Adapting the Elixhauser comorbidity index for cancer patients

Hemalkumar Mehta, Sneha D. Sura, Deepak Adhikari, Clark R. Andersen, Stephen Williams, Anthony J. Senagore, Yong Fang Kuo, James Goodwin

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

BACKGROUND: This study was designed to adapt the Elixhauser comorbidity index for 4 cancer-specific populations (breast, prostate, lung, and colorectal) and compare 3 versions of the Elixhauser comorbidity score (individual comorbidities, summary comorbidity score, and cancer-specific summary comorbidity score) with 3 versions of the Charlson comorbidity score for predicting 2-year survival with 4 types of cancer. METHODS: This cohort study used Texas Cancer Registry–linked Medicare data from 2005 to 2011 for older patients diagnosed with breast (n = 19,082), prostate (n = 23,044), lung (n = 26,047), or colorectal cancer (n = 16,693). For each cancer cohort, the data were split into training and validation cohorts. In the training cohort, competing risk regression was used to model the association of Elixhauser comorbidities with 2-year noncancer mortality, and cancer-specific weights were derived for each comorbidity. In the validation cohort, competing risk regression was used to compare 3 versions of the Elixhauser comorbidity score with 3 versions of the Charlson comorbidity score. Model performance was evaluated with c statistics. RESULTS: The 2-year noncancer mortality rates were 14.5% (lung cancer), 11.5% (colorectal cancer), 5.7% (breast cancer), and 4.1% (prostate cancer). Cancer-specific Elixhauser comorbidity scores (c = 0.773 for breast cancer, c = 0.772 for prostate cancer, c = 0.579 for lung cancer, and c = 0.680 for colorectal cancer) performed slightly better than cancer-specific Charlson comorbidity scores (ie, the National Cancer Institute combined index; c = 0.762 for breast cancer, c = 0.767 for prostate cancer, c = 0.578 for lung cancer, and c = 0.674 for colorectal cancer). Individual Elixhauser comorbidities performed best (c = 0.779 for breast cancer, c = 0.783 for prostate cancer, c = 0.587 for lung cancer, and c = 0.687 for colorectal cancer). CONCLUSIONS: The cancer-specific Elixhauser comorbidity score performed as well as or slightly better than the cancer-specific Charlson comorbidity score in predicting 2-year survival. If the sample size permits, using individual Elixhauser comorbidities may be the best way to control for confounding in cancer outcomes research. Cancer 2018;124:2018-25.

Original languageEnglish (US)
Pages (from-to)2018-2025
Number of pages8
JournalCancer
Volume124
Issue number9
DOIs
StatePublished - May 1 2018

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Keywords

  • Charlson comorbidity score
  • comorbidity
  • confounding control
  • Elixhauser comorbidity score
  • National Cancer Institute combined index

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Mehta, H., Sura, S. D., Adhikari, D., Andersen, C. R., Williams, S., Senagore, A. J., Kuo, Y. F., & Goodwin, J. (2018). Adapting the Elixhauser comorbidity index for cancer patients. Cancer, 124(9), 2018-2025. https://doi.org/10.1002/cncr.31269