A physiologic index of comorbidity: Relationship to mortality and disability
A physiologic index of comorbidity: Relationship to mortality and disability
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DOI：
10.1093/gerona/63.6.603
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发表时间：
2008-06-01
影响因子：
5.1
通讯作者：
Harris, Tamara B.
中科院分区：
文献类型：
--
作者：
Newman, Anne B.;Boudreau, Robert M.;Harris, Tamara B.
背景。在老年人中，通过无创检测通常可以检测到大量未确诊的慢性疾病，但大多数合并症指数并未解释这一点。我们通过对整个数值范围内的五项无创测试进行评分，制定了一个简单的共病生理指数。我们检查了该指数对死亡率和残疾的预测有效性。方法。心血管健康研究（1992-1993）共有 2928 名参与者（平均年龄 74.5 岁，60% 女性，85% 白人，15% 黑人）接受了颈动脉超声、肺功能测试、脑部磁共振扫描、血清胱抑素 C 和空腹血糖检查。这些被组合成一个共病慢性疾病的单一生理指数，评分范围为 0-10。 Cox 比例风险模型用于预测最多 9 年后的死亡率、行动受限和日常生活活动 (ADL) 困难。结果。生理指数的范围相当广泛，总分为0或10的人很少。在对人口统计、行为危险因素和临床诊断条件进行调整后，与得分为0-2的人相比，指数为7-10的人的死亡率风险比为3.80（95%置信区间，2.82-5.13）。与活动受限和日常生活活动困难的关联也很显着。该指数解释了大约 40% 的年龄对死亡风险的影响。结论。慢性病标志物水平较低的老年人相当罕见，但健康状况却非常好。这种指数区分正常风险和低风险的能力可能为更好地了解老年最佳健康状况提供机会。
Background. In older adults, there is often substantial undiagnosed chronic disease detectable on noninvasive testing, not accounted for by most comorbidity indices. We developed a simple physiologic index of comorbidity by scoring five noninvasive tests across the full range of values. We examined the predictive validity of this index for mortality and disability.Methods. There were 2928 (mean age 74.5 years, 60% women, 85% white, and 15% black) participants in the Cardiovascular Health Study (1992-1993) who had carotid ultrasound, pulmonary function testing, brain magnetic resonance scan, serum cystatin-C, and fasting glucose. These were combined into a single physiologic index of comorbid chronic disease on a scale of 0-10. Cox proportional hazard models were used to predict mortality, mobility limitation, and activities of daily living (ADL) difficulty after a maximum of 9 years.Results. The range of the physiologic index was quite broad, with very few individuals having total scores of either 0 or 10. Those with an index of 7-10 had a hazard ratio of 3.80 (95% confidence interval, 2.82-5.13) for mortality compared to those with scores of 0-2, after adjustment for demographics, behavioral risk factors, and clinically diagnosed conditions. Associations with mobility limitation and ADL difficulty were also significant. The index explained about 40% of the age effect on mortality risk.Conclusion. Older adults with low levels of markers of chronic disease are rather rare but have remarkably good health outcomes. The ability of such an index to distinguish usual from low risk might provide an opportunity to better understand optimal health in old age.