Adapted Diabetes Complications Severity Index and Charlson Comorbidity Index in predicting all-cause and cause-specific mortality among patients with type 2 diabetes
Authors' conclusion
The aDCSI predicts all-cause, CVD and diabetes deaths but not cancer deaths better than the CCI. aDCSI is also a good predictor for long-term mortality.
Study context
- Population
- Patients aged ≥20 years with T2D before January 1, 2008, Taiwan National Health Insurance claims data; followed until December 15, 2018
- Participants
- 1,002,589 patients
- Exposure
- Adapted Diabetes Complications Severity Index (aDCSI) vs CCI in predicting mortality
- Outcome
- All-cause and cause-specific (cancer, CVD, diabetes) mortality
- Follow-up
- Median 11.0 years
Methodological detailsnationwide claims data, Cox regression
- Nationwide claims data
- Cox regression
Main finding
As reported in the abstract
All-cause mortality (per score point, age- and sex-adjusted)
| Group | HR (95% CI 1.20 to 1.21) | C-index | HR (1.17 to 1.18) |
|---|---|---|---|
| aDCSI | 1.21 | 0.760 | |
| CCI | 1.18 |
HR (95% CI 1.20 to 1.21)
aDCSI1.21
CCI— not stated in the abstract
C-index
aDCSI0.760
CCI— not stated in the abstract
HR (1.17 to 1.18)
aDCSI— not stated in the abstract
CCI1.18
Observational data: associations, not effects.
Further findings
| Outcome | aDCSI | CCI |
|---|---|---|
| Cancer mortality | ||
| HR (1.04 to 1.05) | 1.04 | — not stated in the abstract |
| HR (1.09 to 1.10) | — not stated in the abstract | 1.10 |
| CVD mortality | ||
| HR (1.27 to 1.28) | 1.27 | — not stated in the abstract |
| C-index | 0.794 | — not stated in the abstract |
| HR (1.16 to 1.17) | — not stated in the abstract | 1.16 |
| Diabetes mortality | ||
| HR (1.28 to 1.29) | 1.28 | — not stated in the abstract |
| C-index | 0.781 | — not stated in the abstract |
| HR (1.16 to 1.17) | — not stated in the abstract | 1.17 |
— not stated in the abstract
- Long-term mortality, aDCSI · after 8 years
- 1.18 · HR (1.17 to 1.18)
Cancer mortality
- In models with both scores, HR of aDCSI for cancer (0.97 to 0.98)
Cardiovascular disease (CVD) mortality
- In models with both scores, HR of CCI for CVD (1.02 to 1.03), became neutral
Diabetes mortality
- In models with both scores, HR of CCI for diabetes mortality (1.02 to 1.03), became neutral
Time-varying scores
- Association with mortality stronger when aDCSI and CCI were time-varying
Original publication
Adapted Diabetes Complications Severity Index and Charlson Comorbidity Index in predicting all-cause and cause-specific mortality among patients with type 2 diabetes. BMJ Open Diabetes Res Care. Published 28 March 2023. doi:10.
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