title: Individualized Absolute Risk Calculations for Persons with Multiple Chronic Conditions: Embracing Heterogeneity, Causality, and Competing Events.
abstract: Approximately 75% of adults over the age of 65 years are affected by two or more chronic medical conditions. We provide a conceptual justification for individualized absolute risk calculators for competing patient-centered outcomes (PCO) (i.e. outcomes deemed important by patients) and patient reported outcomes (PRO) (i.e. outcomes patients report instead of physiologic test results). The absolute risk of an outcome is the probability that a person receiving a given treatment will experience that outcome within a pre-defined interval of time, during which they are simultaneously at risk for other competing outcomes. This allows for determination of the likelihood of a given outcome with and without a treatment. We posit that there are heterogeneity of treatment effects among patients with multiple chronic conditions (MCC) largely depends on those coexisting conditions. We outline the development of an individualized absolute risk calculator for competing outcomes using propensity score methods that strengthen causal inference for specific treatments. Innovations include the key concept that any given outcome may or may not concur with any other outcome and that these competing outcomes do not necessarily preclude other outcomes. Patient characteristics and MCC will be the primary explanatory factors used in estimating the heterogeneity of treatment effects on PCO and PRO. This innovative method may have wide-spread application for determining individualized absolute risk calculations for competing outcomes. Knowing the probabilities of outcomes in absolute terms may help the burgeoning population of patients with MCC who face complex treatment decisions.
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA.
authors.forename: Heather
authors.initials: H
authors.lastname: Allore
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: McAvay
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Veterans Affairs Clinical Epidemiology Research Center, West Haven, CT, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Vaz Fragoso
authors.affiliation: Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.
authors.forename: Terrence E
authors.initials: TE
authors.lastname: Murphy
keywords: Multiple chronic disease; absolute risk; competing outcomes; decision tools; heterogeneity; longitudinal study; propensity scores