Using the Functional Comorbidity Index with administrative workers’ compensation data: Utility, validity, and caveats

Details

• Alternative Title:
  Am J Ind Med
• Personal Author:
  Sears, Jeanne M. ; Rundell, Sean D. ; Fulton-Kehoe, Deborah ; Hogg-Johnson, Sheilah ; Franklin, Gary M.
• 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.
  
  
• Subjects:
  Adult Chronic Disease Comorbidity Humans Prospective Studies Washington Workers' Compensation
• Keywords:
  Administrative Data Chronic Health Conditions Functional Comorbidity Index Workers’ Compensation
• Source:
  Am J Ind Med. 67(2):99-109
• Pubmed ID:
  37982343
• Pubmed Central ID:
  PMC10824282
• Document Type:
  Journal Article
• Funding:
  R03 OH012309/OH/NIOSH CDC HHSUnited States/ ; T42 OH008433/OH/NIOSH CDC HHSUnited States/ ; R03OH012309/OH/NIOSH CDC HHSUnited States/
• Volume:
  67
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:b52c6d985bb98b629f7d00952644a49a4008ee36a27d85338082d37a6fb52c4965f24e7476b4bc0c7b5fc48eacf3ed13594008b146aeb6da653f2077e2b1da0c
• Download URL:
  https://stacks.cdc.gov/view/cdc/147663/cdc_147663_DS1.pdf
• File Type:
  [PDF - 175.24 KB ]