“Recent guidelines recommend considering patients’ life expectancy when deciding whether to pursue preventive interventions with long lag times to benefit (≥ 7 years) such as colorectal cancer screening and intensive glycemic control for diabetes. However, most mortality indices have focused on short-term risk (≤ 5 years),” writes Marisa Cruz, M.D., of the University of California, San Francisco, and colleagues. The researchers examined whether their previously developed 4-year mortality index accurately predicted 10-year mortality.
As reported in a Research Letter, this analysis used 1998 data from the Health and Retirement Study (HRS), a nationally representative cohort of community-dwelling U.S. adults older than 50 years. The primary predictor was a 12-item mortality index, and participants received points depending on answers to the following: age; sex; current tobacco use; body mass index; diabetes; nonskin cancers; chronic lung disease; heart failure; difficulty bathing; difficulty managing finances; difficulty walking several blocks; and difficulty pushing/pulling large objects. The primary outcome was death through 2008 (10-year mortality). A risk score was calculated for each participant by summing the points for each risk factor present.
The researchers found that in the development cohort, 10-year mortality rates ranged from 2.5 percent (n=12/486) for participants with 0 points to 96 percent (n=298/310) for participants with 14 or more points. In the validation cohort, 10-year mortality rates ranged from 2.3 percent (n=8/354) to 93 percent (n= 239/257).
“We validated a mortality index that accurately stratified older adults into groups at varying risk for 10-year mortality,” the authors write. “Patients identified by this index as having a high risk of 10-year mortality may be more likely to be harmed by preventive interventions with long lag times to benefit, whereas patients identified as having a low risk of 10-year mortality may be good candidates for such interventions.”