Development and Validation of a Pediatric Comorbidity Index. Issue 5 (30th October 2020)

• Record Type: Journal Article
• Authors: Sun, Jenny W; Bourgeois, Florence T; Haneuse, Sebastien; Hernández-Díaz, Sonia; Landon, Joan E; Bateman, Brian T; Huybrechts, Krista F
• Is Part Of: American journal of epidemiology. Volume 190:Issue 5(2021)
• Page Start: 918
• Page End: 927
• Publication Date: 2020-10-30
• Subjects: claims data -- comorbidity -- confounding -- health services research -- pediatrics -- pharmacoepidemiology -- risk adjustment; Epidemiology -- Periodicals; Public health -- Periodicals; 614.4
• DOI: 10.1093/aje/kwaa244
• Languages: English
• ISSNs: 0002-9262

Abstract

Abstract: Comorbidity scores are widely used to help address confounding bias in nonrandomized studies conducted within health-care databases, but existing scores were developed to predict all-cause mortality in adults and might not be appropriate for use in pediatric studies. We developed and validated a pediatric comorbidity index, using health-care utilization data from the tenth revision of the International Classification of Diseases . Within the MarketScan database of US commercial claims data, pediatric patients (aged ≤18 years) continuously enrolled between October 1, 2015, and September 30, 2017, were identified. Logistic regression was used to predict the 1-year risk of hospitalization based on 27 predefined conditions and empirically identified conditions derived from the most prevalent diagnoses among patients with the outcome. A single numerical index was created by assigning weights to each condition based on its β coefficient. We conducted internal validation of the index and compared its performance with existing adult scores. The pediatric comorbidity index consisted of 24 conditions and achieved a C statistic of 0.718 (95% confidence interval (CI): 0.714, 0.723). The index outperformed existing adult scores in a pediatric population ( C statistics ranging from 0.522 to 0.640). The pediatric comorbidity index provides a summary measure of disease burden and can be used for risk adjustment in epidemiologic studies of pediatric patients.