighted index (MWI) that embeds physical functioning through disease weightings. We mapped these conditions to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and compared them with existing indices. DESIGN: Population-based prospective cohort. SETTING: Respondents to the 2006-2016 waves of the Health and Retirement Study (HRS) with linked Medicare claims data and continuous enrollment in 2006. PARTICIPANTS: Community-dwelling Medicare-eligible HRS participants (N = 9923; mean age = 75.5 AE 8.5 y). MEASUREMENTS: Individuals were followed for future physical functioning (2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014) and mortality (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016). MWI conditions were mapped to ICD-9-CM codes to produce an ICD-coded MWI (MWI-ICD). We compared MWI-ICD, simple disease count, Charlson, Elixhauser, and the healthrelated quality of life comorbidity index (HRQOL-CI) through distributions, hazard ratios for mortality, and relationships with future physical functioning. RESULTS: MWI-ICD exhibited the broadest distribution and most unique values (5891). Left censoring was most pronounced for Charlson (34.3% score = 0) and Elixhauser (13.1% score = 0) vs MWI (5.0% score = 0). Hazard ratios and concordance (C)-statistics for mortality across extreme quartiles were similar for MWI-ICD, Elixhauser, and Charlson but lower for disease count and the HRQOL-CI. For physical functioning, MWI-ICD yielded the greatest contrast across extreme quartiles and overall coefficient of determination (R 2 ). CONCLUSION: MWI-ICD was significantly associated with mortality and future physical functioning and comparable with established metrics for mortality prediction although not weighted to mortality. MWI-ICD successfully captures diseases accumulation and functioning in claims data. J Am Geriatr Soc 68:999-1006, 2020.