Evidence map›Paper›PMID 38548358›Full record

ArticleBMJ open2024

How valid is a prescription-based multimorbidity index (Rx-risk) in predicting mortality in the Outcomes and Multimorbidity In Type 2 diabetes (OMIT) study? A nation-wide registry-based cohort study from Norway.

Jannicke Igland, Rachel Forster, Anne Karen Jenum, Ragnhild B Strandberg, Tore Julsrud Berg, Jan Ivar Røssberg, Marjolein Memelink Iversen, Esben Selmer Buhl

Erratum issuedAbstract read
In one paragraph

Article in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
  4. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors.

Jannicke IglandDepartment of Global Public Health and Primary Care, University of Bergen, Bergen, Norway Jannicke.Igland@uib.no.ORCID 0000-0002-2289-0978
Rachel ForsterDepartment of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway.
Anne Karen JenumDepartment of General Practice, University of Oslo, Oslo, Norway.
Ragnhild B StrandbergDepartment of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway.ORCID 0000-0003-0256-438X
Tore Julsrud BergDepartment of Endocrinology, Oslo University Hospital, Oslo, Norway.
Jan Ivar RøssbergInstitute of Clinical Medicine, University of Oslo, Oslo, Norway.
Marjolein Memelink IversenDepartment of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Hordaland, Norway.ORCID 0000-0001-9954-171X
Esben Selmer BuhlDepartment of General Practice, University of Oslo, Oslo, Norway.ORCID 0000-0002-7844-2357

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe prescription-based Rx-risk index has previously been developed to measure multimorbidity. We aimed to adapt and evaluate the validity of the Rx-risk index in prediction of mortality among persons with type 2 diabetes.

designRegistry-based study.

settingAdults with type 2 diabetes in Norway identified within the 'Outcomes and Multimorbidity In Type 2 diabetes' cohort, with linkage to prescriptions from the Norwegian Prescription Database and mortality from the Population Registry.

participantsWe defined a calibration sample of 42 290 adults diagnosed with type 2 diabetes 1950-2013, and a temporal validation sample of 7085 adults diagnosed 2014-2016 to evaluate the index validity over time PRIMARY OUTCOME MEASURE: All-cause mortality

methodsFor the calibration sample, dispensed drug prescriptions in 2013 were used to define 44 morbidity categories. Weights were estimated using regression coefficients from a Cox regression model with 5 year mortality as the outcome and all morbidity categories, age and sex included as covariates. The Rx-risk index was computed as a weighted sum of morbidities. The validity of the index was evaluated using C-statistic and calibration plots.

resultsIn the calibration sample, mean (SD) age at start of follow-up and duration of diabetes was 63.8 (12.4) and 10.1 (7.0) years, respectively. The overall C-statistic was 0.82 and varied from 0.74 to 0.85 when stratifying on age groups, sex, level of education and country of origin. In the validation sample, mean (SD) age and duration of diabetes was 59.7 (13.0) and 2.0 (0.8) years, respectively. Despite younger age, shorter duration of diabetes and later time period, the C-index was high both in the total sample (0.84) and separately for men (0.83) and women (0.84).

conclusionsThe Rx-risk index showed good discrimination and calibration in predicting mortality and thus presents a valid tool to assess multimorbidity among persons with type 2 diabetes.

Indexed as

Diabetes Mellitus, Type 2AdultCohort StudiesFemaleHumansMaleMultimorbidityNorwayPrescriptionsCLINICAL PHARMACOLOGYDIABETES & ENDOCRINOLOGYEPIDEMIOLOGYMortality

Identifiers

PMID38548358
PMCPMC10982738

What Socratic holds

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LicenceCC BY-NC
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.