Clinical comorbidity was specific to disease pathology, psychologic distress, and somatic symptom amplification
Clinical comorbidity was specific to disease pathology, psychologic distress, and somatic symptom amplification
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DOI：
10.1016/j.jclinepi.2005.02.007
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发表时间：
2005-09-01
影响因子：
7.2
通讯作者：
Croft, PR
中科院分区：
文献类型：
--
作者：
Kadam, UT;Jordan, K;Croft, PR
目的：通过调查糖尿病、焦虑症和上呼吸道感染 (URTI) 患者的共病模式，检验疾病病理学、心理困扰和躯体症状放大分别影响医疗保健使用的假设。方法：成人糖尿病 (n = 4,365)、焦虑症 (13,42 1) 和 URTI (9,854) 病例，以及从为期 1 年的全国全科医学调查中随机选择的 15,000 名对照者磋商。合并症基于全科医生在实际咨询中使用的标准临床发病率分类。结果：在 122 种发病率的病例对照分析中，与糖尿病相关的显着合并症关联数 (P < .01) 为 30，焦虑为 72，URTI 为 49。这些关联在使用 Cochran's Q 和 12 统计数据估计的比值比中显示出显着的异质性，无论是在病例组还是在病例组之间。在每个病例组内。糖尿病与周围血管疾病（比值比 2.7）、念珠菌病（2.5）、白内障（2.4）、肥胖（2.2）和高血压（1.7）的相关性更强；焦虑伴抑郁症（4.1）、情感性精神病（4.0）、适应反应（3.2）、功能性胃肠道疾病（2.5）和一般症状（2.5）；以及具有非特异性血液检查结果 (5.5)、支气管炎 (5.2) 和损伤 (3.5) 的 URTI。 结论：我们的研究显示了特定于病例情况的临床合并症模式，支持了不同机制（疾病病理学、心理困扰和躯体症状放大）影响咨询行为和合并症的假设。 (c) 2005 Elsevier Inc. 保留所有权利。
Objective: To test the hypothesis that disease pathology, psychologic distress, and somatic symptom amplification separately influence health care use by investigating the patterns of comorbidity in patients with diabetes, anxiety, and upper respiratory tract infection (URTI), respectively.Methods: Adult diabetes (n = 4,365), anxiety (13,42 1), and URTI (9,854) cases, and 15,000 randomly selected controls were identified from a 1-year national survey of general practice consultations. Comorbidity was based on a standard clinical morbidity classification used by general practitioners in actual consultations.Results: In case-control analyses of 122 morbidities, the number of significant comorbid associations (P < .01) for diabetes was 30, anxiety was 72, and URTI was 49. These associations showed significant heterogeneity in the odds ratios estimated using Cochran's Q and 12 statistic, both between case groups and within each case group. Diabetes associations were stronger with peripheral vascular disease (odds ratio 2.7), candidiasis (2.5), cataract(2.4), obesity(2.2), and hypertension (1.7); anxiety with depressive disorder (4.1), affective psychosis (4.0), adjustment reaction (3.2), functional gastrointestinal disorders (2.5) and general symptoms (2.5); and URTI with nonspecific blood findings (5.5), bronchitis (5.2), and injury (3.5).Conclusion: Our study shows patterns of clinical comorbidity specific to the case conditions that supports the hypothesis that different mechanisms (disease pathology, psychologic distress, and somatic symptom amplification) operate to influence consultation behavior and comorbidity. (c) 2005 Elsevier Inc. All rights reserved.