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Using the Functional Comorbidity Index with administrative workers’ compensation data: Utility, validity, and caveats
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2 2024
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Source: Am J Ind Med. 67(2):99-109
[PDF-175.24 KB]
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Alternative Title:Am J Ind Med
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Personal Author:
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Description:BACKGROUND:
Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers’ compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes.
METHODS:
WC data were linked to a prospective survey in Ohio (N=512) and Washington (N=2,839). Workers were interviewed six weeks and six months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using six-month work-related outcomes.
RESULTS:
The WC-based FCI had high specificity but low sensitivity, and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean=1.38; Washington mean=1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean=0.10; Washington mean=0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change).
CONCLUSIONS:
The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution—including state-specific analyses with a reliable reference standard—before using a WC-based FCI in studies involving multiple states.
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Pubmed ID:37982343
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Pubmed Central ID:PMC10824282
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Volume:67
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Issue:2
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