title: Comorbidity-adjusted life expectancy: a new tool to inform recommendations for optimal screening strategies.
abstract: BACKGROUND
  Many guidelines recommend considering health status and life expectancy when making cancer screening decisions for elderly persons.
  
  
  OBJECTIVE
  To estimate life expectancy for elderly persons without a history of cancer, taking into account comorbid conditions.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  A 5% sample of Medicare beneficiaries in selected geographic areas, including their claims and vital status information.
  
  
  METHODS
  Medicare beneficiaries aged 66 years or older between 1992 and 2005 without a history of cancer (n = 407 749).
  
  
  METHODS
  Medicare claims were used to identify comorbid conditions included in the Charlson index. Survival probabilities were estimated by comorbidity group (no, low/medium, and high) and for the 3 most prevalent conditions (diabetes, chronic obstructive pulmonary disease, and congestive heart failure) by using the Cox proportional hazards model. Comorbidity-adjusted life expectancy was calculated based on comparisons of survival models with U.S. life tables. Survival probabilities from the U.S. life tables providing the most similar survival experience to the cohort of interest were used.
  
  
  RESULTS
  Persons with higher levels of comorbidity had shorter life expectancies, whereas those with no comorbid conditions, including very elderly persons, had favorable life expectancies relative to an average person of the same chronological age. The estimated life expectancy at age 75 years was approximately 3 years longer for persons with no comorbid conditions and approximately 3 years shorter for those with high comorbidity relative to the average U.S. population.
  
  
  CONCLUSIONS
  The cohort was limited to Medicare fee-for-service beneficiaries aged 66 years or older living in selected geographic areas. Data from the Surveillance, Epidemiology, and End Results cancer registry and Medicare claims lack information on functional status and severity of comorbidity, which might influence life expectancy in elderly persons.
  
  
  CONCLUSIONS
  Life expectancy varies considerably by comorbidity status in elderly persons. Comorbidity-adjusted life expectancy may help physicians tailor recommendations for stopping or continuing cancer screening for individual patients.
authors.forename: Hyunsoon
authors.initials: H
authors.lastname: Cho
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.forename: K Robin
authors.initials: KR
authors.lastname: Yabroff
authors.forename: Zhuoqiao
authors.initials: Z
authors.lastname: Wang
authors.forename: Angela
authors.initials: A
authors.lastname: Meekins
authors.forename: Iris
authors.initials: I
authors.lastname: Lansdorp-Vogelaar
authors.forename: Angela B
authors.initials: AB
authors.lastname: Mariotto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D055088:Early Detection of Cancer; D005260:Female; D006304:Health Status; D006801:Humans; D008017:Life Expectancy; D015993:Life Tables; D008297:Male; D008403:Mass Screening; D006278:Medicare; D014481:United States