Developing Country-Specific Charlson Comorbidity Index Mappings for Use With German Administrative Data: Methodological Comparative Study.

BACKGROUND

The Charlson Comorbidity Index (CCI) is widely used to quantify comorbidity burden in observational research. Applying it to real-world data requires accurate International Classification of Diseases-based mappings. The commonly used mapping does not reflect current German coding standards.

OBJECTIVE

This study aimed to develop year-specific mappings (2004 to 2026) based on the German modification of the International Classification of Diseases, 10th Revision (ICD-10-GM), for the CCI with an open-source implementation and compare them with the commonly used mapping.

METHODS

For each year, mappings were curated via independent dual review with consensus. In 515,827 inpatient cases from a German tertiary center (2010-2024), year-appropriate mappings and the commonly used mapping were applied, and the results were pooled into 2 corresponding datasets that were subsequently compared. Agreement was assessed using the intraclass correlation coefficient (2-way mixed-effects model for absolute agreement based on single measurement), and the significance of the discordances was measured using the McNemar test.

RESULTS

Agreement was very high; 3.1% (16,136/515,827) of cases differed. A single code was present in 48.9% (7896/16,136) of the discordant cases and was intentionally excluded in the new mappings as it was not diagnostic for the category it was assigned to. Discordant results were found in 58.8% (10/17) of the categories ("peripheral vascular disease," "mild liver disease," and "severe liver disease") being present in, respectively, 51.7% (8339/16,136), 17.4% (2813/16,136), and 16.4% (2657/16,136) of the discordant cases. After filtering the dataset to only include observations with any diagnosis of a malignant disease, 6.9% (9377/136,607) of cases differed, and 79.3% (7434/9377) of those differences were caused by the "peripheral vascular disease" category, suggesting significant discrepancies for specific research questions.

CONCLUSIONS

We provide transparent, year-specific ICD-10-GM (2004-2026) mappings and an open-source tool for CCI calculation. The mappings align with current German coding practice and enable reproducible, year-appropriate comorbidity adjustment using administrative data.