A comparison of two comorbidity instruments in arthritis
A comparison of two comorbidity instruments in arthritis
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DOI：
10.1016/s0895-4356(99)00124-9
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发表时间：
1999-12-01
影响因子：
7.2
通讯作者：
O'Fallon, WM
中科院分区：
文献类型：
--
作者：
Gabriel, SE;Crowson, CS;O'Fallon, WM
合并症（CM）是健康结果和成本的有力预测因子，也是许多流行病学研究中一个重要的混杂因素。然而，选择最合适的CM测量仪器是困难的，因为关于可用仪器在各种疾病环境中的表现的比较数据有限。我们使用两种不同的CM仪器，从完整的医疗记录中收集了两个基于人群的类风湿关节炎（RA）和骨关节炎（OA）患病率队列和一个没有关节炎（NA）的比较队列的CM数据：Charlson CM指数（Charl），它基于17种诊断，每种诊断都以死亡风险加权，以及共存疾病指数（ICED），它估计14种合并症的严重程度和频率，并提供对每种合并症造成的损害或残疾的评估。采用Cox比例风险模型评估两种类型的合并症评分（Charl和ICED）对流行（指数）日期后生存率的影响，并对年龄、性别和疾病状态进行调整。RA组、OA组和NA组分别有450、441和889人，平均随访时间为10.6年。在随访期间，RA组、OA组和NA组分别发生293、307和546例死亡。平均年龄和女性比例分别为：63.3岁，74%；70.7岁，74%；RA组、OA组和NA组分别为67.5岁，占75%。Charl和ice的合并症在RA中最高，在OA中中等，在NA中最低。Cox比例风险模型表明，在调整了年龄、性别和疾病状态（RA、OA或NA）后，Charl和ICED都是具有高度统计学意义的死亡率预测因子（P < 0.0001），即使在调整了Charl之后，ICED仍然是死亡率的高度显著预测因子。我们的结论是，使用ICED（一种包含损伤和残疾评估的工具）从医疗记录中估计CM是可行的，而且这种评估提供了独立预测死亡率的信息，即使在调整了传统的基于诊断的CM测量方法（如Charl）的结果之后也是如此。(C) 1999 Elsevier Science Inc.；
Comorbidity (CM) is a powerful predictor of health outcome and cost, as well as an important confounder in many epidemiologic studies. However, choosing the most appropriate CM measurement instrument is difficult because comparative data on how the available instruments perform in various disease settings are limited. We collected CM data (from the complete medical records) for two population-based prevalence cohorts with rheumatoid arthritis (RA) and osteoarthritis (OA) and a comparison cohort without arthritis (NA), using two different CM instruments: the Charlson CM index (Charl), which is based on 17 diagnoses each weighted by mortality risk, and the Index of Coexistent Diseases (ICED), which estimates the severity and frequency of 14 comorbid conditions and provides an assessment of the impairment or disability caused by each. Cox proportional hazards modeling was used to assess the impact of the two types of comorbidity scores (Charl and ICED) on survival after prevalence (index) date, adjusting for the age, sex, and disease status. There were 450, 441, and 889 individuals in the RA, OA, and NA groups, respectively, with a mean follow-up period of 10.6 years. During the follow-up, 293, 307, and 546 deaths occurred in the RA, OA, and NA groups, respectively. The mean age and percent females were: 63.3 years, 74%; 70.7 years, 74%; and 67.5 years, 75% for the RA, OA, and NA groups, respectively. Comorbidity was highest in RA, intermediate in OA, and lowest in NA by both Charl and ICED. Cox proportional hazards modeling demonstrated that both Charl and ICED were highly statistically significant predictors of mortality (P < 0.0001) after adjusting for age, sex, and disease state (RA, OA, or NA) and that ICED remained highly significant as a predictor of mortality, even after adjusting for Charl. We conclude that estimating CM from medical records using ICED, an instrument that incorporates an assessment of impairment and disability, is feasible and that such as assessment provides information that independently predicts mortality, even after adjusting for the results of traditional diagnosis-based CM measures, such as Charl. (C) 1999 Elsevier Science Inc.