Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Sources and Study Population
2.2. Outcomes
2.3. Confounding Variables
2.4. Statistical Analysis
3. Results
3.1. Hospitalization
3.2. Deaths
3.3. Comorbidities
3.4. Adjusted Models of Overall Mortality
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Total (n = 3827) | Age Groups | Sex | ||||||
---|---|---|---|---|---|---|---|---|
65–74 (n = 2433) 63.57% | 75–84 (n = 1166) 30.47% | 85+ (n = 228) 5.96% | p Value | Male (n = 2007) 52.44% | Female (n = 1820) 47.56% | p Value | ||
Age distribution | ||||||||
Mean age (years) | 72.89 ± 6.37 | 74.07 ± 6.70 | 71.60 ± 5.71 | |||||
No. of males (%) | 2007 | 1124 (56.00) | 716 (35.68) | 167 (8.32) | <0.0001 | |||
No. of Females (%) | 1820 | 1309 (71.92) | 450 (24.73) | 61 (3.35) | ||||
Number of hospitalization (except first admission) | ||||||||
SZ-related | 1.80 ± 3.37 | 2.04 ± 3.68 | 1.47 ± 2.79 | 0.95 ± 2.05 | <0.0001 | 1.91 ± 3.71 | 1.69 ± 2.94 | 0.0423 |
Non-SZ-related | 3.58 ± 5.48 | 3.29 ± 5.66 | 4.19 ± 5.26 | 3.49 ± 4.38 | <0.0001 | 4.27 ± 6.08 | 2.81 ± 4.62 | <0.0001 |
Hospital stay (days) of first admission due to schizophrenia | ||||||||
Days | 26.00 | 29.00 | 20.00 | 14 | 0.0613 | 22.00 | 28.00 | 0.0110 |
(Q1, Q3) | (9.00, 58.00) | (10.00, 60.00) | (8.00, 52.00) | (7.00, 41.50) | (8.00, 59.00) | (10.00, 56.00) | ||
Follow-up | ||||||||
Year | 4.11 | 6.71 | 4.43 | 2.14 | <0.0001 | 3.58 | 4.70 | <0.0001 |
(Q1, Q3) | (1.66, 7.35) | (3.05, 11.39) | (1.74, 8.39) | (0.75, 4.38) | (1.30, 6.75) | (2.23, 7.89) | ||
Working type | ||||||||
Heavy labor | 614 (16.04) | 444 (18.25) | 153 (13.12) | 17 (7.46) | <0.0001 | 198 (9.87) | 416 (22.86) | <0.0001 |
Moderate labor | 960 (25.08) | 698 (28.69) | 229 (19.64) | 33 (14.47) | 429 (21.38) | 531 (29.18) | ||
Light labor | 2253 (58.88) | 1291 (53.06) | 784 (67.24) | 178 (78.07) | 1380 (68.75) | 873 (47.97) | ||
Hospital location | ||||||||
North | 1279 (33.42) | 859 (35.31) | 363 (31.13) | 57 (25.00) | <0.0001 | 528 (26.31) | 751 (41.26) | <0.0001 |
Center | 857 (22.39) | 593 (24.37) | 222 (19.04) | 42 (18.42) | 442 (22.02) | 415 (22.80) | ||
South | 1010 (26.39) | 676 (27.78) | 285 (24.44) | 49 (21.49) | 507 (25.26) | 503 (27.64) | ||
East | 664 (17.35) | 297 (12.21) | 287 (24.61) | 80 (35.09) | 518 (25.81) | 146 (8.02) | ||
Offshore | 17 (0.45) | 8 (0.33) | 9 (0.78) | - | 12 (0.60) | 5 (0.27) | ||
Hospital level | ||||||||
Medical centers | 608 (15.89) | 414 (17.02) | 160 (13.72) | 34 (14.91) | <0.0001 | 215 (10.71) | 393 (21.59) | <0.0001 |
Metropolitan hospitals | 1513 (39.53) | 1087 (44.68) | 371 (31.82) | 55 (24.12) | 667 (33.23) | 846 (46.48) | ||
Local community | 1695 (44.29) | 923 (37.94) | 633 (54.29) | 139 (60.96) | 1121 (55.85) | 574 (31.54) | ||
Physician clinics | 11 ( 0.29) | 9 (0.37) | 2 (0.17) | - | 4 (0.21) | 7 (0.38) | ||
Death | ||||||||
Number of deaths (from first admission of SZ) | 1899 | 982 | 755 | 162 | 1218 | 681 | ||
Mean age at death (years) | 73.50 ± 4.32 | 82.14 ± 3.83 | 89.32 ± 2.94 | 78.77 ± 6.68 | 77.41 ± 6.54 | |||
(Q1, Q3) | (70.00, 76.00) | (79.00, 85.00) | (87.00, 91.00) | (74.00, 84.00) | (72.00, 82.00) | |||
Time from 1st admission to death (years) | 4.24 ± 3.19 | 3.33 ± 2.86 | 1.87 ± 1.71 | 3.41 ± 2.97 | 4.15 ± 3.12 | |||
(Q1, Q3) | (1.46, 6.47) | (0.945, 4.95) | (0.44, 3.06) | (0.88, 5.20) | (1.46, 6.30) | |||
Days of hospitalization | 106.80 ± 330.15 | 92.62 ± 258.63 | 61.75 ± 158.19 | 111.49 ± 332.89 | 86.90 ± 263.52 | |||
(Q1, Q3) | (10.00, 60.00) | (8.00, 52.00) | (7.00, 41.50) | (8.00, 59.00) | (10.00, 56.00) | |||
Number of hospitalizations | 5.33 ± 6.90 | 5.67 ± 5.91 | 4.44 ± 4.96 | 6.18 ± 7.19 | 4.50 ± 5.55 | |||
(Q1, Q3) | (1.00, 7.00) | (2.00, 8.00) | (1.00, 6.00) | (2.00, 8.00) | (1.00. 6.00) |
CCI Scores | Total (n = 3827) | Age Group | Sex | |||
---|---|---|---|---|---|---|
65–74 (n = 2433) | 75–84 (n = 1166) | 85+ (n = 228) | Male (n = 2007) | Female (n = 1820) | ||
0 | 1182 (30.89) | 899 (36.95) | 254 (21.78) | 29 (12.72) | 540 (26.91) | 642 (35.27) |
1 | 902 (23.57) | 612 (25.15) | 258 (22.13) | 32 (14.04) | 455 (22.67) | 447 (24.56) |
2 | 653 (17.06) | 374 (15.37) | 225 (19.30) | 54 (23.68) | 359 (17.89) | 294 (16.15) |
3 | 443 (11.58) | 230 (9.45) | 178 (15.27) | 35 (15.35) | 250 (12.46) | 193 (10.60) |
4 | 271 (7.08) | 145 (5.96) | 97 (8.32) | 29 (12.72) | 171 (8.52) | 100 (5.49) |
5 | 170 (4.44) | 87 (3.58) | 59 (5.06) | 24 (10.53) | 89 (4.43) | 81 (4.45) |
6 | 89 (2.33) | 34 (1.40) | 48 (4.12) | 7 (3.07) | 66 (3.29) | 23 (1.26) |
7 | 45 (1.18) | 23 (0.95) | 14 (1.20) | 8 (3.51) | 31 (1.54) | 14 (0.77) |
8 | 35 (0.91) | 16 (0.66) | 15 (1.29) | 4 (1.75) | 22 (1.10) | 13 (0.71) |
9 | 14 (0.37) | 6 (0.25) | 6 (0.51) | 2 (0.88) | 8 (0.40) | 6 (0.33) |
10 | 11 (0.29) | 4 (0.16) | 6 (0.51) | 1 (0.44) | 9 (0.45) | 2 (0.11) |
11 | 5 (0.13) | 1 (0.04) | 2 (0.17) | 2 (0.88) | 2 (0.10) | 3 (0.16) |
12 | 3 (0.08) | 1 (0.04) | 2 (0.17) | 0 (0.00) | 2 (0.10) | 1 (0.05) |
13 | 2 (0.05) | 1 (0.04) | 0 (0.00) | 1 (0.44) | 1 (0.05) | 1 (0.05) |
14 | 1 (0.03) | 0 (0.00) | 1 (0.09) | 0 (0.00) | 1 (0.05) | 0 (0.00) |
15 | 1 (0.03) | 0 (0.00) | 1 (0.09) | 0 (0.00) | 1 (0.05) | 0 (0.00) |
Mean | 1.82 ± 1.98 | 1.52 ± 0.79 | 2.25 ± 2.14 | 2.96 ± 2.31 | 2.04 ± 2.09 | 1.59 ± 1.83 |
<3 | 2737 (71.52) | 1885 (77.48) | 737 (63.21) | 115 (50.44) | 1354 (67.46) | 1383 (75.99) |
≥3 | 1090 (28.48) | 548 (22.52) | 429 (36.79) | 113 (49.56) | 653 (32.54) | 437 (24.01) |
Comorbidity | Total (n = 3827) | Age Groups | |||
---|---|---|---|---|---|
65–74 (n = 2433) | 75–84 (n = 1166) | 85+ (n = 228) | |||
Myocardial infarction | 66 (1.72) | 36 (1.48) | 23 (1.97) | 7 (3.07) | |
Congestive heart failure | 357 (9.33) | 151 (6.21) | 161 (13.81) | 45 (19.74) | |
Peripheral vascular disease | 114 (2.98) | 55 (2.26) | 47 (4.03) | 12 (5.26) | |
Cerebrovascular disease | 752 (19.65) | 401 (16.48) | 274 (23.50) | 77 (33.77) | |
Dementia | 1294 (33.81) | 579 (23.80) | 559 (47.94) | 156 (68.42) | |
Chronic pulmonary disease | 973 (25.42) | 468 (19.24) | 395 (33.88) | 110 (48.25) | |
Rheumatic disease | 75 (1.96) | 46 (1.89) | 24 (2.06) | 5 (2.19) | |
Peptic ulcer disease | 834 (21.79) | 470 (19.32) | 299 (25.64) | 65 (28.51) | |
Mild liver disease | 442 (11.55) | 269 (11.06) | 143 (12.26) | 30 (13.16) | |
Diabetes | 891 (22.29) | 577 (23.72) | 265 (22.72) | 49 (21.49) | |
Hemiplegia or paraplegia | 53 (1.38) | 31 (1.27) | 17 (1.46) | 5 (2.19) | |
Renal disease | 188 (4.91) | 91 (3.74) | 71 (6.09) | 26 (11.40) | |
Any malignancy a | 169 (4.42) | 94 (3.86) | 61 (5.23) | 14 (6.14) | |
Moderate or severe liver disease | 15 (0.39) | 6 (0.25) | 7 (0.60) | 2 (0.88) | |
Metastatic solid tumor | 25 (0.65) | 13 (0.53) | 10 (0.86) | 2 (0.88) | |
AIDS/HIV | - | - | - | ||
65–69 | 70–74 | 75–79 | 80–84 | 85+ | |
Dementia | 276 (18.76) | 303 (31.50) | 315 (42.74) | 244 (56.88) | 156 (68.42) |
Diabetes without chronic complication | 299 (20.33) | 170 (17.67) | 138 (18.72) | 76 (17.72) | 39 (17.11) |
Diabetes with chronic complication | 71 (4.83) | 37 (3.85) | 35 (4.75) | 16 (3.73) | 10 (4.39) |
Univariate Analysis | Multivariable Analysis | |||
---|---|---|---|---|
Hazard Ratio (95% CI) | p Value | Hazard Ratio (95% CI) | p Value | |
Age | 1.08 (1.08–1.09) | p < 0.0001 | 1.07 (1.06–1.08) | p < 0.0001 |
Sex | ||||
Male | 2.09 (1.87–2.34) | p < 0.0001 | 1.66 (1.47–1.87) | p < 0.001 |
Female | 1 | 1 | ||
CCI score | 1.20 (1.17–1.23) | p < 0.0001 | 1.14 (1.12–1.17) | p < 0.0001 |
Working type | ||||
Heavy labor | 1 | 1 | ||
Moderate labor | 1.31 (1.07–1.59) | p = 0.0072 | 1.25 (1.03–1.52) | p = 0.0264 |
Light labor | 1.74 (1.47–2.06) | p < 0.0001 | 1.25 (1.05–1.49) | p = 0.0136 |
Hospital location | ||||
North | 1 | |||
Center | 1.06 (0.91–1.24) | NS | ||
South | 1.14 (0.99–1.32) | NS | ||
East and Offshore | 1.83 (1.58–2.12) | p < 0.0001 | ||
Hospital level | ||||
Medical Centers | 1 | |||
Metropolitan H. | 0.91 (0.76–1.09) | NS | ||
Local Community H. | 1.63 (1.38–1.92) | p < 0.0001 | ||
Physician Clinics | 1.14 (0.42–3.07) | NS |
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Hsu, M.-C.; Lee, S.-C.; Ouyang, W.-C. Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia. Healthcare 2021, 9, 783. https://doi.org/10.3390/healthcare9070783
Hsu M-C, Lee S-C, Ouyang W-C. Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia. Healthcare. 2021; 9(7):783. https://doi.org/10.3390/healthcare9070783
Chicago/Turabian StyleHsu, Mei-Chi, Shang-Chi Lee, and Wen-Chen Ouyang. 2021. "Use of Charlson Comorbidity Index and Nomogram to Predict Mortality in Elderly Patients with Late-Life Schizophrenia" Healthcare 9, no. 7: 783. https://doi.org/10.3390/healthcare9070783