PMID- 31721394
OWN - NLM
STAT- MEDLINE
DCOM- 20210728
LR  - 20210728
IS  - 1365-2753 (Electronic)
IS  - 1356-1294 (Linking)
VI  - 26
IP  - 4
DP  - 2020 Aug
TI  - Optimizing the measurement of comorbidity for a South Australian colorectal 
      cancer population using administrative data.
PG  - 1250-1258
LID - 10.1111/jep.13305 [doi]
AB  - RATIONALE AND OBJECTIVES: In epidemiological research, it is essential to account 
      for the confounding effects of factors such as age, stage, and comorbidity for 
      accurate prediction of cancer outcomes. There are several internationally 
      developed and commonly used comorbidity indices. However, none are regarded as 
      the gold-standard method. This study will assess and compare the predictive 
      validity of established indices for use in a South Australian (SA) colorectal 
      cancer (CRC) population against a local index. Furthermore, the prognostic 
      influence of comorbidity on survival is investigated. METHODS: A population-based 
      study of patients diagnosed with CRC from 2003 to 2012 and linked to in-hospital 
      data to retrieve comorbidity information was conducted. The predictive 
      performance of established indices, Charlson comorbidity index (CCI), National 
      Cancer Institute comorbidity index (NCI), Elixhauser comorbidity index (ECI), and 
      C3 index was evaluated using the Fine and Gray competing risk regression and 
      reported using measures of calibration and discrimination, area under the curve 
      (AUC), and Brier score. Furthermore, to identify the optimal index, a local CRC 
      comorbidity index (CRCCI) was also developed and its performance compared with 
      the established indices. RESULTS: Comorbidity models adjusted for age, sex, and 
      stage showed that all indices were good predictors of mortality as measured by 
      the AUC (CCI: 0.738, NCI: 0.742, ECI: 0.733, C3: 0.739). CRCCI had similar 
      mortality prediction as established indices (CRCCI: 0.747). There was a 
      significant increase in cumulative risk of noncancer and CRC-specific mortality 
      with increase in comorbidity scores. The two most prevalent comorbidities were 
      hypertension and diabetes. CONCLUSIONS: The existing indices are still valid for 
      adjusting for comorbidity and accurately predicting mortality in an SA CRC 
      population. Internationally developed indices are preferred when policymakers and 
      researchers wish to compare local study results with those of studies (national 
      and international) that have used these indices. Comorbidity is a predictor of 
      mortality and should be considered when assessing CRC survival.
CI  - (c) 2019 John Wiley & Sons, Ltd.
FAU - Pule, Lettie
AU  - Pule L
AUID- ORCID: 0000-0001-6114-9317
AD  - Cancer Epidemiology and Population Health Research Group, University of South 
      Australia Cancer Research Institute, Adelaide, South Australia, Australia.
FAU - Buckley, Elizabeth
AU  - Buckley E
AUID- ORCID: 0000-0001-8980-1194
AD  - Cancer Epidemiology and Population Health Research Group, University of South 
      Australia Cancer Research Institute, Adelaide, South Australia, Australia.
FAU - Niyonsenga, Theo
AU  - Niyonsenga T
AD  - Cancer Epidemiology and Population Health Research Group, University of South 
      Australia Cancer Research Institute, Adelaide, South Australia, Australia.
AD  - Centre for Research and Action in Public Health, University of Canberra, 
      Canberra, Australian Capital Territory, Australia.
FAU - Roder, David
AU  - Roder D
AUID- ORCID: 0000-0001-6442-4409
AD  - Cancer Epidemiology and Population Health Research Group, University of South 
      Australia Cancer Research Institute, Adelaide, South Australia, Australia.
LA  - eng
GR  - Kate Powell and SA Clinical Cancer Registry/
GR  - South Australian Health Epidemiology Branch/
GR  - University of South Australia/
PT  - Journal Article
DEP - 20191113
PL  - England
TA  - J Eval Clin Pract
JT  - Journal of evaluation in clinical practice
JID - 9609066
SB  - IM
MH  - Australia
MH  - *Colorectal Neoplasms/epidemiology
MH  - Comorbidity
MH  - Humans
MH  - Prognosis
MH  - South Australia/epidemiology
OTO - NOTNLM
OT  - colorectal cancer
OT  - comorbidity
OT  - prediction models
OT  - survival
EDAT- 2019/11/14 06:00
MHDA- 2021/07/29 06:00
CRDT- 2019/11/14 06:00
PHST- 2019/03/15 00:00 [received]
PHST- 2019/09/11 00:00 [revised]
PHST- 2019/10/08 00:00 [accepted]
PHST- 2019/11/14 06:00 [pubmed]
PHST- 2021/07/29 06:00 [medline]
PHST- 2019/11/14 06:00 [entrez]
AID - 10.1111/jep.13305 [doi]
PST - ppublish
SO  - J Eval Clin Pract. 2020 Aug;26(4):1250-1258. doi: 10.1111/jep.13305. Epub 2019 
      Nov 13.