Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life.
Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life.
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DOI：
10.1186/1477-7525-3-74
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发表时间：
2005-11-23
影响因子：
3.6
通讯作者：
Soubhi, Hassan
中科院分区：
文献类型：
--
作者：
Fortin, Martin;Hudon, Catherine;Soubhi, Hassan
背景：多发病的测量通常应用于原始数据、人群或超出其原始发展工作范围的结果。由于多病指标的制定受到所使用的人群和结果的影响，因此在选择多病指数时应考虑到这些影响。本研究的目的是比较健康相关生活质量（HRQOL）与三种多病指标的相关性：累积疾病评定量表（CIRS）、查尔森指数（Charlson）和功能共病指数（FCI）。前两个指标不是根据HRQOL制定的。方法：我们使用了先前一项研究中238名成人初级保健患者的慢性疾病数据和SF-36 HRQOL问卷。我们从病历回顾中提取每位患者的所有诊断，并对CIRS、FCI和Charlson评分。还收集了潜在混杂因素（年龄、性别、自我感知的经济状况和自我感知的社会支持）的数据。在控制混杂因素的情况下，我们计算了SF-36评分与三种多重发病率指标的Pearson相关系数(r)，以及决定系数R2。结果：CIRS指数的r值（范围：-0.55 ~ -0.18）始终高于FCI指数（-0.47 ~ -0.10）和Charlson指数（-0.31 ~ -0.04）。CIRS在SF-36的所有分数中解释了最高的变异百分比，除了心理成分总结分数，变异并不显著。FCI解释的差异在SF-36测量身体健康的所有分数和两个评估心理健康的量表中都是显著的。Charlson所解释的变化只有在测量身体健康的三个分数上是显著的。结论：当HRQOL是关注的结果时，CIRS比FCI和Charlson是衡量多病性的更好选择。然而，FCI可能为评估HRQOL的物理方面提供了一个很好的选择，因为它易于管理和评分。在与HRQOL的身体或精神方面相关的研究中，Charlson指数可能不推荐作为多重发病率的衡量标准。
BACKGROUND: Measures of multimorbidity are often applied to source data, populations or outcomes outside the scope of their original developmental work. As the development of a multimorbidity measure is influenced by the population and outcome used, these influences should be taken into account when selecting a multimorbidity index. The aim of this study was to compare the strength of the association of health-related quality of life (HRQOL) with three multimorbidity indices: the Cumulative Illness Rating Scale (CIRS), the Charlson index (Charlson) and the Functional Comorbidity Index (FCI). The first two indices were not developed in light of HRQOL.METHODS: We used data on chronic diseases and on the SF-36 questionnaire assessing HRQOL of 238 adult primary care patients who participated in a previous study. We extracted all the diagnoses for every patient from chart review to score the CIRS, the FCI and the Charlson. Data for potential confounders (age, sex, self-perceived economic status and self-perceived social support) were also collected. We calculated the Pearson correlation coefficients (r) of the SF-36 scores with the three measures of multimorbidity, as well as the coefficient of determination, R2, while controlling for confounders.RESULTS: The r values for the CIRS (range: -0.55 to -0.18) were always higher than those for the FCI (-0.47 to -0.10) and Charlson (-0.31 to -0.04) indices. The CIRS explained the highest percent of variation in all scores of the SF-36, except for the Mental Component Summary Score where the variation was not significant. Variations explained by the FCI were significant in all scores of SF-36 measuring physical health and in two scales evaluating mental health. Variations explained by the Charlson were significant in only three scores measuring physical health.CONCLUSION: The CIRS is a better choice as a measure of multimorbidity than the FCI and the Charlson when HRQOL is the outcome of interest. However, the FCI may provide a good option to evaluate the physical aspect of HRQOL for the ease in its administration and scoring. The Charlson index may not be recommended as a measure of multimorbidity in studies related to either physical or mental aspects of HRQOL.