Predicting mortality in the very old: a machine learning analysis on claims data

Machine learning (ML) may be used to predict mortality. We used claims data from one large German insurer to develop and test differently complex ML prediction models, comparing them for their (balanced) accuracy, but also the importance of different predictors, the relevance of the follow-up period before death (i.e. the amount of accumulated data) and the time distance of the data used for prediction and death. A sample of 373,077 insured very old, aged 75 years or above, living in the Northeast of Germany in 2012 was drawn and followed over 6 years. Our outcome was whether an individual died in one of the years of interest (2013–2017) or not; the primary metric was (balanced) accuracy in a hold-out test dataset. From the 86,326 potential variables, we used the 30 most important ones for modeling. We trained a total of 45 model combinations: (1) Three different ML models were used; logistic regression (LR), random forest (RF), extreme gradient boosting (XGB); (2) Different periods of follow-up were employed for training; 1–5 years; (3) Different time distances between data used for prediction and the time of the event (death/survival) were set; 0–4 years. The mortality rate was 9.15% in mean per year. The models showed (balanced) accuracy between 65 and 93%. A longer follow-up period showed limited to no advantage, but models with short time distance from the event were more accurate than models trained on more distant data. RF and XGB were more accurate than LR. For RF and XGB sensitivity and specificity were similar, while for LR sensitivity was significantly lower than specificity. For all three models, the positive-predictive-value was below 62% (and even dropped to below 20% for longer time distances from death), while the negative-predictive-value significantly exceeded 90% for all analyses. The utilization of and costs for emergency transport as well as emergency and any hospital visits as well as the utilization of conventional outpatient care and laboratory services were consistently found most relevant for predicting mortality. All models showed useful accuracies, and more complex models showed advantages. The variables employed for prediction were consistent across models and with medical reasoning. Identifying individuals at risk could assist tailored decision-making and interventions.