A note on proposed estimation procedures for claims-based frailty indexes

Dane R. Van Domelen, Karen Bandeen-Roche

Research output: Contribution to journalReview articlepeer-review


The groups use competing frailty measures, but the premise is similar: In a validation data set, model the frailty measure versus claims variables; in the primary data set, impute frailty status from claims variables, and conduct inference with those imputed values in place of the unobserved frailty measure. Potential use cases include risk prediction, confounding control, and prevalence estimation. In this commentary, we describe validity issues underlying these approaches, focusing mainly on risk prediction. Our main concern is that these approaches do not permit valid estimation of associations between the reference standard frailty measure (i.e., "frailty") and health outcomes. We argue that Segal's approach is akin to multiple imputation but with the outcome variable omitted from the imputation model, while Kim's is akin to regression calibration but with many variables improperly treated as surrogates.We discuss alternatives for risk prediction, including a secondary approach previously considered by Kim et al., and briefly comment on other use cases.

Original languageEnglish (US)
Pages (from-to)369-371
Number of pages3
JournalAmerican journal of epidemiology
Issue number5
StatePublished - 2020


  • Multiple imputation
  • Regression calibration
  • Surrogacy
  • Validation data

ASJC Scopus subject areas

  • Epidemiology


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