Mild anemia and 11- to 15-year mortality risk in young-old and old-old: Results from two population-based cohort studies

Background Mild anemia is a frequent although often overlooked finding in old age. Nevertheless, in recent years anemia has been linked to several adverse outcomes in the elderly population. Objective of the study was to investigate the association of mild anemia (hemoglobin concentrations: 10.0–11.9/12.9 g/dL in women/men) with all-cause mortality over 11–15 years and the effect of change in anemia status on mortality in young-old (65–84 years) and old-old (80+ years). Methods The Health and Anemia and Monzino 80-plus are two door-to-door, prospective population-based studies that included residents aged 65-plus years in Biella municipality and 80-plus years in Varese province, Italy. No exclusion criteria were used. Results Among 4,494 young-old and 1,842 old-old, mortality risk over 15/11 years was significantly higher in individuals with mild anemia compared with those without (young-old: fully-adjusted HR: 1.35, 95%CI, 1.15–1.58; old-old: fully-adjusted HR: 1.28, 95%CI, 1.14–1.44). Results were similar in the disease-free subpopulation (age, sex, education, smoking history, and alcohol consumption adjusted HR: 1.54, 95%CI, 1.02–2.34). Both age groups showed a dose-response relationship between anemia severity and mortality (P for trend <0.0001). Mortality risk was significantly associated with chronic disease and chronic kidney disease mild anemia in both age groups, and with vitamin B12/folate deficiency and unexplained mild anemia in young-old. In participants with two hemoglobin determinations, seven-year mortality risk was significantly higher in incident and persistent anemic cases compared to constant non-anemic individuals in both age groups. In participants without anemia at baseline also hemoglobin decline was significantly associated with an increased mortality risk over seven years in both young-old and old-old. Limited to the Monzino 80-plus study, the association remained significant also when the risk was further adjusted also for time-varying covariates and time-varying anemia status over time. Conclusions Findings from these two large prospective population-based studies consistently suggest an independent, long-term impact of mild anemia on survival at older ages.

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Erythropoietin Dose and Mortality in Hemodialysis Patients: Marginal Structural Model to Examine Causality

International Journal of Nephrology ◽

10.1155/2016/6087134 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 8

Author(s):

Elani Streja ◽

Jongha Park ◽

Ting-Yan Chan ◽

Janet Lee ◽

Melissa Soohoo ◽

...

Keyword(s):

Mortality Risk ◽

Structural Model ◽

Positive Association ◽

Hemodialysis Patients ◽

Adverse Outcomes ◽

Time Varying ◽

Marginal Structural Model ◽

Time Varying Covariates ◽

Dose Dependent

It has been previously reported that a higher erythropoiesis stimulating agent (ESA) dose in hemodialysis patients is associated with adverse outcomes including mortality; however the causal relationship between ESA and mortality is still hotly debated. We hypothesize ESA dose indeed exhibits a direct linear relationship with mortality in models of association implementing the use of a marginal structural model (MSM), which controls for time-varying confounding and examines causality in the ESA dose-mortality relationship. We conducted a retrospective cohort study of 128 598 adult hemodialysis patients over a 5-year follow-up period to evaluate the association between weekly ESA (epoetin-α) dose and mortality risk. A MSM was used to account for baseline and time-varying covariates especially laboratory measures including hemoglobin level and markers of malnutrition-inflammation status. There was a dose-dependent positive association between weekly epoetin-αdoses ≥18 000 U/week and mortality risk. Compared to ESA dose of <6 000 U/week, adjusted odds ratios (95% confidence interval) were 1.02 (0.94–1.10), 1.08 (1.00–1.18), 1.17 (1.06–1.28), 1.27 (1.15–1.41), and 1.52 (1.37–1.69) for ESA dose of 6 000 to <12 000, 12 000 to <18 000, 18 000 to <24 000, 24 000 to <30 000, and ≥30 000 U/week, respectively. High ESA dose may be causally associated with excessive mortality, which is supportive of guidelines which advocate for conservative management of ESA dosing regimen in hemodialysis patients.

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Knowledge, attitudes and intention regarding mHealth in generation Y: evidence from a population based cross sectional study in Chakaria, Bangladesh

BMJ Open ◽

10.1136/bmjopen-2017-016217 ◽

2017 ◽

Vol 7 (11) ◽

pp. e016217 ◽

Cited By ~ 4

Author(s):

M Shafiqur Rahman ◽

Syed Hanifi ◽

Fatema Khatun ◽

Mohammad Iqbal ◽

Sabrina Rasheed ◽

...

Keyword(s):

Young People ◽

Sex Education ◽

Mobile Phones ◽

Generation Y ◽

Healthcare Providers ◽

Age Groups ◽

Household Survey ◽

Population Based ◽

Cross Sectional ◽

Level Of Knowledge

Background and objectivesmHealth offers a new opportunity to ensure access to qualified healthcare providers. Therefore, to better understand its potential in Bangladesh, it is important to understand how young people use mobile phones for healthcare. Here we examine the knowledge, attitudes and intentions to use mHealth services among young population.DesignPopulation based cross sectional household survey.Setting and participantsA total of 4909 respondents, aged 18 years and above, under the Chakaria Health and Demographic Surveillance System (HDSS) area, were interviewed during the period November 2012 to April 2013.MethodsParticipants younger than 30 years of age were defined as young (or generation Y). To examine the level of knowledge about and intention towards mHealth services in generation Y compared with their older counterparts, the percentage of the respective outcome measure from a 2×2 contingency table and adjusted odds ratio (aOR), which controls for potential confounders such as mobile ownership, sex, education, occupation and socioeconomic status, were estimated. The aOR was estimated using both the Cochran–Mantel–Haenszel approach and multivariable logistic regression models controlling for confounders.ResultsGeneration Y had significantly greater access to mobile phones (50%vs40%) and better knowledge about its use for healthcare (37.8%vs27.5%;aOR 1.6 (95% CI1.3 to 2.0)). Furthermore, the level of knowledge about two existing mHealth services in generation Y was significantly higher compared with their older counterparts, with aOR values of 3.2 (95% CI 2.6 to 5.5) and 1.5 (95% CI 1.1 to 1.8), respectively. Similarly, generation Y showed significantly greater intention towards future use of mHealth services compared with their older counterparts (aOR 1.3 (95% CI 1.1 to 1.4)). The observed associations were not modified by sociodemographic factors.ConclusionThere is a greater potential for mHealth services in the future among young people compared with older age groups. However, given the low overall use of mHealth, appropriate policy measures need to be formulated to enhance availability, access, utilisation and effectiveness of mHealth services.

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Atrial fibrillation detected at screening is not a benign condition - a comparison of clinical outcomes in screen-detected vs. hospital-detected atrial fibrillation

EP Europace ◽

10.1093/europace/euab116.144 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

VW Zwartkruis ◽

B Geelhoed ◽

N Suthahar ◽

RT Gansevoort ◽

SJL Bakker ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcomes ◽

Cox Regression ◽

Population Based ◽

Adverse Outcomes ◽

Albumin Concentration ◽

Benign Condition ◽

National Budget ◽

History Of ◽

Time Varying Covariates

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation Background Screening for atrial fibrillation (AF) improves detection of AF. However, it is unknown whether AF detected at screening carries risks similar to clinically detected AF, and if it should be treated similarly. Purpose We aimed to compare clinical outcomes in individuals with screen-detected vs. hospital-detected incident AF. Methods We studied 8265 individuals (mean age 49 ± 13 years, 50% women) without prevalent AF from the population-based PREVEND (Prevention of Renal and Vascular End-Stage Disease) cohort study. By design, 70% of PREVEND participants had urinary albumin concentration ≥10 mg/l. AF was considered screen-detected when first detected on a 12-lead electrocardiogram (ECG) during one of the PREVEND study visits, and hospital-detected when first detected on a hospital ECG. Using Cox regression models with screen-detected and hospital-detected AF as time-varying covariates, we studied the association of screen-detected vs. hospital-detected AF with mortality, incident heart failure (HF), and incident cardiovascular (CV) events. Results During a mean follow-up of 9.7 years, 265 participants (3.2%) developed incident AF (mean age 62 ± 9 years, 30% women, 65% hypertension, 23% obesity, 9% diabetes, 15% history of myocardial infarction, 3% history of stroke, 2% prevalent HF). Of all incident AF cases, 60 (23%) were screen-detected and 205 (77%) hospital-detected. Baseline characteristics were generally comparable between participants with screen-detected and hospital-detected AF. A larger proportion of incident AF was screen-detected in men (26%) compared to women (15%). In univariabe analysis, both screen-detected and hospital-detected AF were strongly associated with death, incident HF, and incident CV events. After multivariable adjustment, hospital-detected AF was significantly associated with death (HR 2.95, 95% CI 2.18-4.00), incident HF (HR 3.98, 95% CI 2.49-6.34), and incident CV events (HR 1.92, 95% CI 1.21-3.06). Screen-detected AF was significantly associated with death (HR 2.21, 95% CI 1.09-4.47) and incident HF (HR 4.90, 95% CI 2.28-10.57), but not with incident CV events (HR 1.12, 95% CI 0.46-2.71). Conclusions In a population-based cohort enriched for microalbuminuria, almost a quarter of incident AF cases was first detected through ECG screening. Compared to hospital-detected AF, screen-detected AF was similarly associated with adverse outcomes. Although randomised trials are needed, this study highlights that AF screening may help decrease the general burden of CV disease.

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Curative treatments and survival benefit in elderly patients with hepatocellular carcinoma: A SEER population-based analysis.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.355 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 355-355

Author(s):

Oxana V. Makarova-Rusher ◽

Susanna Varkey Ulahannan ◽

Austin G. Duffy ◽

Tim F. Greten ◽

Sean Altekruse

Keyword(s):

Hepatocellular Carcinoma ◽

Elderly Patients ◽

Age Groups ◽

Relative Survival ◽

Population Based ◽

Outcome Data ◽

Chi Square ◽

Diagnostic Codes ◽

Kaplan Meier ◽

Young Old

355 Background: Transplant, resection, and ablation are potentially curative treatments for hepatocellular carcinoma (HCC) with limited outcome data in young-old (65-74) and older (≥75) patients. Methods: We evaluated curative treatment and relative survival (RS) outcomes in patients with HCC in 3 age groups (<65 years, 65-74 years, and ≥75 years). Patients with HCC diagnostic codes (histology 8,170-8,175, morphology C22) were identified in the SEER 18 database from 2000 to 2011. Treatments included curative (transplant, resection, radiofrequency ablation (RFA), and other ablations) and palliative therapies. Primary outcome was 5 year RS. Statistical analysis was performed using Kaplan-Meier and Chi-Square tests. Results: We identified 29,654 cases. The mean age was 62 years with almost 40% of HCC cases in patients over 65 years old. Potentially curable, localized stage rates were similar in all age groups, 46%, 48% and 46%, respectively. As a result of less resection and rare transplant use, fewer cases underwent curative treatments in the group 75 years and older in comparison to all other age groups (15% vs. 27%, p = 0.001). Five-year RS in all 3 age groups (<65 years, 65-74 years, and ≥75 years) was better after resection relative to RFA (47% vs. 35% p<0.0001, 44% vs. 37%, p=0.0093, and 43% vs. 28% p=0.0002). The highest survival was seen after liver transplant. Interestingly, among transplanted patients with HCC, 13% were 65-75 years old. Five-year RS was similar in transplanted patients 65-75 vs. those under 65 (76% vs 74% p=0.65). Conclusions: The use of curative treatments for HCC significantly decreases with age, yet there are clear survival benefits in elderly patients receiving such. Even when considering transplant, the data shows that outcome is as good in elderly patients as in younger patients. The benefit of hepatic resection appears to be superior compared to RFA in all age groups, in our analysis. [Table: see text]

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Lifelong smoking trajectories of Northern Finns are characterized by sociodemographic and lifestyle differences in a 46-year follow-up

Scientific Reports ◽

10.1038/s41598-020-73334-3 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Petteri Oura ◽

Ina Rissanen ◽

Juho-Antti Junno ◽

Terttu Harju ◽

Markus Paananen

Keyword(s):

Birth Cohort ◽

Sex Education ◽

Latent Class ◽

Population Based ◽

Smoking Behaviour ◽

Smoking History ◽

Substance Addiction ◽

Male Sex ◽

Never Smokers ◽

Late Starters

Abstract Smoking remains among the leading causes of mortality worldwide. Obtaining a comprehensive understanding of a population’s smoking behaviour is essential for tobacco control. Here, we aim to characterize lifelong smoking patterns and explore underlying sociodemographic and lifestyle factors in a population-based birth cohort population followed up for 46 years. Our analysis is based on 5797 individuals from the Northern Finland Birth Cohort 1966 who self-reported their tobacco smoking behaviour at the ages of 14, 31 and 46. Data on sex, education, employment, body mass index, physical activity, alcohol consumption, and substance addiction were also collected at the follow-ups. We profile each individual’s annual smoking history from the age of 5 to 47, and conduct a latent class trajectory analysis on the data. We then characterize the identified smoking trajectory classes in terms of the background variables, and compare the heaviest smokers with other classes in order to reveal specific predictors of non-smoking and discontinued smoking. Six smoking trajectories are identified in our sample: never-smokers (class size 41.0%), youth smokers (12.6%), young adult quitters (10.8%), late adult quitters (10.5%), late starters (4.3%), and lifetime smokers (20.7%). Smoking is generally associated with male sex, lower socioeconomic status and unhealthier lifestyle. Multivariable between-class comparisons identify unemployment (odds ratio [OR] 1.28–1.45) and physical inactivity (OR 1.20–1.52) as significant predictors of lifetime smoking relative to any other class. Female sex increases the odds of never-smoking and youth smoking (OR 1.29–1.33), and male sex increases the odds of adult quitting (OR 1.30–1.41), relative to lifetime smoking. We expect future initiatives to benefit from our data by exploiting the identified predictors as direct targets of intervention, or as a means of identifying individuals who may benefit from such interventions.

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The Effect of Paternal Age on Fetal Birth Outcomes

American Journal of Men s Health ◽

10.1177/1557988312440718 ◽

2012 ◽

Vol 6 (5) ◽

pp. 427-435 ◽

Cited By ~ 60

Author(s):

Amina P. Alio ◽

Hamisu M. Salihu ◽

Cheri McIntosh ◽

Euna M. August ◽

Hanna Weldeselasse ◽

...

Keyword(s):

Preterm Birth ◽

Birth Outcomes ◽

Age Groups ◽

Estimating Equation ◽

Population Based ◽

Adverse Outcomes ◽

Paternal Age ◽

Data Set ◽

Advanced Paternal Age ◽

Increased Risk

Research investigating the role of paternal age in adverse birth outcomes is limited. This population-based retrospective cohort study used the Missouri maternally linked data set from 1989 to 2005 to assess whether paternal age affects fetal birth outcomes: low birth weight (LBW), preterm birth (PTB), stillbirth, and small size for gestational age (SGA). We examined these outcomes among infants across seven paternal age-groups (<20, 20-24, 25-29, 30-34, 35-39, 40-45, and >45 years) using the generalized estimating equation framework. Compared with infants born to younger fathers (25-29 years), infants born to fathers aged 40 to 45 years had a 24% increased risk of stillbirth but a reduced risk of SGA. A 48% increased risk of late stillbirth was observed in infants born to advanced paternal age (>45 years). Moreover, advanced paternal age (>45 years) was observed to result in a 19%, 13%, and 29% greater risk for LBW, PTB, and VPTB (very preterm birth) infants, respectively. Infants born to fathers aged 30 to 39 years had a lower risk of LBW, PTB, and SGA, whereas those born to fathers aged 24 years or younger had an elevated likelihood of experiencing these same adverse outcomes. These findings demonstrate that paternal age influences birth outcomes and warrants further investigation.

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Stroke and osteoporosis: a Taiwan cohort study

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2019-136959 ◽

2020 ◽

pp. postgradmedj-2019-136959

Author(s):

Li Zhang ◽

Zi-Hao Zhang ◽

Qing-Rui Wang ◽

Ying-Ju Su ◽

Ying-Yi Lu ◽

...

Keyword(s):

Age Groups ◽

Population Based ◽

Adverse Outcomes ◽

Treatment Modalities ◽

Research Database ◽

Outpatient Basis ◽

Stroke Group ◽

Taiwan National Health Insurance ◽

Cox Proportional Hazard Regression ◽

Osteoporosis Risk

BackgroundOsteoporosis and stroke are major health problems that have potentially overlapping pathophysiological mechanisms. The aim of this study was to estimate osteoporosis risk in Taiwan patientswho had a stroke.MethodThis study retrieved data contained in the Taiwan National Health Insurance Research Database for a population-based sample of consecutive patients either hospitalised for stroke or treated for stroke on an outpatient basis. A total of 7550 newly diagnosed patientswho had a stroke were enrolled during 1996–2010. Osteoporosis risk in these patients was then compared with a matched group of patients who had not had a stroke randomly selected from the database at a ratio of 1:4 (n=30 200). The relationship between stroke history and osteoporosis risk was estimated with Cox proportional hazard regression models.ResultsDuring the follow-up period, osteoporosis developed in 1537 patients who had a stroke and in 5830 patients who had not had a stroke. The incidence of osteoporosis for cohorts with and without stroke was 32.97 and 14.28 per 1000 person-years, respectively. After controlling for covariates, the overall risk of osteoporosis was 1.82-fold higher in the stroke group than in the non-stroke group. The relative osteoporosis risk contributed by stroke had apparently greater impact among male gender and younger age groups.ConclusionHistory of stroke is a risk factor for osteoporosis in Taiwan. Much attention to stroke-targeted treatment modalities might minimise adverse outcomes of osteoporosis.

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Longitudinal profile of a set of biomarkers in predicting Covid-19 mortality using joint models

10.36253/978-88-5518-461-8.36 ◽

2021 ◽

pp. 191-196

Author(s):

Matteo Di Maso ◽

Monica Ferraroni ◽

Pasquale Ferrante ◽

Serena Delbue ◽

Federico Ambrogi

Keyword(s):

Mortality Risk ◽

Fixed Effects ◽

Cox Model ◽

Time Dependent ◽

Neutrophil Granulocytes ◽

Time Varying ◽

C Reactive Protein ◽

Joint Models ◽

Reactive Protein ◽

Time Varying Covariates

In survival analysis, time-varying covariates are endogenous when their measurements are directly related to the event status and incomplete information occur at random points during the follow-up. Consequently, the time-dependent Cox model leads to biased estimates. Joint models (JM) allow to correctly estimate these associations combining a survival and longitudinal sub-models by means of a shared parameter (i.e., random effects of the longitudinal sub-model are inserted in the survival one). This study aims at showing the use of JM to evaluate the association between a set of inflammatory biomarkers and Covid-19 mortality. During Covid-19 pandemic, physicians at Istituto Clinico di Città Studi in Milan collected biomarkers (endogenous time-varying covariates) to understand what might be used as prognostic factors for mortality. Furthermore, in the first epidemic outbreak, physicians did not have standard clinical protocols for management of Covid-19 disease and measurements of biomarkers were highly incomplete especially at the baseline. Between February and March 2020, a total of 403 COVID-19 patients were admitted. Baseline characteristics included sex and age, whereas biomarkers measurements, during hospital stay, included log-ferritin, log-lymphocytes, log-neutrophil granulocytes, log-C-reactive protein, glucose and LDH. A Bayesian approach using Markov chain Monte Carlo algorithm were used for fitting JM. Independent and non-informative priors for the fixed effects (age and sex) and for shared parameters were used. Hazard ratios (HR) from a (biased) time-dependent Cox and joint models for log-ferritin levels were 2.10 (1.67-2.64) and 1.73 (1.38-2.20), respectively. In multivariable JM, doubling of biomarker levels resulted in a significantly increase of mortality risk for log-neutrophil granulocytes, HR=1.78 (1.16-2.69); for log-C-reactive protein, HR=1.44 (1.13-1.83); and for LDH, HR=1.28 (1.09-1.49). Increasing of 100 mg/dl of glucose resulted in a HR=2.44 (1.28-4.26). Age, however, showed the strongest effect with mortality risk starting to rise from 60 years.

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Predictive value of spirometry in early detection of lung disease in adults: a cohort study

BJGP Open ◽

10.3399/bjgpopen20x101059 ◽

2020 ◽

Vol 4 (4) ◽

pp. bjgpopen20X101059

Author(s):

Lene Maria Ørts ◽

Bodil Hammer Bech ◽

Torsten Lauritzen ◽

Janus Laust Thomsen ◽

Niels Henrik Bruun ◽

...

Keyword(s):

Cohort Study ◽

Lung Disease ◽

Predictive Value ◽

Lung Diseases ◽

Age Groups ◽

Population Based ◽

Forced Expiratory Volume ◽

Smoking History ◽

Positive Predicted Value ◽

Prognostic Outcome

BackgroundSpirometry is essential to identify cases with obstructive lung diseases (OLDs) in primary care. However, knowledge about the long-term prognostic outcome among younger individuals is sparse.AimTo describe the predictive value of spirometry among individuals in the age groups 30–49 years and 45–64 years.Design & settingA population-based cohort study supplied with data from Danish national registries.MethodSpirometry was performed in 905 adults aged 30–49 years in 1991 and in 1277 adults aged 45–64 years in 2006. The participants were categorised into three groups: forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <70, 70–75, and >75. They were followed throughout 2017 using Danish national registries. Lung disease was defined as fulfilling at least one of the following: two prescriptions for respiratory medicine were redeemed within a year; one lung-related contact to the hospital; or lung-related death.ResultsIn the 1991 cohort, 21% developed lung diseases and in the 2006 cohort 17% developed lung diseases throughout 2017. The probability of developing lung disease if FEV1/FVC 70–75 was 35% (95% confidence interval [CI] = 25% to 44%) in the 1991 cohort and 23% (95% CI = 17% to 28%) in the 2006 cohort. The positive predicted value (PPV) was higher for both cohorts when focusing on smoking history and self-reported respiratory symptoms.ConclusionThe initial spirometry has a high predictive value to identify cases of future lung diseases. In addition, the group with FEV1/FVC 70–75 had a high risk of developing lung diseases later in life, suggesting this group would be a meaningful target of special interest.

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Does Identifying Frailty from ICD-10 Coded Data on Hospital Admission Improve Prediction of Adverse Outcomes in Older Surgical Patients

International Journal for Population Data Science ◽

10.23889/ijpds.v5i5.1503 ◽

2020 ◽

Vol 5 (5) ◽

Author(s):

Lara Harvey ◽

Barbara Toson ◽

Ian Harris ◽

Robert Gandy ◽

Jacqueline Close

Keyword(s):

External Validation ◽

Age Groups ◽

Information Criterion ◽

Population Based ◽

Adverse Outcomes ◽

Unplanned Readmission ◽

Surgical Specialty ◽

Prolonged Length ◽

Logistic Regression Models ◽

Poor Outcomes

IntroductionAs the population ages, increasing numbers of older adults are undergoing surgery. Outcomes for older people are known to be worse than younger people following surgical procedures, and identifying which patients stand to benefit from surgery can be challenging. Frailty is recognised as a major contributor to poor outcomes, however assessing frailty clinically is time-consuming and not routinely undertaken. Using data available from electronic medical records can potentially provide the opportunity to routinely screen for frailty electronically at time of admission. Objectives and ApproachThis population-based external validation study aimed to: 1. assess the performance of the Hospital Frailty Risk Score (HFRS) in the prediction of adverse outcomes (mortality, prolonged length of stay (LOS) and 28-day readmission), 2. to determine optimal age-groups and lookback periods and 3. compare HFRS performance against the Charlson Comorbidity Index (CCI). Hospital and death data for individuals (n=487,197) aged >50 years admitted under a surgical specialty to all public/private hospitals in NSW, Australia, 2013-2017 were linked. Logistic regression models were tested for each outcome of interest. Area under receiving operator curve (AUC) and Akaike information criterion (AIC) were assessed for each model. ResultsFor prediction of 30-day, all models performed better than age and sex alone; however adjusting for CCI (AUC 0.76) provided marginally better prediction than adjusting for HFRS (AUC 0.75). Models consistently performed better in the younger age-group (50-65), providing excellent discrimination (AUC 0.82). In contrast, all models had poor ability to predict prolonged-LOS (AUC range 0.62- 0.63) or readmission (AUC range 0.62-0.65). Using a 5-year lookback period did not improve model discrimination over using a 2-year period. Conclusion / ImplicationsAdjusting for frailty using the HFRS did not improve prediction of 30-mortality over that achieved by the CCI. Neither HFRS nor CCI were useful for predicting prolonged-LOS r 28-day unplanned readmission.

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