Common comorbidity scales were similar in their ability to predict health care costs and mortality

Objective: To compare the ability of commonly used measures of medical comorbidity (ambulatory care groups [ACGs], Charlson comorbidity index, chronic disease score, number of prescribed medications, and number of chronic diseases) to predict mortality and health care costs over 1 year. Study Design and Setting: A prospective cohort study of community-dwelling older adults (n = 3,496) attending a large primary care practice. Results: For predicting health care charges, the number of medications had the highest predictive validity (R-2 = 13.6%) after adjusting for demographics. ACGs (R-2 = 16.4%) and the number of medications (15.0%) had the highest predictive validity for predicting ambulatory visits. ACGs and the Charlson comorbidity index (area under the receiver operator characteristic [ROC] curve = 0.695-0.767) performed better than medication-based measures (area under the ROC curve = 0.662-0.679) for predicting mortality. There is relatively little difference, however, in the predictive validity across these scales. Conclusion: In an outpatient setting, a simple count of medications may be the most efficient comorbidity measure for predicting utilization and health-care charges over the ensuing year. In contrast, diagnosis-based measures have greater predictive validity for 1-year mortality. Current comorbidity measures, however, have only poor to moderate predictive validity for costs or mortality over 1 year. (C) 2004 Elsevier Inc. All rights reserved.