Diabetes Complications Severity Index and Risk of Mortality, Hospitalization, and Healthcare Utilization

Am J Manag Care. 2008 Jan;14(1):15-23.

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.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Diabetes Complications / diagnosis*
  • Diabetes Complications / mortality*
  • Diabetes Mellitus, Type 1 / complications
  • Diabetes Mellitus, Type 1 / diagnosis
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / diagnosis
  • Disease Management
  • Female
  • Health Maintenance Organizations / statistics & numerical data*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Medical Records Systems, Computerized
  • Middle Aged
  • Poisson Distribution
  • Primary Health Care / statistics & numerical data*
  • Proportional Hazards Models
  • Risk Assessment / methods*
  • Risk Factors
  • Severity of Illness Index*
  • Survival Analysis
  • Washington / epidemiology