title: Diabetes complications severity index and risk of mortality, hospitalization, and healthcare utilization.
abstract: OBJECTIVE
  To determine whether the number and severity of diabetes complications are associated with increased risk of mortality and hospitalizations.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Veterans Affairs Puget Sound Health Care System (152-E), Epidemiologic Research and Information Center, Seattle, WA 98108, USA. youngb@u.washington.edu
authors.forename: Bessie Ann
authors.initials: BA
authors.lastname: Young
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lin
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Greg
authors.initials: G
authors.lastname: Simon
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Evette J
authors.initials: EJ
authors.lastname: Ludman
authors.forename: Siobhan
authors.initials: S
authors.lastname: Everson-Stewart
authors.forename: Leslie
authors.initials: L
authors.lastname: Kinder
authors.forename: Malia
authors.initials: M
authors.lastname: Oliver
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Katon
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000175:diagnosis* / Q000401:mortality*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis; D019468:Disease Management; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D016012:Poisson Distribution; D011320:Primary Health Care / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D016019:Survival Analysis; D014861:Washington / Q000453:epidemiology