Mortality of Stroke Patients Based on Charlson Comorbidity Index

뇌졸중 환자의 Charlson Comorbidity Index에 따른 사망률 분석

  • 김가희 (양산부산대학교병원 보건의료정보파트) ;
  • 임지혜 (영산대학교 의료경영학과)
  • Received : 2015.09.30
  • Accepted : 2015.12.02
  • Published : 2016.03.28


As the number of aged population rapidly goes up, the cases of stroke and the related medical expenses continuously increase. The purpose of this study is to investigate the mortality of stroke patients based on CCI(Charlson Comorbidity Index) by utilizing the Korea National Hospital Discharge Injury Survey, analyzing the factors associated with the mortality of stroke patients. We analyzed 21,494 cases which are classified as the death of strokes aged over 20 years by using the Korea National Hospital Discharge Injury Survey between the year 2005 and 2010. In order to find out the mortality based on CCI and status of comorbidity, we used the technical statistics. We performed a logistic regression analysis to examine the reasons for the mortality of the strokes. We found that the independent variables for the influence of the mortality of strokes include age, type of insurance, residence urban size, size of hospital beds, the location of hospital, admission route, physical therapy, brain surgery, type of stroke, and CCI. This indicates that the effective monitoring on the age, types of stroke, comorbidity is needed. In addition to this, more medical support toward medicaid patients are needed, too. We believe that these results will be used positively for the evaluation of the stroke patients, providing the basic materials for the further research on the establishment of the health-related policy.


CCI(Charlson comorbidity index);Korea National Hospital Discharge Injury Survey;Mortality;Comorbidity


  1. 통계청, 2013년 사망원인통계, 2014.
  2. 김선희, 이해종, "뇌졸중 환자의 결과지표에 영향을 주는 요인: 다변량 회귀분석과 다수준분석 비교," 보건행정학회지, 제25권, 제1호, pp.31-39, 2015.
  3. 건강보험심사평가원, 급성 뇌졸중 평가, 2012.
  4. 신중일, 김경윤, "연하장애에 대한 병식이 없는 뇌졸중 환자들의 연하장애 유무와 양상," 한국산학기술학회논문지, 제12권, 제1호, pp.294-300, 2011.
  5. 권영대, "의료의 결과 평가와 위험요인 보정," 한국의료 QA학회지, 제13권, 제1호, pp.59-67, 2007.
  6. 윤석준, "건강결과연구의 개념," 한국의료 QA학회지, 제13권, 제1호, pp.9-12, 2007.
  7. M. E. Charlson, P. Pompei, K. Ales, and C. R. Mackenize, "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation," J Chron Dis, Vol.40, No.5, pp.373-383, 1987.
  8. N. S. Bardach, S. Zhao, D. R. Gress, M. T. Lawton, and S. C. Johnston, "Association between subarachnoid hemorrhage outcomes and number of cases treated at Caliofornia hospitals," Stroke, Vol.33, No.7, pp.1851-1856, 2002.
  9. B. Ovbiagele, "Nationwide trends in in-hospital mortality among patients with stroke," Stroke, Vol.41, No.8, pp.1748-1754, 2010.
  10. 김남권, 이동효, 조가원, 서은성, "뇌졸중 환자의 기대여명과 삶의 질, QALY에 대한 연구," 대한예방한의학회지, 제16권, 제3호, pp.15-26, 2012.
  11. 황세민, 윤석준, 안형식, 안형진, 김상후, 경민호, 이은경, "위암 수술 환자의 건강결과 측정을 위한 동반상병 측정도구의 유용성 연구," 예방의학회지, 제42권, 제1호, pp.49-58, 2009.
  12. C. Melfi, E. Holleman, D. Arthur, and B. Katz, "Selecting a patient characteristics index for the prediction of medical outcomes using administrative claims data," J Clin Epidemiol, Vol.48, No.7, pp.917-926, 1995.
  13. J. Librero, S. Peiro, and R. Ordinana, "Chronic comorbidity and outcomes of hospital care: Length of stay, mortality, and readmission at 30 and 365 days," J Clin Epidemiol, Vol.52, No.3, pp.171-179, 1999.
  14. L. I. Iezzoni, "Assessing quality using administrative data," Annals of Internal Medicine, Vol.127, No.8, pp.666-674, 1997.
  15. P. Aylin, A. Bottle, and A. Majeed, "Use of administrative data or clinical databases as predictors of risk of death in hospital: comparison of models," BMJ, Vol.334, No.7602, p.1044, 2007.
  16. 임지혜, 박재용, "급성심근경색증 환자의 동반상병지수에 따른 건강결과 분석," 보건행정학회지, 제21권, 제4호, pp.541-564, 2011.
  17. 강성홍, 퇴원환자의 재원일수 변이 분석: 2004-2006년 퇴원손상심층조사 결과 중심으로, 질병관리본부, 2009.
  18. 임지혜, 이건세, 김건엽, 홍남수, 이상원, 배희준, "뇌졸중 환자의 사망 추적연구," 대한의사협회지, 제54권, 제11호, pp.1199-1208, 2011.
  19. Pedro Enrique Jimenez Caballero, Field Lopez Espuela, Juan Carlos Portilla Cuenca, Jose Maria Ramirez Moreno, Juan Diego Pedrera Zamorano, and Ignacio Casado Naranjo, "Charlson comorbidity index in ischemic stroke and intracerebral hemorrhage as predictor of mortality and functional outcome after 6 Months," J Stroke Cerebrovasc Dis, Vol.22, No.7, pp.214-218, 2013.
  20. 최원호, Charlson Comorbidity Index를 활용한 고관절치환술 환자의 건강결과 예측에 관한 연구, 고려대학교, 박사학위논문, 2008.
  21. 김은정, 동반질환 및 동반상병 지수와 수술한 암의 질병부담 간의 관련성, 고려대학교, 박사학위논문, 2011.
  22. R. G. Hart, L. A. Pearce, J. L. Halperin, E. M. Hylek, G. W. Albers, D. C. Anderson, S. J. Connolly, G. H. Friday, B. F. Gage, A. S. Go, L. B. Goldstein, G. Gronseth, G. Y. Lip, D. G. Sherman, D. E. Singer, and C. Walraven, "Comparison of 12 risk stratification schemes to predict stroke in patients with nonvalvular atrial fibrillation," Stroke, Vol.39, No.6, pp.1901-1910, 2008.
  23. V. J. Howard, J. Acker, C. R. Gomez, A. H. Griffies, W. Magers, M. Michael, S. R. Orr, M. Phillips, J. M. Raczynski, J. E. Searcy, R. M. Zweifler, and G. Howard, "An approach to coordinate efforts to reduce the public health burden of stroke: the Delta States Stroke Consortium," Prev Chronic Dis, Vol.1, No.4, p.A19, 2004.
  24. Myzoon Ali, Sari Atula, Philip M. W. Bath, James Grotta, Werner Hacke, Patrick Lyden, R. John. Marler, L. Ralph, Sacco, and R. L. Kennedy, "Stroke outcome in clinical trial patiens deriving from different countries," Stroke, Vol.40, pp.35-40, 2009.
  25. Y. Bejot, O. Rouaud, J. Durier, M. Caillier, C. Marie, M. Freysz, J. M. Yeguiayan, A. Chantegret, G. Osseby, T. Moreau, and M. Giroud, "Decrease in the stroke case fatality rates in a French population-based twenty-year study: a comparison between men and women," Cerebrovasc Dis, Vol.24, pp.439-444, 2007.
  26. A. C Goulart, I. M. Bensenor, T. G. Fernandes, A. P. Alencar, L. M. Fedeli, and P. A. Lotufo, "Early and one-year stroke case fatality in SaoPaulo, Brazil: applying the World Health Organization's stroke STEPS," J Stroke Cerebrovasc Dis, Vol.21, No.8, pp.832-838, 2012.