title: Why Summary Comorbidity Measures Such As the Charlson Comorbidity Index and Elixhauser Score Work.
abstract: BACKGROUND
  Comorbidity adjustment is an important component of health services research and clinical prognosis. When adjusting for comorbidities in statistical models, researchers can include comorbidities individually or through the use of summary measures such as the Charlson Comorbidity Index or Elixhauser score. We examined the conditions under which individual versus summary measures are most appropriate.
  
  
  METHODS
  We provide an analytic proof of the utility of comorbidity summary measures when used in place of individual comorbidities. We compared the use of the Charlson and Elixhauser scores versus individual comorbidities in prognostic models using a SEER-Medicare data example. We examined the ability of summary comorbidity measures to adjust for confounding using simulations.
  
  
  RESULTS
  We devised a mathematical proof that found that the comorbidity summary measures are appropriate prognostic or adjustment mechanisms in survival analyses. Once one knows the comorbidity score, no other information about the comorbidity variables used to create the score is generally needed. Our data example and simulations largely confirmed this finding.
  
  
  CONCLUSIONS
  Summary comorbidity measures, such as the Charlson Comorbidity Index and Elixhauser scores, are commonly used for clinical prognosis and comorbidity adjustment. We have provided a theoretical justification that validates the use of such scores under many conditions. Our simulations generally confirm the utility of the summary comorbidity measures as substitutes for use of the individual comorbidity variables in health services research. One caveat is that a summary measure may only be as good as the variables used to create it.
authors.affiliation: *Whiting School of Engineering Undergraduate Student, Johns Hopkins University, Baltimore, MD Departments of †Medical Oncology ‡Surgery, Fox Chase Cancer Center §Academic Affairs, Fox Chase Cancer Center, Temple University Health System ∥Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Austin
authors.forename: Yu-Ning
authors.initials: YN
authors.lastname: Wong
authors.forename: Robert G
authors.initials: RG
authors.lastname: Uzzo
authors.forename: J Robert
authors.initials: JR
authors.lastname: Beck
authors.forename: Brian L
authors.initials: BL
authors.lastname: Egleston
mesh_terms: D000368:Aged; D000465:Algorithms; D015897:Comorbidity; D005260:Female; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D007345:Insurance Claim Review; D007680:Kidney Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D008297:Male; D006278:Medicare; D015233:Models, Statistical; D009367:Neoplasm Staging; D011379:Prognosis; D020379:Risk Adjustment; D018426:SEER Program; D014481:United States / Q000453:epidemiology