Primary Care Prognostic (PCP) Index of 11-Year Mortality Risk: Development and Validation of a Brief Prognostic Tool

BACKGROUND: Healthcare providers use a life expectancy

of at least 5 to 10 years in shared clinical decision-making

with older adults about cancer screening, major surgeries,

and disease prevention interventions. At present, few prognostic

indexes predict long-termmortality beyond 10 years

or are suited for use in primary care settings.

OBJECTIVE: We developed and validated an 8-item multidimensional

index predicting 11-year mortality for use

in primary care.

DESIGN, SETTING, AND PARTICIPANTS: Using data

from the Singapore Longitudinal Ageing Studies (SLAS),

we developed a Primary Care Prognostic (PCP) Index for

predicting 11-year mortality risk in a development cohort

(n = 1550) and validated it in a geographically different

cohort (n = 928).

MAIN MEASURES: The PCP Index was derived fromeight

indicators (body mass loss, weakness, slow gait, comorbidity,

polypharmacy, IADL/BADL dependency, low albumin,

low total cholesterol, out of 25 candidate indicators)

using stepwise Cox proportional hazard models.

KEY RESULTS: In the developmental cohort, the mortality

hazard ratio increased by 53% per PCP point score increase,

independent of age and sex. Across risk categories, absolute

risks of mortality increased from 5% (score 0) to 67.9%

(scores 7–9), with area under curve (AUC = 0.77 (95% CI

0.73–0.80)). The PCP Index also predicted mortality in the

validation cohort, with AUC = 0.70 (95% CI 0.64–0.75).

CONCLUSIONS: The PCP Index using simple clinical assessments

and point scoring is a potentially useful prognostic

tool for predicting long-term mortality and is well

suited for risk stratification and shared clinical decisionmaking

with older adults in primary care.