Disability weights for comorbidity and their influence on health-adjusted life expectancy.
Disability weights for comorbidity and their influence on health-adjusted life expectancy.
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DOI：
10.1186/1478-7954-4-1
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发表时间：
2006-04-10
影响因子：
3.3
通讯作者：
Westert, Gert P
中科院分区：
文献类型：
--
作者：
van Baal, Pieter H M;Hoeymans, Nancy;Westert, Gert P
背景技术背景：科摩罗使使用疾病负担研究中的疾病患病率和残疾权重估计健康调整预期寿命（黑尔）变得复杂。通常情况下，合并症的确切数额是未知的，没有残疾的权重被定义为comormality.METHODS：使用数据的荷兰国家疾病负担的研究，不同的方法来调整合并症的影响黑尔计算估计。将定义合并症残疾权重的默认乘法调整方法与未调整合并症的黑尔估计值进行比较，并与患有多种疾病的患者的残疾程度仅由导致大多数残疾的疾病（最大调整方法）确定的黑尔估计值进行比较。为了估计合并症的数量，疾病之间的独立性assumption.RESULTS：乘法调整方法相比，最大调整方法降低黑尔估计男性1.2年，女性1.9年。与不作调整相比，乘性调整使黑尔估计值男性降低1.0年，女性降低1.4年。结论：不同调整方法引起的黑尔差异表明，在黑尔计算中进行共病调整是一个需要更多关注的重要课题。需要更多的实证研究来发展一个更普遍的理论，以了解合并症如何影响残疾。
BACKGROUND: Comorbidity complicates estimations of health-adjusted life expectancy (HALE) using disease prevalences and disability weights from Burden of Disease studies. Usually, the exact amount of comorbidity is unknown and no disability weights are defined for comorbidity.METHODS: Using data of the Dutch national burden of disease study, the effects of different methods to adjust for comorbidity on HALE calculations are estimated. The default multiplicative adjustment method to define disability weights for comorbidity is compared to HALE estimates without adjustment for comorbidity and to HALE estimates in which the amount of disability in patients with multiple diseases is solely determined by the disease that leads to most disability (the maximum adjustment method). To estimate the amount of comorbidity, independence between diseases is assumed.RESULTS: Compared to the multiplicative adjustment method, the maximum adjustment method lowers HALE estimates by 1.2 years for males and 1.9 years for females. Compared to no adjustment, a multiplicative adjustment lowers HALE estimates by 1.0 years for males and 1.4 years for females.CONCLUSION: The differences in HALE caused by the different adjustment methods demonstrate that adjusting for comorbidity in HALE calculations is an important topic that needs more attention. More empirical research is needed to develop a more general theory as to how comorbidity influences disability.