title: Utilizing national patient-register data to control for comorbidity in prognostic studies.
abstract: OBJECTIVE
  To construct an updated comorbidity index (Patient Register Index [PRI]) using national data collections from Norway and compare its predictive ability of 1-year mortality with the Charlson Comorbidity Index (CCI).
  
  
  METHODS
  Data regarding over 1.11 million patients registered in the Norwegian Patient Register in 2010 and 2011 were used to construct the PRI. The PRI was evaluated by comparing its model fit and discrimination with the CCI.
  
  
  RESULTS
  Compared with the CCI, the PRI weights decreased for six, increased for four, and were unchanged for seven diseases. When the PRI was added to the model including age and sex, the age effects were reduced by up to 38% for patients older than 50 years. All measures of model fit improved for the PRI model.
  
  
  CONCLUSIONS
  Adjustment for comorbidity is especially important for patients 50 years of age or older, and its effect on 1-year mortality is almost comparable to the age effect. The PRI is based on more recent data than the CCI, and is more representative of the general population due to its construction.
authors.affiliation: Department of Registration, Cancer Registry of Norway, Oslo, Norway.
authors.forename: Yngvar
authors.initials: Y
authors.lastname: Nilssen
authors.affiliation: Department of Registration, Cancer Registry of Norway, Oslo, Norway.
authors.forename: Trond-Eirik
authors.initials: TE
authors.lastname: Strand
authors.affiliation: Norwegian Patient Register Department, Norwegian Directorate of Health, Trondheim, Norway.
authors.forename: Robert
authors.initials: R
authors.lastname: Wiik
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: Inger Johanne
authors.initials: IJ
authors.lastname: Bakken
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia ; School of Public Health, University of Sydney, Sydney, NSW, Australia.
authors.forename: Xue Qin
authors.initials: XQ
authors.lastname: Yu
authors.affiliation: Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia ; School of Public Health, University of Sydney, Sydney, NSW, Australia ; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia ; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Dianne L
authors.initials: DL
authors.lastname: O'Connell
authors.affiliation: Department of Registration, Cancer Registry of Norway, Oslo, Norway.
authors.forename: Bjørn
authors.initials: B
authors.lastname: Møller
keywords: Charlson Comorbidity Index; National Patient Register; comorbidity; patient-register index; predictive ability; prognostic value