Previously developed risk scores contained an error in their construction adding ratios instead of multiplying them. Furthermore, as demonstrated here, adding ratios fail to even work adequately from a practical standpoint. CCS derived using regression coefficients performed slightly better than in fitting the data compared to risk ratio-based scoring systems. Researchers should use a regression coefficient-based scoring system to develop a risk index, which is theoretically correct.

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IMPORTANCE Nursing home residents account for approximately 40% of deaths from SARS-CoV-2. OBJECTIVE To identify risk factors for SARS-CoV-2 incidence, hospitalization, and mortality among nursing home residents in the US.

Trimodal therapy was associated with significantly decreased overall survival and cancer-specific survival as well as $335 million in excess spending in 2011. These findings have important health policy implications regarding the appropriate use of high value-based care among older adults with invasive bladder cancer who are candidates for either radical cystectomy or trimodal therapy.

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Introduction The optimal methodology for assessing comorbidity to predict various surgical outcomes such as mortality, readmissions, complications and failure to rescue (FTR) using claims data has not been established. Objective Compare diagnosis- and prescription-based comorbidity scores for predicting surgical outcomes. Methods We used 100% Texas Medicare data (2006–2011) and included patients undergoing coronary artery bypass grafting (CABG), pulmonary lobectomy, endovascular repair of abdominal aortic aneurysm, open repair of abdominal aortic aneurysm, colectomy, and hip replacement (N=39,616). The ability of diagnosis-based (Charlson comorbidity score, Elixhauser comorbidity score, Combined Comorbidity Score, Centers for Medicare & Medicaid Services-Hierarchical Condition Categories [CMS-HCC]) vs. prescription-based chronic disease (CDS) score in predicting 30-day mortality, 1-year mortality, 30-day readmission, complications, and FTR were compared using c-statistics (c) and integrated discrimination improvement (IDI). Results The overall 30-day mortality was 5.8%, 1-year mortality was 17.7%, 30-day readmission was 14.1%, complication rate was 39.7%, and FTR was 14.5%. CMS-HCC performed the best in predicting surgical outcomes (30-day mortality, c=0.791, IDI=4.59%; 1-year mortality, c=0.798, IDI=9.60%; 30-day readmission, c=0.630, IDI=1.27%; complications, c=0.766, IDI=9.37%; FTR, c=0.811, IDI=5.24%) followed by Elixhauser comorbidity index/disease categories (30-day mortality, c=0.750, IDI=2.37%; 1-year mortality, c=0.755, IDI=5.82%; 30-day readmission, c=0.629, IDI=1.43%; complications, c=0.730, IDI=3.99%; FTR, c=0.749, IDI=2.17%). Addition of prescription-based scores to diagnosis-based scores did not improve performance. Conclusions The CMS-HCC had superior performance in predicting surgical outcomes. Prescription-based scores, alone or in addition to diagnosis-based scores, were not better than any diagnosis-based scoring system.

BACKGROUND:The concomitant use of tyrosine kinase inhibitors (TKIs) and proton pump inhibitors (PPIs) is a significant concern because of potential drug-drug interaction that reduces TKI absorption, thus potentially reducing the effectiveness of TKIs. The objective of this study was to evaluate the prevalence and predictors of concomitant TKI-PPI receipt and its impact on survival and therapy discontinuation in older adults with cancer. METHODS: This retrospective study used linked Surveillance, Epidemiology, and End Results-Medicare data for the years 2007 through 2012. In total, 12,538 patients with lung cancer, renal cell cancer, chronic myelogenous leukemia, liver cancer, or pancreatic cancer were included. The primary exposure variable was concomitant receipt of TKI-PPI, defined as at least 30 days of PPI use in the first 90 days from the start of the TKI (exposure period). The outcomes measured were overall survival and discontinuation of therapy in 90 days and 1 year after the end of the exposure period. Cox proportional-hazards regression with inverse probability of treatment weighting was used to evaluate the association between exposure and outcome. RESULTS: The overall prevalence of TKI-PPI receipt was 22.7%. Predictors that were associated with increased use included polypharmacy and prior PPI receipt. TKI-PPI use decreased survival in 90 days (hazard ratio, 1.16; 95% confidence interval, 1.05-1.28) and in 1 year (hazard ratio, 1.10; 95% confidence interval, 1.04-1.18) but was not associated with discontinuation. CONCLUSIONS: Nearly 1 in 4 older adults with cancer who receive TKIs also receive PPIs concomitantly, and concomitant use is associated with an increased risk of death. Concerted efforts to manage medications are needed to identify and reduce the receipt of PPIs when TKIs are initiated.

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