Highlights
- •Mortality prediction models are used in clinical decision making in old age.
- •The added value of health indicators to mortality predictions is not yet explored.
- •Age and sex contributed the most to mortality predictions in old age.
- •The added value of health indicators is likely to be limited.
- •The lack of validation samples made it difficult to assess their true value.
Abstract
Background
Numerous risk prediction models use indicators of health to predict mortality in old
age. The added value to mortality predictions based on demographic variables is unknown.
Objective
To evaluate the accuracy of health indicators in predicting all-cause mortality among
individuals aged 50+ using area under receiver operating characteristic curve (AUC).
Specifically, to assess the added value of health indicators relative to demographic
variables.
Methods
We conducted a systematic review following the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses. There were no restrictions on study designs, follow-up
duration, language, or publication dates. We also examined the quality of studies
using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews
of Prediction Modelling Studies.
Results
Out of 804 studies investigating all-cause mortality in older persons, 16 studies
were eligible. In community-dwelling populations, the accuracy of demographic variables
and health indicators combined ranged from AUC 0.71 to 0.82, indicating modest ability
to predict mortality. Age contributed the most to mortality prediction (AUC 0.65 to
0.78) and compared to age and sex, the added values of genetics, physiology, functioning,
mood, cognition, nutritional status, subjective health, disease, frailty, and lifestyle
ranged from AUC 0.01 to 0.10. The lack of validation samples made it difficult to
assess their true added value. Findings were similar in institutionalized populations.
Heterogeneity of the studies prevented us from performing a meta-analysis.
Conclusion
Age and sex contributed the most to mortality predictions in old age while the added
value of health indicators is likely to be limited.
Keywords
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Article info
Publication history
Published online: July 15, 2018
Accepted:
June 21,
2018
Received in revised form:
June 18,
2018
Received:
March 1,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
