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. 2008 Jan;14(1):15-23.

Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization

Bessie Ann Young  1 , Elizabeth Lin, Michael Von Korff, Greg Simon, Paul Ciechanowski, Evette J Ludman, Siobhan Everson-Stewart, Leslie Kinder, Malia Oliver, Edward J Boyko, Wayne J Katon
Affiliations

Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization

Bessie Ann Young et al. Am J Manag Care. 2008 Jan.

Abstract

Objective: To determine whether the number and severity of diabetes complications are associated with increased risk of mortality and hospitalizations.

Study design: Validation sample.

Methods: The Diabetes Complications Severity Index (DCSI) was developed from automated clinical baseline data of a primary care diabetes cohort and compared with a simple count of complications to predict mortality and hospitalizations. Cox proportional hazard and Poisson regression models were used to predict mortality and hospitalizations, respectively.

Results: Of 4229 respondents, 356 deaths occurred during 4 years of follow-up. Those with 1 complication did not have an increased risk of mortality, whereas those with 2 complications (hazard ratio [HR] = 1.90, 95% confidence interval [CI] = 1.27, 2.83), 3 complications (HR = 2.66, 95% CI = 1.77, 4.01), 4 complications (HR = 3.41, 95% CI = 2.18, 5.33), and >5 complications (HR = 7.18, 95% CI = 4.39, 11.74) had greater risk of death. Replacing the complications count with the DCSI showed a similar mortality risk. Each level of the continuous DCSI was associated with a 1.34-fold (95% CI = 1.28, 1.41) greater risk of death. Similar results were obtained for the association of the DCSI with risk of hospitalization. Comparison of receiver operating characteristic curves verified that the DCSI was a slightly better predictor of mortality than a count of complications (P < .0001).

Conclusion: Compared with the complications count, the DCSI performed slightly better and appears to be a useful tool for prediction of mortality and risk of hospitalization.

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Conflict of interest statement

Author Disclosures: The authors (BAY, EL, MVK, GS, PC, EJL, SE-S, LK, MO, EJB, WJK) report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Figures

Figure 1
Figure 1. Kaplan-Meier Survival Curves Stratified by Complications Count
Patients with a greater number of complications at baseline had worse mortality.
Figure 2
Figure 2. Receiver Operating Characteristic (ROC) Curves Comparing the Diabetes Complications Severity Index (DCSI) With the Complications Count
The AUC for the DCSI (0.76) was significantly different from the AUC for the complications count (0.74) (P <.0001). AUC indicates area under the curve.
See this image and copyright information in PMC

References

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    1. Von Korff M, Katon W, Lin EH, et al. Work disability among individuals with diabetes. Diabetes Care. 2005;28:1326–1332. - PubMed

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