Association of comorbidity with disability in older women: The Women's Health and Aging Study
Association of comorbidity with disability in older women: The Women's Health and Aging Study
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DOI：
10.1016/s0895-4356(98)00124-3
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发表时间：
1999-01-01
影响因子：
7.2
通讯作者：
Guralnik, JM
中科院分区：
文献类型：
--
作者：
Fried, LP;Bandeen-Roche, K;Guralnik, JM
有大量证据表明，身体残疾是慢性疾病造成的，慢性疾病的数量与残疾的存在和严重程度有关。有一些证据表明，特定疾病之间的相互作用是造成残疾的重要因素。然而，除了关节炎之外，人们对未来研究中可能需要重点关注的疾病对知之甚少。本研究探讨了多种疾病对和不同类型的身体残疾之间的关联，其目的是假设;关于疾病相互作用的重要性的发展。研究人群包括3841名居住在巴尔的摩的65岁及以上女性的代表性样本，筛选参与女性健康与衰老研究。研究设计是横断面的。一个面试官管理的筛选问卷管理自我报告的身体残疾在15个日常生活的任务，医生诊断的14种慢性疾病的历史，和MiniMental状态检查。任务难度根据经验分为六个子集的最小重叠的残疾，与一个比较组组成的那些没有困难的任何任务子集。多元逻辑回归模型拟合评估主要慢性疾病的关系和疾病对与每个残疾亚型和任何残疾的相互作用，调整混杂因素。14%的人群仅报告了移动困难; 5%仅报告了上肢困难; 9%报告了这两种困难，但没有其他困难; 7%报告了较高功能困难，但没有自理任务; 7%报告了自理任务困难，但没有较高功能任务; 15%报告了较高功能和自理困难（加权数据）。后三组中几乎所有人在行动或上肢任务方面也有困难。在回归模型中，特定疾病对与不同类型的残疾协同相关。例如，与不同残疾类型相关的反复出现的重要疾病对是关节炎和视力障碍、关节炎和高血压、心脏病和癌症、肺病和癌症以及中风和高血压。此外，与疾病相关的残疾类型也各不相同，取决于存在的其他疾病。最后，当考虑到相互作用时，许多疾病本身不再与特定类型的残疾独立相关。将残疾分为六个亚型比评估“任何残疾”的概括类别在相关性方面提供更多信息。“这些发现为进一步假设发展和测试特定疾病与残疾的协同关系提供了基础。如果测试证实了这些观察结果，这些发现可以提供一个新的策略，通过减少共病的相互作用，预防残疾的基础。临床流行病学杂志52;1：27-37，1999年。(C)1999 Elsevier Science Inc.
There is substantial evidence that physical disability results from chronic diseases and that the number of chronic diseases is associated with the presence and severity of disability. There is some evidence that interactions between specific diseases are of import in causing disability. Beyond arthritis, however, little is known of the disease pairs that may be important to focus on in future research. This study explores the associations between multiple disease pairs and different types of physical disability, with the objective of hypothesis;development regarding the importance of disease interactions. The study population comprised a representative sample of 3841 women 65 years and older living in Baltimore, screened for participation in the Women's Health and Aging Study. The study design was cross-sectional. An interviewer-administered screening questionnaire was administered regarding self-reported physical disability in 15 tasks of daily life, history of physician diagnosis of 14 chronic diseases, and MiniMental State examination. Task difficulty was empirically grouped into six subsets of minimally overlapping disabilities, with a comparison group consisting of those with no difficulty in any task subset. Multiple logistic regression models were fit assessing the relationship of major chronic diseases and of interactions of disease pairs with each disability subtype and with any disability, adjusting for confounders. Fourteen percent of the population reported mobility difficulty only; 5%, upper extremity difficulty only; 9%, both of these difficulties but no others; 7%, difficulty in higher function but not self-care tasks; 7%, self-care task difficulty but not higher function tasks; and 15%, difficulty in both higher function and self-care (weighted data). Almost all in the latter three groups had difficulty, as well, in mobility or upper extremity tasks. In regression models, specific disease pairs were synergistically associated with different types of disability. For example, important disease pairs that recurred in their associations with different disability types were the presence of arthritis and visual impairments, arthritis and high blood pressure, heart disease and cancer, lung disease and cancer, and stroke and high blood pressure. In addition, the type of disability that a disease was associated with varied, depending on the other disease that was present. Finally, when interactions were accounted for, many diseases were no longer, in themselves, independently associated with a given type of disability. Partitioning disability into six subtypes was more informative in terms of associations than was evaluating a summary category of "any disability." These findings provide a basis for further hypothesis development and testing of synergistic relationships of specific diseases with disabilities. If testing confirms these observations, these findings could provide a basis for new strategies for prevention of disability by minimizing comorbid interactions. J CLIN EPIDEMIOL 52;1:27-37, 1999. (C) 1999 Elsevier Science Inc.