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Cao X, Li R, Tang W, Wang W, Ji J, Yin C, Niu L, Gao Y, Ma Q. How health risk factors affect inpatient costs among adults with stroke in China: the mediating role of length of stay. BMC Geriatr 2024; 24:131. [PMID: 38373895 PMCID: PMC10877923 DOI: 10.1186/s12877-024-04656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND As stroke has become the leading cause of death and disability in China, it has induced a heavy disease burden on society, families, and patients. Despite much attention within the literature, the effect of multiple risk factors on length of stay (LOS) and inpatient costs in China is still not fully understood. AIM To analyse the association between the number of risk factors combined and inpatient costs among adults with stroke and explore the mediating effect of LOS on inpatient costs. METHODS A retrospective cross-sectional study was conducted among stroke patients in a tertiary hospital in Nantong City from January 2018 to December 2019. Lifestyle factors (smoking status, exercise), personal disease history (overweight, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation), family history of stroke, and demographic characteristics were interviewed by trained nurses. Inpatient costs and LOS were extracted from electronic medical records. Hierarchical multiple linear regression models and mediation analysis were used to examine the direct and indirect effects of the number of risk factors combined for stroke on inpatient costs. RESULTS A total of 620 individuals were included, comprising 391 ischaemic stroke patients and 229 haemorrhagic stroke patients, and the mean age was 63.2 years, with 60.32% being male. The overall mean cost for stroke inpatients was 30730.78 CNY ($ 4444.91), and the average length of stay (LOS) was 12.50 days. Mediation analysis indicated that the greater number of risk factors was not only directly related to higher inpatient costs (direct effect = 0.16, 95%CI:[0.11,0.22]), but also indirectly associated with inpatient cost through longer LOS (indirect effect = 0.08, 95% CI: [0.04,0.11]). Furthermore, patients with high risk of stroke had longer LOS than those in low-risk patients, which in turn led to heavier hospitalization expenses. CONCLUSIONS Both the greater number of risk factors and high-risk rating among stroke patients increased the length of stay and inpatient costs. Preventing and controlling risk behaviors of stroke should be strengthened.
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Affiliation(s)
- Xin Cao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Ruyu Li
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Weiwei Tang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu Province, 211166, China
| | - Wenjun Wang
- Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Jingya Ji
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Chengjie Yin
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Luyao Niu
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Yuexia Gao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China.
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China.
| | - Qiang Ma
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China.
- Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, 226019, China.
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Liu C, Luo L, He X, Wang T, Liu X, Liu Y. Patient Readmission for Ischemic Stroke: Risk Factors and Impact on Mortality. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241241271. [PMID: 38529892 DOI: 10.1177/00469580241241271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Patient readmission for ischemic stroke significantly strains the healthcare and medical insurance systems. Current understanding of the risk factors associated with these readmissions, as well as their subsequent impact on mortality within China, remains insufficient. This is particularly evident in the context of comprehensive, contemporary population studies. This 4-year retrospective cohort study included 125 397 hospital admissions for ischemic stroke from 838 hospitals located in 22 regions (13 urban and 9 rural) of a major city in western China, between January 1, 2015 and December 31, 2018. The Chi-square tests were used in univariate analysis. Accounting for intra-subject correlations of patients' readmissions, accelerated failure time (AFT) shared frailty models were used to examine readmission events and pure AFT models for mortality. Risk factors for patient readmission after ischemic stroke include frequent admission history, male gender, employee's insurance, advanced age, residence in urban areas, index hospitalization in low-level hospitals, extended length of stay (LOS) during index hospitalization, specific comorbidities and subtypes of ischemic stroke. Furthermore, our findings indicated that an additional admission for ischemic stroke increased patient mortality by 16.4% (P < .001). Stroke readmission contributed to an increased risk of hospital mortality. Policymakers can establish more effective and targeted policies to reduce readmissions for stroke by controlling these risk factors.
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Affiliation(s)
- Chuang Liu
- Chengdu Vocational & Technical College of Industry, Chengdu, Sichuan, China
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Li Luo
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Xiaozhou He
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Tao Wang
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Xiaofei Liu
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Yiyou Liu
- Sichuan Nursing Vocational College, Chengdu, Sichuan, China
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Wan Y, Liu J, Zhan X, Zhang Y, You R. Methodology and results of cost-effectiveness of LDL-C lowering with evolocumab in patients with acute myocardial infarction in China. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:93. [PMID: 38041072 PMCID: PMC10690971 DOI: 10.1186/s12962-023-00501-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND According to the Chinese guidelines for lipid management (2023), evolocumab in combination with statins was recommended as secondary prevention of cardiovascular disease. However, because of the variation in the price of evolocumab and its different methods of confirming clinical efficacy, it was necessary to explore its economics and the impact of different methods of confirming efficacy on its economic studies. OBJECTIVE The purpose of this paper was to assess the cost-effectiveness of evolocumab with statins versus statins alone for patients with acute myocardial infarction(AMI) in China and to investigate the impact of different clinical effectiveness modeling approaches on economic outcomes. METHODS A Markov cohort state-transition model was used to estimate the incremental cost-effectiveness ratio (ICER) based on Chinese observational data on cardiovascular event rates, efficacy from the Asian subgroup of the FOURIER trial, cost and utility from the Chinese Yearbook of Health Statistics, health insurance data, and published studies conducted in China. This study conducted subgroup analyses for different populations and dosing regimens; sensitivity analyses for parameters such as cost, utility, and cardiovascular event rates; and scenario analyses on hospital hierarchy, time horizon, starting age, and price for statins. RESULTS ICERs ranged from 27423 to 214777 Chinese yuan(CNY) per QALY gained, all below the willingness-to-pay threshold of CNY 257094. Only when the time horizon became small, the ICERs were greater than the willingness-to-pay. The probabilities that adding evolocumab to statins was cost-effective ranged from 76 to 98%. When the time horizon became small, i.e. evolocumab was discontinued before the age of 75 (after conversion), the corresponding ICERs were almost always greater than the willingness-to-pay. ICERs for modelling approaches based on clinical endpoints were 1.34 to 1.95 times higher than ICERs for modelling approaches based on reduced LDL-C levels. CONCLUSIONS From the Chinese healthcare and private payer perspectives, adding evolocumab to statin therapy in AMI patients is more likely to be a cost-effective treatment option at the current list price of CNY 283.8. However, evolocumab may not be cost-effective if used for shorter periods of time. The results based on different clinical effectiveness modeling approaches were significantly different.
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Affiliation(s)
- Yuansheng Wan
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
| | - Jinyu Liu
- Department of Pharmacy, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaolian Zhan
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
| | - Yu Zhang
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China
| | - Ruxu You
- Department of Pharmacy, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, Hubei, China.
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Lv W, Wang A, Wang Q, Wang R, Xu Q, Wu S, Han Y, Jiang Y, Lin J, Jing J, Li H, Wang Y, Meng X. One-year direct and indirect costs of ischaemic stroke in China. Stroke Vasc Neurol 2023:svn-2023-002296. [PMID: 37788911 DOI: 10.1136/svn-2023-002296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 08/09/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND This is the first real-world study to estimate the direct costs and indirect costs of first-ever ischaemic stroke with 1-year follow-up in China, based on a nationally representative sample. METHODS Patients were chosen from 20 geographically diverse sites from the nationally representative database China National Stroke Registry-III (CNSR-III). The inclusion criteria were surviving patients who were hospitalised with first-ever ischaemic stroke from February 2017 to February 2018 (the index event); aged 18-80 during the index event; no history of other stroke types. The primary endpoints were direct medical costs, direct non-medical costs, indirect costs and total cost (ie, the sum of all cost components). Patient characteristics and clinical data were extracted from CNSR-III. Stroke-related in-hospital direct medical costs were collected from hospital electronic medical records. The patient survey collected data related to out-of-hospital direct medical costs, direct non-medical costs and indirect costs. The secondary objective was to explore clinical factors associated with cost outcomes through univariate analysis and multiple regression. RESULTS The study enrolled 520 patients. The total cost was 57 567.48 CNY, with 26 612.67 CNY direct medical costs, 2 787.56 CNY direct non-medical costs and 28 167.25 CNY indirect costs. Univariate analysis showed that longer lengths of stay during the index event, higher National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were associated with higher costs in all categories. Conversely, EuroQol 5 Dimension utility scores were associated with decreased costs except direct non-medical costs. Multiple regressions showed that higher admission NIHSS scores were independently associated with higher direct medical costs, indirect costs and total cost. Higher 3-month utilities were associated with lower total cost. CONCLUSION This real-world study showed substantial 1-year economic burden following first-ever ischaemic stroke in China, and that indirect costs are a non-negligible driver of costs.
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Affiliation(s)
- Wei Lv
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qianyi Wang
- School of Basic Medical Science, Capital Medical University, Beijing, China
| | - Ruimin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qin Xu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuqing Wu
- Department of Cardiology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yi Han
- Health Economic Research Institute, Sun Yat-Sen University, Guangzhou, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jinxi Lin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Makkiyah FA, Dicha S, Nurrizzka RH. A Single-Center Experience of Correlation of Pulse Pressure to Mortality of Stroke Hemorrhage Patients in Indonesia. ScientificWorldJournal 2023; 2023:5517493. [PMID: 37593547 PMCID: PMC10432090 DOI: 10.1155/2023/5517493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/19/2023] Open
Abstract
Introduction The relationship between pulse pressure and mortality in acute stroke hemorrhage patients is a subject of debate. To investigate this relationship in the Indonesian context, a study was conducted due to the increasing prevalence of stroke in the country. Methods The study sample consisted of 111 patients with acute stroke hemorrhage admitted to the hospital between January 1, 2016, and December 31, 2019. Patients with sepsis, cancer, or other hematology disorders were excluded, as were those who were lost to follow-up. Statistical analysis was performed using SPSS 22, and correlations were evaluated between various patient characteristics and laboratory values. Results It was revealed that patients with a wider pulse pressure were more likely to die (adjusted odds ratio = 3,070) than those with a normal or constricted pulse pressure. Conclusion Pulse pressure had an impact on the mortality of patients with acute hemorrhagic stroke.
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Affiliation(s)
- Feda Anisah Makkiyah
- Department of Neurosurgery, Universitas Pembangunan Nasional Veteran Jakarta, Jalan RS Fatmawati No. 1 Pondok Labu, Jakarta 12520, Indonesia
| | - Saraah Dicha
- Department of Neurosurgery, Universitas Pembangunan Nasional Veteran Jakarta, Jalan RS Fatmawati No. 1 Pondok Labu, Jakarta 12520, Indonesia
| | - Rahmah Hida Nurrizzka
- Faculty of Public Health, Universitas Islam Negeri Syarif Hidayatullah Jakarta, Jakarta Selatan, Indonesia
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Kazemi Z, Emamgholipour Sefiddashti S, Daroudi R, Ghorbani A, Yunesian M, Hassanvand MS, Shahali Z. Estimation and predictors of direct hospitalisation expenses and in-hospital mortality for patients who had a stroke in a low-middle income country: evidence from a nationwide cross-sectional study in Iranian hospitals. BMJ Open 2022; 12:e067573. [PMID: 36523213 PMCID: PMC9748924 DOI: 10.1136/bmjopen-2022-067573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Stroke is the second most prevalent cardiovascular disease in Iran. This study investigates the estimation and predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke in Iranian hospitals. SETTING Patients who had a stroke in Iran between 2019 and 2020 were identified through the data collected from the Iran Health Insurance Organization and the Ministry of Health and Medical Education. This study is the first to conduct a pervasive, nationwide investigation. DESIGN This is a cross-sectional, prevalence-based study. Generalised linear models and a multiple logistic regression model were used to determine the predictors of hospitalisation expenses and in-hospital mortality for patients who had a stroke. PARTICIPANTS A total of 19 150 patients suffering from stroke were studied. RESULTS Mean hospitalisation expenses per patient who had a stroke in Iran amounted to US$590.91±974.44 (mean±SD). Mean daily hospitalisation expenses per patient who had a stroke were US$55.18±37.89. The in-hospital mortality for patients who had a stroke was 18.80%. Younger people (aged ≤49 years) had significantly higher expenses than older patients. The OR of in-hospital mortality in haemorrhagic stroke was significantly higher by 1.539 times (95% CI, 1.401 to 1.691) compared with ischaemic and unspecified strokes. Compared with patients covered by the rural fund, patients covered by Iranian health insurance had significantly higher costs by 1.14 times (95% CI, 1.186 to 1.097) and 1.319 times (95% CI, 1.099 to 1.582) higher mortality. There were also significant geographical variations in patients who had a stroke's expenses and mortality rates. CONCLUSION Applying cost-effective stroke prevention strategies among the younger population (≤49 years old) is strongly recommended. Migration to universal health insurance can effectively reduce the inequality gap among all insured patients.
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Affiliation(s)
- Zohreh Kazemi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | | | - Rajabali Daroudi
- Department of Health Management and Economics, Tehran University of Medical Sciences, Tehran, Iran
- National Center for Health Insurance Research, Tehran, Iran
| | - Askar Ghorbani
- Department of Neurology, Tehran University of Medical Sciences School of Medicine, Tehran, Iran
| | - Masud Yunesian
- Department of Research Methodology and Data Analysis, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Zahra Shahali
- National Center for Health Insurance Research, Tehran, Iran
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Liu C, Luo L, Liu Q, Ying Q, Luo F, Xiang J. Predictors, timing, causes and cost of 30-day readmission after acute ischemic stroke: insights from a Chinese cohort 2015-2018. Neurol Res 2022; 44:1011-1023. [PMID: 35876140 DOI: 10.1080/01616412.2022.2105489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Chuang Liu
- Department of Industrial Engineering and Management, Business School, Sichuan University, Chengdu, Sichuan, China
- School of Finance and Business, Chengdu Vocational & Technical College of Industry, Chengdu, Sichuan, China
| | - Li Luo
- Department of Industrial Engineering and Management, Business School, Sichuan University, Chengdu, Sichuan, China
| | - Qingqing Liu
- Laboratory of Genetic Disease and Perinatal Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiaoqiao Ying
- Zhongyi Hospital of Jinyang County, Jinyang, Sichuan, China
| | - Feifei Luo
- Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
| | - Jie Xiang
- Department of Industrial Engineering and Management, Business School, Sichuan University, Chengdu, Sichuan, China
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Hu WH, Liu YY, Yang CH, Zhou T, Yang C, Lai YS, Liao J, Hao YT. Developing and validating a Chinese multimorbidity-weighted index for middle-aged and older community-dwelling individuals. Age Ageing 2022; 51:6535928. [PMID: 35211718 DOI: 10.1093/ageing/afab274] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/09/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To develop and validate an index to quantify the multimorbidity burden in Chinese middle-aged and older community-dwelling individuals. METHODS We included 20,035 individuals aged 45 and older from the China Health and Retirement Longitudinal Study (CHARLS) and 19,297 individuals aged 65 and older from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Health outcomes of physical functioning (PF), basic and instrumental activities of daily living (ADL and IADL) and mortality were obtained. Based on self-reported disease status, we calculated five commonly used western multimorbidity indexes for CHARLS baseline participants. The one that predicted the health outcomes the best was selected and then modified through a linear mixed model using the repeated individual data in CHARLS. The performance of the modified index was internally and externally evaluated with CHARLS and CLHLS data. RESULTS The multimorbidity-weighted index (MWI) performed the best among the five indexes. In the modified Chinese multimorbidity-weighted index (CMWI), the weights of the diseases varied greatly (range 0.2-5.1). The top three diseases with the highest impact were stroke, memory-related diseases and cancer, corresponding to weights of 5.1, 4.3 and 3.4, respectively. Compared with the MWI, the CMWI showed better model fits for PF and IADL with larger R2 and smaller Akaike information criterion, and comparable prediction performances for ADL, IADL and mortality (e.g. the same predictive accuracy of 0.80 for ADL disability). CONCLUSION The CMWI is an adequate index to quantify the multimorbidity burden for Chinese middle-aged and older community-dwelling individuals. It can be directly computed via disease status examined in regular community health check-ups to facilitate health management.
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Affiliation(s)
- Wei-Hua Hu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, P.R. China
| | - Yu-Yang Liu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, P.R. China
| | - Cong-Hui Yang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, P.R. China
| | - Tong Zhou
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, P.R. China
| | - Chun Yang
- Department of Chronic Disease Prevention and Treatment and Health Education, Huangpu District Center for Disease Control and Prevention, Guangzhou, P.R. China
| | - Ying-Si Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, P.R. China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, P.R. China
| | - Jing Liao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, P.R. China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, P.R. China
| | - Yuan-Tao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, P.R. China
- Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, P.R. China
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