Baseline characteristics of the study base for 5 alpha reductase inhibitors (5-ARI) exposed with known start date and selected non-exposed men.

<p>SD, Standard deviation. ANGII, Angiotensin II Inhibitors. CCI, Charlson weighted comorbidity index. TURP, Transurethral resection of prostate</p><p>Baseline characteristics of the study base for 5 alpha reductase inhibitors (5-ARI) exposed with known start date and selected non-exposed men.</p

Sensitivity analysis when hip fracture, any fracture and falls are divided in men exposed to finasteride or dutasteride, shown as a multivariate adjusted hazard ratio (HR) with 95% confidence intervals (CI).

<p>Sensitivity analysis when hip fracture, any fracture and falls are divided in men exposed to finasteride or dutasteride, shown as a multivariate adjusted hazard ratio (HR) with 95% confidence intervals (CI).</p

Risk of hip fractures, any fractures and falls by exposure to 5-ARI for men with a known start date for former users separated according to duration of use and time since last use and for current users into four categories divided into duration of current use (<1, 1–2, 2–3, 3–4 and >4 years).

<p>Risk of hip fractures, any fractures and falls by exposure to 5-ARI for men with a known start date for former users separated according to duration of use and time since last use and for current users into four categories divided into duration of current use (<1, 1–2, 2–3, 3–4 and >4 years).</p

Baseline characteristics for men exposed to 5 alpha reductase inhibitors (5-ARI) and selected non exposed men.

<p>SD, Standard deviation. ANGII, Angiotensin II Inhibitors. CCI, Charlson weighted comorbidity index. TURP, Transurethral resection of prostate</p><p>Baseline characteristics for men exposed to 5 alpha reductase inhibitors (5-ARI) and selected non exposed men.</p

Risk of hip fractures, any fractures and falls by 5-ARI exposure with a known start date.

<p>^&Adjusted for previous use of Alpha blockers (Yes/No), Calcium antagonist (Yes/No), Angiotensin II antagonist (Yes/No)</p><p>Beta blockers (Yes/No), ACE inhibitors (Yes/No), Lipid-modifying agents (Yes/No), Diabetes mellitus treatment (Insulin/Peroral/No), Diuretics (Thiazides/Potassium-sparing agents/High ceiling diuretics/Combination diuretics/No), Previous TURP (Yes/No), Educational level (Low/medium/High), CCI (0,1,2,3+), Civil status (Single, not single)</p><p>^#Adjusted for ^& and previous fractures 0–1 years before start of follow-up (Yes/No), previous fractures 1–5 years before start of follow-up (Yes/No), previous hospitalisation due to fall 0–1 years before start of follow-up (Yes/No), previous hospitalisation due to fall 1–5 years before start of follow-up (Yes/No).</p><p>Risk of hip fractures, any fractures and falls by 5-ARI exposure with a known start date.</p

Overview of the code extraction and creation of predictors.

Overview of the code extraction and creation of predictors.</p

Risk of hip fractures, any fractures and falls by 5-ARI exposure.

<p>^&Adjusted for previous use of Alpha blockers (Yes/No), Calcium antagonist (Yes/No), Angiotensin II antagonist (Yes/No)</p><p>Beta blockers (Yes/No), ACE inhibitors (Yes/No), Lipid-modifying agents (Yes/No), Diabetes mellitus treatment (Insulin/tablets/No), Diuretics (Thiazides/Potassium-sparing agents/High ceiling diuretics/Combination diuretics/No), Previous TURP (Yes/No), Educational level (Low/medium/High), CCI (0,1,2,3+), Civil status (Single, not single)</p><p>^#Adjusted for ^& and previous fractures 0–1 years before start of follow up (Yes/No), previous fractures 1–5 years before start of follow up (Yes/No), previous hospitalisation due to fall 0–1 years before start of follow up (Yes/No), previous hospitalisation due to fall 1–5 years before start of follow up (Yes/No).</p><p>Risk of hip fractures, any fractures and falls by 5-ARI exposure.</p

Survival by the multi-dimensional diagnosis-based comorbidity indices (MDCI).

Developed using 10 years of follow-up for mortality vs the drug comorbidity index (DCI) in the validation cohort of comparison men. (PDF)</p

Selected ICD-10 codes.

ICD-10 codes with 2–5 characters in each circle (inner circle = 2 characters, outer circle = 5 characters) and grouped predictors (occurrence, frequency, recency, duration). Each predictor for each code corresponds to a circle segment and this segment is colored if any coefficient within that group of predictors was included in the multi-dimensional diagnosis-based comorbidity index developed using 1, 5, and 10 years of follow-up for mortality, respectively. (PDF)</p

TRIPOD checklist.

Assessment of comorbidity is crucial for confounding adjustment and prediction of mortality in register-based studies, but the commonly used Charlson comorbidity index is not sufficiently predictive. We aimed to develop a multidimensional diagnosis-based comorbidity index (MDCI) that captures comorbidity better than the Charlson Comorbidity index. The index was developed based on 286,688 men free of prostate cancer randomly selected from the Swedish general population, and validated in 54,539 men without and 68,357 men with prostate cancer. All ICD-10 codes from inpatient and outpatient discharges during 10 years prior to the index date were used to define variables indicating frequency of code occurrence, recency, and total duration of related hospital admissions. Penalized Cox regression was used to predict 10-year all-cause mortality. The MDCI predicted risk of death better than the Charlson comorbidity index, with a c-index of 0.756 (95% confidence interval [CI] = 0.751, 0.762) vs 0.688 (95% CI = 0.683, 0.693) in the validation cohort of men without prostate cancer. Men in the lowest vs highest MDCI quartile had distinctively different survival in the validation cohort of men with prostate cancer, with an overall hazard ratio [HR] of 5.08 (95% CI = 4.90, 5.26). This was also consistent within strata of age and Charlson comorbidity index, e.g. HR = 5.90 (95% CI = 4.65, 7.50) in men younger than 60 years with CCI 0. These results indicate that comorbidity assessment in register-based studies can be improved by use of all ICD-10 codes and taking related frequency, recency, and duration of hospital admissions into account.</div