Development of a Claims-based Frailty Indicator Anchored to a Well-established Frailty Phenotype

Abstract

Background: Fried and colleagues described a frailty phenotype measured in the Cardiovascular Health Study (CHS). This phenotype is manifest when ≥3 of the following are present: low grip strength, low energy, slowed waking speed, low physical activity, or unintentional weight loss. We sought to approximate frailty phenotype using only administrative claims data to enable frailty to be assessed without physical performance measures.

Study design: We used the CHS cohort data linked to participants Medicare claims. The reference standard was the frailty phenotype measured at visits 5 and 9. With penalized logistic regression, we developed a parsimonious index for predicting the frailty phenotype using a linear combination of diagnoses, operationalized with claims data. We assessed the predictive validity of frailty index by examining how well it predicted common aging-related outcomes including hospitalization, disability, and death.

Results: There were 4454 CHS participants from 4 clinical sites. In total, 84% were white, 58% were women and their mean age was 72 years at enrollment. Approximately 11% of the cohort was frail. The model had an area under the receiver operating curve of 0.75 to concurrently predict a frailty phenotype. This Claims-based Frailty Indicator significantly predicted death (odds ratio, 1.84), time to death (hazards ratio, 1.71), number of hospital admissions (incidence rate ratio, 1.74), and nursing home admission (odds ratio, 1.47) in models adjusted for age and sex.

Conclusions: Claims data alone can be used to classify individuals as frail and nonfrail. The Claims-based Frailty Indicator might be used in research with large datasets for confounding adjustment or risk prediction. The indicator might also be used for emergency preparedness for identification of regions enriched with frail individuals.

Figure 1

Receiver Operator Curve for Claims-based Frailty Index

Figure 2

Percentage of Individuals with Inpatient Visits as Classified by Claims-based Frailty Index with a Cutoff of 0.20 Light boxes represent percentages of frail individuals. Dark boxes represents percentages of non-frail individuals. *p-value <0.05

Figure 3

Figure 3a. Comparison of Outcomes Prediction by Claims-based Frailty Index with a Cutoff of 0.20 and Measured Frailty Phenotype, Unadjusted Models Light diamond represents odds ratio or hazards ratio with Claims-based Frailty Index. Dark circle represents odds ratio or hazards ratio with Frailty Phenotype. Confidence bars are 95% confidence intervals around estimates of odds ratio or hazards ratio. Figure 3b. Comparison of Outcomes Prediction by Claims-based Frailty Index with a Cutoff of 0.20 and Measured Frailty Phenotype, Models Adjusted for Age and Sex Light diamond represents odds ratio or hazards ratio with Claims-based Frailty Index. Dark circle represents odds ratio or hazards ratio with Frailty Phenotype. Confidence bars are 95% confidence intervals around estimates of odds ratio or hazards ratio.

Figure 3

Figure 3a. Comparison of Outcomes Prediction by Claims-based Frailty Index with a Cutoff of 0.20 and Measured Frailty Phenotype, Unadjusted Models Light diamond represents odds ratio or hazards ratio with Claims-based Frailty Index. Dark circle represents odds ratio or hazards ratio with Frailty Phenotype. Confidence bars are 95% confidence intervals around estimates of odds ratio or hazards ratio. Figure 3b. Comparison of Outcomes Prediction by Claims-based Frailty Index with a Cutoff of 0.20 and Measured Frailty Phenotype, Models Adjusted for Age and Sex Light diamond represents odds ratio or hazards ratio with Claims-based Frailty Index. Dark circle represents odds ratio or hazards ratio with Frailty Phenotype. Confidence bars are 95% confidence intervals around estimates of odds ratio or hazards ratio.