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Comorbidity-adjusted life expectancy: a new tool to inform recommendations for optimal screening strategies.
Ann Intern Med. 2013 Nov 19; 159(10):667-76.AIM

Abstract

BACKGROUND

Many guidelines recommend considering health status and life expectancy when making cancer screening decisions for elderly persons.

OBJECTIVE

To estimate life expectancy for elderly persons without a history of cancer, taking into account comorbid conditions.

DESIGN

Population-based cohort study.

SETTING

A 5% sample of Medicare beneficiaries in selected geographic areas, including their claims and vital status information.

PARTICIPANTS

Medicare beneficiaries aged 66 years or older between 1992 and 2005 without a history of cancer (n = 407 749).

MEASUREMENTS

Medicare claims were used to identify comorbid conditions included in the Charlson index. Survival probabilities were estimated by comorbidity group (no, low/medium, and high) and for the 3 most prevalent conditions (diabetes, chronic obstructive pulmonary disease, and congestive heart failure) by using the Cox proportional hazards model. Comorbidity-adjusted life expectancy was calculated based on comparisons of survival models with U.S. life tables. Survival probabilities from the U.S. life tables providing the most similar survival experience to the cohort of interest were used.

RESULTS

Persons with higher levels of comorbidity had shorter life expectancies, whereas those with no comorbid conditions, including very elderly persons, had favorable life expectancies relative to an average person of the same chronological age. The estimated life expectancy at age 75 years was approximately 3 years longer for persons with no comorbid conditions and approximately 3 years shorter for those with high comorbidity relative to the average U.S. population.

LIMITATIONS

The cohort was limited to Medicare fee-for-service beneficiaries aged 66 years or older living in selected geographic areas. Data from the Surveillance, Epidemiology, and End Results cancer registry and Medicare claims lack information on functional status and severity of comorbidity, which might influence life expectancy in elderly persons.

CONCLUSION

Life expectancy varies considerably by comorbidity status in elderly persons. Comorbidity-adjusted life expectancy may help physicians tailor recommendations for stopping or continuing cancer screening for individual patients.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24247672

Citation

Cho, Hyunsoon, et al. "Comorbidity-adjusted Life Expectancy: a New Tool to Inform Recommendations for Optimal Screening Strategies." Annals of Internal Medicine, vol. 159, no. 10, 2013, pp. 667-76.
Cho H, Klabunde CN, Yabroff KR, et al. Comorbidity-adjusted life expectancy: a new tool to inform recommendations for optimal screening strategies. Ann Intern Med. 2013;159(10):667-76.
Cho, H., Klabunde, C. N., Yabroff, K. R., Wang, Z., Meekins, A., Lansdorp-Vogelaar, I., & Mariotto, A. B. (2013). Comorbidity-adjusted life expectancy: a new tool to inform recommendations for optimal screening strategies. Annals of Internal Medicine, 159(10), 667-76. https://doi.org/10.7326/0003-4819-159-10-201311190-00005
Cho H, et al. Comorbidity-adjusted Life Expectancy: a New Tool to Inform Recommendations for Optimal Screening Strategies. Ann Intern Med. 2013 Nov 19;159(10):667-76. PubMed PMID: 24247672.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comorbidity-adjusted life expectancy: a new tool to inform recommendations for optimal screening strategies. AU - Cho,Hyunsoon, AU - Klabunde,Carrie N, AU - Yabroff,K Robin, AU - Wang,Zhuoqiao, AU - Meekins,Angela, AU - Lansdorp-Vogelaar,Iris, AU - Mariotto,Angela B, PY - 2013/11/20/entrez PY - 2013/11/20/pubmed PY - 2014/1/28/medline SP - 667 EP - 76 JF - Annals of internal medicine JO - Ann Intern Med VL - 159 IS - 10 N2 - BACKGROUND: Many guidelines recommend considering health status and life expectancy when making cancer screening decisions for elderly persons. OBJECTIVE: To estimate life expectancy for elderly persons without a history of cancer, taking into account comorbid conditions. DESIGN: Population-based cohort study. SETTING: A 5% sample of Medicare beneficiaries in selected geographic areas, including their claims and vital status information. PARTICIPANTS: Medicare beneficiaries aged 66 years or older between 1992 and 2005 without a history of cancer (n = 407 749). MEASUREMENTS: Medicare claims were used to identify comorbid conditions included in the Charlson index. Survival probabilities were estimated by comorbidity group (no, low/medium, and high) and for the 3 most prevalent conditions (diabetes, chronic obstructive pulmonary disease, and congestive heart failure) by using the Cox proportional hazards model. Comorbidity-adjusted life expectancy was calculated based on comparisons of survival models with U.S. life tables. Survival probabilities from the U.S. life tables providing the most similar survival experience to the cohort of interest were used. RESULTS: Persons with higher levels of comorbidity had shorter life expectancies, whereas those with no comorbid conditions, including very elderly persons, had favorable life expectancies relative to an average person of the same chronological age. The estimated life expectancy at age 75 years was approximately 3 years longer for persons with no comorbid conditions and approximately 3 years shorter for those with high comorbidity relative to the average U.S. population. LIMITATIONS: The cohort was limited to Medicare fee-for-service beneficiaries aged 66 years or older living in selected geographic areas. Data from the Surveillance, Epidemiology, and End Results cancer registry and Medicare claims lack information on functional status and severity of comorbidity, which might influence life expectancy in elderly persons. CONCLUSION: Life expectancy varies considerably by comorbidity status in elderly persons. Comorbidity-adjusted life expectancy may help physicians tailor recommendations for stopping or continuing cancer screening for individual patients. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/24247672/Comorbidity_adjusted_life_expectancy:_a_new_tool_to_inform_recommendations_for_optimal_screening_strategies_ DB - PRIME DP - Unbound Medicine ER -