Dataset Information

Development and Validation of the Life Expectancy Estimator for Older Adults with Diabetes (LEAD): the Diabetes and Aging Study.

ABSTRACT:

Background

Estimated life expectancy for older patients with diabetes informs decisions about treatment goals, cancer screening, long-term and advanced care, and inclusion in clinical trials. Easily implementable, evidence-based, diabetes-specific approaches for identifying patients with limited life expectancy are needed.

Objective

Develop and validate an electronic health record (EHR)-based tool to identify older adults with diabetes who have limited life expectancy.

Design

Predictive modeling based on survival analysis using Cox-Gompertz models in a retrospective cohort.

Participants

Adults with diabetes aged ≥ 65 years from Kaiser Permanente Northern California: a 2015 cohort (N = 121,396) with follow-up through 12/31/2019, randomly split into training (N = 97,085) and test (N = 24,311) sets. Validation was conducted in the test set and two temporally distinct cohorts: a 2010 cohort (n = 89,563; 10-year follow-up through 2019) and a 2019 cohort (n = 152,357; 2-year follow-up through 2020).

Main measures

Demographics, diagnoses, utilization and procedures, medications, behaviors and vital signs; mortality.

Key results

In the training set (mean age 75 years; 49% women; 48% racial and ethnic minorities), 23% died during 5 years follow-up. A mortality prediction model was developed using 94 candidate variables, distilled into a life expectancy model with 11 input variables, and transformed into a risk-scoring tool, the Life Expectancy Estimator for Older Adults with Diabetes (LEAD). LEAD discriminated well in the test set (C-statistic = 0.78), 2010 cohort (C-statistic = 0.74), and 2019 cohort (C-statistic = 0.81); comparisons of observed and predicted survival curves indicated good calibration.

Conclusions

LEAD estimates life expectancy in older adults with diabetes based on only 11 patient characteristics widely available in most EHRs and claims data. LEAD is simple and has potential application for shared decision-making, clinical trial inclusion, and resource allocation.

SUBMITTER: Karter AJ

PROVIDER: S-EPMC10228886 | biostudies-literature | 2023 Oct

REPOSITORIES: biostudies-literature

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Publications

Development and Validation of the Life Expectancy Estimator for Older Adults with Diabetes (LEAD): the Diabetes and Aging Study.

Karter Andrew J AJ Parker Melissa M MM Moffet Howard H HH Lipska Kasia J KJ Laiteerapong Neda N Grant Richard W RW Lee Catherine C Huang Elbert S ES

Journal of general internal medicine 20230530 13

<h4>Background</h4>Estimated life expectancy for older patients with diabetes informs decisions about treatment goals, cancer screening, long-term and advanced care, and inclusion in clinical trials. Easily implementable, evidence-based, diabetes-specific approaches for identifying patients with limited life expectancy are needed.<h4>Objective</h4>Develop and validate an electronic health record (EHR)-based tool to identify older adults with diabetes who have limited life expectancy.<h4>Design</ ...[more]

PMID: 37254010

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Project description:BackgroundAs populations are aging, the number of older patients with multiple chronic diseases demanding complex care increases. Although clinical guidelines recommend care to be personalized accounting for life expectancy, there are no tools to estimate life expectancy among multimorbid patients. Our objective was therefore to develop and internally validate a life expectancy estimator specifically for older multimorbid adults.MethodsWe analyzed data from the OPERAM (OPtimising thERapy to prevent avoidable hospital admissions in multimorbid older people) study in Bern, Switzerland. Participants aged 70 years old or more with multimorbidity (3 or more chronic medical conditions) and polypharmacy (use of 5 drugs or more for > 30 days) were included. All-cause mortality was assessed during 3 years of follow-up. We built a 3-year mortality prognostic index and transformed this index into a life expectancy estimator. Mortality risk candidate predictors included demographic variables (age, sex), clinical characteristics (metastatic cancer, number of drugs, body mass index, weight loss), smoking, functional status variables (Barthel-Index, falls, nursing home residence), and hospitalization. We internally validated and optimism corrected the model using bootstrapping techniques. We transformed the mortality prognostic index into a life expectancy estimator using the Gompertz survival function.ResultsEight hundred five participants were included in the analysis. During 3 years of follow-up, 292 participants (36%) died. Age, metastatic cancer, number of drugs, lower body mass index, weight loss, number of hospitalizations, and lower Barthel-Index (functional impairment) were selected as predictors in the final multivariable model. Our model showed moderate discrimination with an optimism-corrected C statistic of 0.70. The optimism-corrected calibration slope was 0.96. The Gompertz-predicted mean life expectancy in our sample was 5.4 years (standard deviation 3.5 years). Categorization into three life expectancy groups led to visually good separation in Kaplan-Meier curves. We also developed a web application that calculates an individual's life expectancy estimation.ConclusionA life expectancy estimator for multimorbid older adults based on an internally validated 3-year mortality risk index was developed. Further validation of the score among various populations of multimorbid patients is needed before its implementation into practice.Trial registrationClinicalTrials.gov NCT02986425. First submitted 21/10/2016. First posted 08/12/2016.

Project description:BackgroundOlder multimorbid adults have a high risk of mortality and a short life expectancy (LE). Providing high-value care and avoiding care overuse, including of preventive care, is a serious challenge among multimorbid patients. While guidelines recommend to tailor preventive care according to the estimated LE, there is no tool to estimate LE in this specific population. Our objective is therefore to develop an LE estimator for older multimorbid adults by transforming a mortality prognostic index, which will be developed and internally validated in a prospective cohort.Methods and analysisWe will analyse data of the Optimising Therapy to Prevent Avoidable Hospital Admissions in Multimorbid Older People cohort study in Bern, Switzerland. 822 participants were included at hospitalisation with age of 70 years or older, multimorbidity (three or more chronic medical conditions) and polypharmacy (use of five drugs or more for >30 days). All-cause mortality will be assessed during 3 years of follow-up. We will apply a flexible parametric survival model with backward stepwise selection to identify the mortality risk predictors. The model will be internally validated using bootstrapping techniques. We will derive a point-based risk score from the regression coefficients. We will transform the 3-year mortality prognostic index into an LE estimator using the Gompertz survival function. We will perform a qualitative assessment of the clinical usability of the LE estimator and its application. We will conduct the development and validation of the mortality prognostic index following the Prognosis Research Strategy (PROGRESS) framework and report it following the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) statement.Ethics and disseminationWritten informed consent by patients themselves or, in the case of cognitive impairment, by a legal representative, was required before enrolment. The local ethics committee (Kantonale Ethikkommission Bern) has approved the study. We plan to publish the results in peer-reviewed journals and present them at national and international conferences.

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Dataset Information

Development and Validation of the Life Expectancy Estimator for Older Adults with Diabetes (LEAD): the Diabetes and Aging Study.

Background

Objective

Design

Participants

Main measures

Key results

Conclusions

Publications

Development and Validation of the Life Expectancy Estimator for Older Adults with Diabetes (LEAD): the Diabetes and Aging Study.

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