Author(s): Young BA, Lin E, Von Korff M, Simon G, Ciechanowski P,
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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.
This article was published in Am J Manag Care
and referenced in Internal Medicine: Open Access