The effect of comorbidity on health-related quality of life for injury patients in the first year following injury: comparison of three comorbidity adjustment approaches.
The effect of comorbidity on health-related quality of life for injury patients in the first year following injury: comparison of three comorbidity adjustment approaches.
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DOI：
10.1186/1478-7954-9-10
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发表时间：
2011-04-24
影响因子：
3.3
通讯作者：
Bonsel GJ
中科院分区：
文献类型：
--
作者：
Haagsma JA;van Beeck EF;Polinder S;Toet H;Panneman M;Bonsel GJ
疾病负担研究中存在三种方法来处理合并症的影响-最大限度方法，加法方法和乘法方法。本研究的目的是比较三种合并症的方法在患者的暂时性损伤的后果，以及合并慢性疾病的健康影响不平凡。使用EuroQol Group开发的EQ-5D工具中的数据评估残疾权重，这些数据来自于在急诊科治疗后2.5个月和9个月对2，295名受伤患者进行的邮政调查。我们使用9个月随访时从损伤中恢复的合并症和非合并症损伤患者的数据，比较了合并症病例中观察到的和预测的EQ-5D残疾权重。使用最大限值法、加法法和乘法法计算预测残疾权重。组内相关系数（ICC）被用来测试观察到的残疾权重和三个模型预测的残疾权重的值是否相关。伤害患者的EQ-5D失能权重随共病疾病的增多而显著增加。加性、乘性和最大极限模型的ICC分别为0.817、0.778和0.674。虽然三种模型ICC的95%置信区间重叠，但最大限度模型似乎不如加性和乘性模型拟合得好。对于轻度至中度慢性疾病（残疾权重低于0.21），预测和观察到的残疾权重之间的关联很低。科摩罗对EQ-5D测量的残疾有很大影响。忽视合并症的影响限制了疾病负担概念在多病人群中的应用。如果大量患者患有其他疾病，保健或干预措施的收益可能容易被高估。这项研究的结果发现，在占共病效应，所有三个模型显示出预测和观察到的病态残疾体重之间的强关联，虽然最大限度的模型似乎适合不如加性和乘法模型。这三种模型在轻度至中度预先存在的疾病的情况下并不适合。
Three approaches exist to deal with the impact of comorbidity in burden of disease studies - the maximum limit approach, the additive approach, and the multiplicative approach. The aim of this study was to compare the three comorbidity approaches in patients with temporary injury consequences as well as comorbid chronic conditions with nontrivial health impacts. Disability weights were assessed using data from the EQ-5D instrument developed by the EuroQol Group and derived from a postal survey among 2,295 injury patients at 2.5 and 9 months after being treated at an emergency department. We compared the observed and predicted EQ-5D disability weights in comorbid cases using data from injury patients with and without comorbidity who were restored from their injuries at 9 months follow-up. The predicted disability weights were calculated using the maximum limit approach, additive approach, and multiplicative approach. The intraclass correlation coefficient (ICC) was used to test whether the values of the observed disability weights and the three model-predicted disability weights were correlated. The EQ-5D disability weight of injury patients increased significantly with the number of comorbid diseases. The ICCs of the additive, multiplicative, and maximum limit models were 0.817, 0.778, and 0.674, respectively. Although the 95% confidence intervals of the ICCs of the three models overlap, the maximum limit model seems to fit less well than the additive and multiplicative models. For mild to moderate chronic disease (disability weight below 0.21), the association between predicted and observed disability weights was low. Comorbidity has a high impact on disability measured with EQ-5D. Ignoring the effect of comorbidity restricts the use of the burden of disease concept in multimorbid populations. Gains from health care or interventions may be easily overestimated if a substantial number of patients suffer from additional conditions. The results of this study found that in accounting for comorbidity effects, all three models showed a strong association between the predicted and observed morbid disability weight, though the maximum limit model seems to fit less well than the additive and multiplicative models. The three models do not fit well in the case of mild to moderate pre-existing disease.
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DOI：
10.1097/ta.0b013e31802b71c9
发表时间：
2007-01-01
影响因子：
--
作者：
Polinder, Suzanne;van Beeck, Ed F.;Meerding, Willem Jan
通讯作者：
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影响因子：
3.3
作者：
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影响因子：
3.6
作者：
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影响因子：
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影响因子：
3.3
作者：
van Baal, Pieter H M;Hoeymans, Nancy;Westert, Gert P
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