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Index to Predict 5-Year Mortality of Community-Dwelling Adults Aged 65 and Older Using Data from the National Health Interview Survey

Journal of General Internal Medicine volume 24, Article number: 1115 (2009) Cite this article

Abstract

BACKGROUND

Prognostic information is becoming increasingly important for clinical decision-making.

OBJECTIVE

To develop and validate an index to predict 5-year mortality among community-dwelling older adults.

DESIGN AND PARTICIPANTS

A total of 24,115 individuals aged >65 who responded to the 1997-2000 National Health Interview Survey (NHIS) with follow-up through 31 December 2002 from the National Death Index; 16,077 were randomly selected for the development cohort and 8,038 for the validation cohort.

MEASUREMENTS

39 risk factors (functional measures, illnesses, behaviors, demographics) were included in a multivariable Cox proportional hazards model to determine factors independently associated with mortality. Risk scores were calculated for participants using points derived from the final model’s beta coefficients. To evaluate external validity, we compared survival by quintile of risk between the development and validation cohorts.

RESULTS

Seventeen percent of participants had died by the end of the study. The final model included 11 variables: age (1 point for 70-74 up to 7 points for >85); male: 3 points; BMI <25: 2 points; perceived health (good: 1 point, fair/poor: 2 points); emphysema: 2 points; cancer: 2 points; diabetes: 2 points; dependent in instrumental activities of daily living: 2 points; difficulty walking: 3 points; smoker-former: 1 point, smoker-current: 3 points; past year hospitalizations-one: 1 point, >2: 3 points. We observed close agreement between 5-year mortality in the two cohorts; which ranged from 5% in the lowest risk quintile to 50% in the highest risk quintile in the validation cohort.

CONCLUSIONS

This validated mortality index can be used to account for participant life expectancy in analyses using NHIS data.

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Acknowledgements

We would like to thank Long Ngo, PhD, from the Division of General Medicine and Primary Care, Department of Medicine, at Beth Israel Deaconess Medical Center and Harvard Medical School for his help in discussions of the analysis plan. Dr. Mara Schonberg was supported by a National Institute on Aging K23 award (K23AG028584).

Conflict of Interest Statement

None disclosed.

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Authors and Affiliations

  1. Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, 1309 Beacon, Office 202, Brookline, Boston, MA, USA

    Mara A. Schonberg MD, MPH, Roger B. Davis ScD, Ellen P. McCarthy PhD, MPH & Edward R. Marcantonio MD, SM

Authors
  1. Mara A. Schonberg MD, MPH
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  2. Roger B. Davis ScD
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  3. Ellen P. McCarthy PhD, MPH
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  4. Edward R. Marcantonio MD, SM
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Corresponding author

Correspondence to Mara A. Schonberg MD, MPH.

Appendix

Appendix

Five-year Mortality Index for Adults Aged 65 and Older.

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Schonberg, M.A., Davis, R.B., McCarthy, E.P. et al. Index to Predict 5-Year Mortality of Community-Dwelling Adults Aged 65 and Older Using Data from the National Health Interview Survey. J GEN INTERN MED 24, 1115 (2009). https://doi.org/10.1007/s11606-009-1073-y

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  • DOI: https://doi.org/10.1007/s11606-009-1073-y

KEY WORDS

  • mortality prediction
  • life expectancy
  • prevention
  • older adults