Health Policy Manag.  2016 Mar;26(1):71-78. 10.4332/KJHPA.2016.26.1.71.

Comorbidity Adjustment in Health Insurance Claim Database

Affiliations
  • 1Health Insurance Review and Assessment Service, Wonju, Korea. rudgns112@hiramail.net

Abstract

The value of using health insurance claim database is continuously rising in healthcare research. In studies where comorbidities act as a confounder, comorbidity adjustment holds importance. Yet researchers are faced with a myriad of options without sufficient information on how to appropriately adjust comorbidity. The purpose of this study is to assist in selecting an appropriate index, look back period and data range for comorbidity adjustment. No consensus has been formed regarding the appropriate index, look back period and data range in comorbidity adjustment. This study recommends the Charlson comorbidity index be selected when predicting the outcome such as mortality, and the Elixhauser's comorbidity measures be selected when analyzing the relations between various comorbidities and outcomes. A longer look back period and inclusion of all diagnoses of both inpatient and outpatient data led to increased prevalence of comorbidities, but contributed little to model performance. Limited data range, such as the inclusion of primary diagnoses only, may complement limitations of the health insurance claim database, but could miss important comorbidities. This study suggests that all diagnoses of both inpatients and outpatients data, excluding rule-out diagnosis, be observed for at least 1 year look back period prior to the index date. The comorbidity index, look back period, and data range must be considered for comorbidity adjustment. To provide better guidance to researchers, follow-up studies should be conducted using the three factors based on specific diseases and surgeries.

Keyword

Health insurance claim database; Comorbidity adjustment; Comorbidity index; Look back period; Data range

MeSH Terms

Comorbidity*
Complement System Proteins
Consensus
Diagnosis
Follow-Up Studies
Health Services Research
Humans
Inpatients
Insurance, Health*
Mortality
Outpatients
Prevalence
Complement System Proteins
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