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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.130955v1 98/7/1209    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Lee, S. J. Articles by Covinsky, K. E. PubMed PubMed Citation Articles by Lee, S. J. Articles by Covinsky, K. E. Related Collections Aging Other Chronic Disease Surveys

Sei J. Lee, MD, MAS, Alan S. Go, MD, Karla Lindquist, MS, Daniel Bertenthal, MPH and Kenneth E. Covinsky, MD, MPH

Sei J. Lee, Daniel Bertenthal, and Kenneth E. Covinsky are with the San Francisco Veterans Affairs Medical Center, Health Services Research and Development Research Enhancement Award Program, San Francisco, CA. Sei J. Lee, Karla Lindquist, and Kenneth E. Covinsky are with the Division of Geriatrics, University of California, San Francisco. Alan S. Go is with the Division of Research, Northern California Kaiser Permanente, Oakland, CA.

Correspondence: Requests for reprints should be sent to Sei J. Lee, San Francisco VA Medical Center, HSR&D Research Enhancement Award Program, 4150 Clement St., Bldg. 1, Room 211A, San Francisco, CA 94121 (e-mail: sei.lee{at}ucsf.edu).

Objectives. We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults.

Methods. Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality.

Results. As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50–59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90–99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004).

Conclusions. The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years.