Using elastic nets to estimate frailty burden from routinely collected national aged care data
Date
2020
Authors
Moldovan, M.
Khadka, J.
Visvanathan, R.
Wesselingh, S.
Inacio, M.C.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
Journal of the American Medical Informatics Association : JAMIA, 2020; 27(3):419-428
Statement of Responsibility
Max Moldovan, Jyoti Khadka, Renuka Visvanathan, Steve Wesselingh, and Maria C. Inacio
Conference Name
Abstract
OBJECTIVES: To (1) use an elastic net (EN) algorithm to derive a frailty measure from a national aged care eligibility assessment program; (2) compare the ability of EN-based and a traditional cumulative deficit (CD) based frailty measures to predict mortality and entry into permanent residential care; (3) assess if the predictive ability can be improved by using weighted frailty measures. MATERIALS AND METHODS: A Cox proportional hazard model based EN algorithm was applied to the 2003-2013 cohort of 903 996 participants for selecting items to enter an EN based frailty measure. The out-of-sample predictive accuracy was measured by the area under the curve (AUC) from Cox models fitted to 80% training and validated on 20% testing samples. RESULTS: The EN approach resulted in a 178-item frailty measure including items excluded from the 44-item CD-based measure. The EN based measure was not statistically significantly different from the CD-based approach in terms of predicting mortality (AUC 0.641, 95% CI: 0.637-0.644 vs AUC 0.637, 95% CI: 0.634-0.641) and permanent care entry (AUC 0.626, 95% CI: 0.624-0.629 vs AUC 0.627, 95% CI: 0.625-0.63). However, the weighted EN based measure statistically outperforms the weighted CD measure for predicting mortality (AUC 0.774, 95% CI: 0.771-0.777 vs AUC 0.757, 95% CI: 0.754-0.760) and permanent care entry (AUC 0.676, 95% CI: 0.673-0.678 vs AUC 0.671, 95% CI: 0.668-0.674). CONCLUSIONS: The weighted EN and CD-based measures demonstrated similar prediction performance. The CD-based measure items are relevant to frailty measurement and easier to interpret. We recommend using the weighted and unweighted CD-based frailty measures.
School/Discipline
Dissertation Note
Provenance
Description
Advance Access Publication Date: 17 January 2020
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Rights
© The Author(s) 2020. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved.