Also Appearing in This Issue of JAMA


Index May Help Predict 10-Year Mortality Among Older Adults

“Recent guidelines recommend considering patients’ life expectancy when deciding whether to pursue preventive interventions with long lag times to benefit (≥ 7 years) such as colorectal cancer screening and intensive glycemic control for diabetes. However, most mortality indices have focused on short-term risk (≤ 5 years),” writes Marisa Cruz, M.D., of the University of California, San Francisco, and colleagues. The researchers examined whether their previously developed 4-year mortality index accurately predicted 10-year mortality.

As reported in a Research Letter, this analysis used 1998 data from the Health and Retirement Study (HRS), a nationally representative cohort of community-dwelling U.S. adults older than 50 years. The primary predictor was a 12-item mortality index, and participants received points depending on answers to the following: age; sex; current tobacco use; body mass index; diabetes; nonskin cancers; chronic lung disease; heart failure; difficulty bathing; difficulty managing finances; difficulty walking several blocks; and difficulty pushing/pulling large objects. The primary outcome was death through 2008 (10-year mortality). A risk score was calculated for each participant by summing the points for each risk factor present.

The researchers found that in the development cohort, 10-year mortality rates ranged from 2.5 percent (n=12/486) for participants with 0 points to 96 percent (n=298/310) for participants with 14 or more points. In the validation cohort, 10-year mortality rates ranged from 2.3 percent (n=8/354) to 93 percent (n= 239/257).

“We validated a mortality index that accurately stratified older adults into groups at varying risk for 10-year mortality,” the authors write. “Patients identified by this index as having a high risk of 10-year mortality may be more likely to be harmed by preventive interventions with long lag times to benefit, whereas patients identified as having a low risk of 10-year mortality may be good candidates for such interventions.”

(JAMA. 2013;309[9]:874-876. Available pre-embargo to the media at


Viewpoints in This Issue of JAMA

Keeping an Eye on Distracted Driving

In 2003, cell phone use while driving was estimated to cause 333,000 total injuries, 12,000 serious to critical injuries, and 2,600 fatalities annually. From 2005 to 2009, fatalities associated with driver distraction increased by 22 percent. Jeffrey H. Coben, M.D., and Motao Zhu, M.D., Ph.D., of West Virginia University, Morgantown, write that new technological and regulatory approaches are needed to reduce handheld phone use and texting while driving.

“Strong and courageous action is needed to effectively deal with the problem of cell phone use while driving. Education, legislation, and voluntary guidelines are insufficient. The federal government should enact stringent new safety standards that require all handheld devices to be rendered inoperable when the motor vehicle is in motion. Failure to act in this manner will result in the continued loss of thousands of lives each year to this preventable public safety hazard. In this era of smartphones and smart cars, it is time to be smarter about keeping them apart from one another.

(JAMA. 2013;309[9]:877-878. Available pre-embargo to the media at

Please Note: An author podcast on this study will be available post-embargo on the JAMA website.


Improving Opioid Prescribing – The New York City Recommendations

“On January 10, 2013, New York City Mayor Michael Bloomberg announced new guidelines for the prescribing of opioid analgesics to patients being discharged from the city’s emergency departments. The guidelines were developed by a panel of emergency physicians and are intended to reduce opioid addiction and overdose deaths while preserving access to opioids for patients in whom the benefits are expected to exceed the harms,” writes David N. Juurlink, M.D., Ph.D., of the University of Toronto, and colleagues.

In this Viewpoint, the authors examine “why such guidelines are necessary and what complementary actions physicians, patients, and health authorities should take to address the increasing problem of opioid-related harm.”

(JAMA. 2013;309[9]:879-880. Available pre-embargo to the media at

Editor’s Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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