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Quinzler, Renate; Freitag, Michael H.; Wiese, Birgitt; Beyer, Martin; Brenner, Hermann; Dahlhaus, Anne; Döring, Angela; Freund, Tobias; Heier, Margit; Knopf, Hildtraud; Luppa, Melanie; Prokein, Jana; Riedel-Hellerk, Steffi G.; Schäfer, Ingmar; Scheidt-Nave, Christa; Scherer, Martin; Schoettker, Ben; Szecsenyi, Joachim; Thuermann, Petra; van den Bussche, Hendrik; Gensichen, Jochen and Haefeli, Walter E. (2019): A novel superior medication-based chronic disease score predicted all-cause mortality in independent geriatric cohorts. In: Journal of Clinical Epidemiology, Vol. 105: pp. 112-124

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Objectives: On the basis of current treatment guidelines, we developed and validated a medication-based chronic disease score (medCDS) and tested its association with all-cause mortality of older outpatients. Study Design and Setting: Considering the most prevalent chronic diseases in the elderly German population, we compiled a list of evidence-based medicines used to treat these disorders. Based on this list, a score (medCDS) was developed to predict mortality using data of a large longitudinal cohort of older outpatients (training sample;MultiCare Cohort Study). By assessing receiver-operating characteristics (ROC) curves, the performance of medCDS was then confirmed in independent cohorts (ESTHER, KORA-Age) of community-dwelling older patients and compared with already existing medication-based scores and a score using selected anatomical-therapeutic-chemical (ATC) codes. Results: The final medCDS score had an ROC area under the curve (AUC) of 0.73 (95% CI 0.70-0.76). In the validation cohorts, its ROC AUCs were 0.79 (0.76-0.82, KORA-Age) and 0.74 (0.71-0.78, ESTHER), which were superior to already existing medication-based scores (RxRisk, CDS) and scores based on pharmacological ATC code subgroups (ATC3) or age and sex alone (Age&Sex). Conclusions: A new medCDS, which is based on actual treatment standards, predicts mortality of older outpatients significantly better than already existing scores. (C) 2018 Elsevier Inc. All rights reserved.

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