title: Comparison of Elixhauser and Charlson Methods for Predicting Oral Cancer Survival.
abstract: Cancer survival correlates not only with the features of primary malignancy but also with the degree of underlying comorbidities. Of the multiple methods used for evaluating the impact of comorbidities on survival, the Charlson and Elixhauser methods are most common. This study compared these 2 comorbidity measures for predicting survival in oral cancer patients. Using the Taiwan National Health Insurance claims data (2008-2011), we acquired data regarding patients' characteristics, comorbidities, and survival from 3583 oral cancer patients. Comorbidity was classified according to both the Charlson comorbidity and Elixhauser comorbidity based on the International Classification of Diseases, 9th Revision. The Elixhauser comorbidity score and Charlson comorbidity score were also calculated. The prediction of survival was determined using measures of discrimination, including the Akaike information criterion and Harrell C (C-statistic). The mean age of the study cohort was 52 ± 10 years, and 94.9% of the patients were male. The median follow-up time was 30.1 months, and the 3-year overall survival was 61.6%. Elixhauser comorbidity method added higher discrimination, compared with the Charlson comorbidity method (Harrell C, 0.677 vs 0.651). Furthermore, the Elixhauser comorbidity score outperformed the Charlson comorbidity score in continuous variable (Harrell C, 0.654 vs 0.646) and category (Harrell C, 0.658 vs 0.645). The Elixhauser method is a superior comorbidity risk-adjustment model for oral cancer survival prediction. Utilization of the Elixhauser comorbidity method may be encouraged for risk adjustment in oral cancer study.
authors.affiliation: From the Department of Radiation Oncology, Min-Sheng General Hospital, Taoyuan (H-JC); Department of Radiation Oncology, Pingtung Christian Hospital, Pingtung (P-CC); Department of Radiation Oncology, Chi-Mei Medical Center, Tainan (C-CY); Department of Hema-Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi (Y-CS); Department of Otorhinolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung (C-CL); Department of Otolaryngology, Head and Neck Surgery, Tri-Service General Hospital (C-CL); and School of Medicine, National Defense Medical Center (C-CL), Taipei, Taiwan.
authors.forename: Heng-Jui
authors.initials: HJ
authors.lastname: Chang
authors.forename: Po-Chun
authors.initials: PC
authors.lastname: Chen
authors.forename: Ching-Chieh
authors.initials: CC
authors.lastname: Yang
authors.forename: Yu-Chieh
authors.initials: YC
authors.lastname: Su
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
mesh_terms: D000328:Adult; D000465:Algorithms; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000401:mortality; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment; D013624:Taiwan / Q000453:epidemiology