Abstract
The objective of this study was to develop a method of classifying comorbid conditions that accounts for both the severity and joint effects of the diseases. The Tromsø Study is a cohort study with a longitudinal design utilizing a survey approach with physical examinations in the Tromsø municipality from 1974 to 2008, where in total 40051 subjects participated. We used Tromsø 4 as reference population and the Norwegian Institute of Public Health (FHI) panel as validation population. Ordinal regression was used to assess the effect of comorbid disease on Self-Reported Health (SRH). The model is controlled for interaction between diseases, mental health, age, and gender. The health impact index estimated levels of SRH. The comparison of predicted and observed SRH showed no significant differences. Spearman’s correlation showed that increasing levels of comorbidity were related to lower levels of SRH (RS = -0.36, p <.001). The Charlson Comorbidity Index(CCI) was also associated with SRH (r = -.25, p <.001). When focusing on only individuals with a comorbid disease, the relation between SRH and the Health Impact Index (HII) was strengthened (r = -.42, p <.001), while the association between SRH and CCI was attenuated (r = -.14, p <.001). CCI was designed to control for comorbid conditions when survival/mortality is the outcome of interest but is inaccurate when the outcome is SRH. We conclude that HII should be used when SRH is not available, and well-being or quality of survival/life is the outcome of interest.
Highlights
The prevalence of coexisting chronic conditions is rising [1]
The effect of comorbid disease differs in severity, Self-Reported Health (SRH) levels were significantly lower in the presence of a comorbid disease (p
The impact on SRH is reported as Odds Ratio (OR) and conditions such as angina and osteoporosis had the highest impact on SRH while pollen allergies (OR .97) and atopic eczema had low impact
Summary
The prevalence of coexisting chronic conditions is rising [1]. Comorbidity is associated with worse health outcomes, more complex clinical management and increased health care costsPLOS ONE | DOI:10.1371/journal.pone.0148830 February 5, 2016Health Impact Index receive a confirmation that data will be available upon request to all interested researchers. The prevalence of coexisting chronic conditions is rising [1]. Comorbidity is associated with worse health outcomes, more complex clinical management and increased health care costs. Health Impact Index receive a confirmation that data will be available upon request to all interested researchers. All variables are described in the NESSTAR database, http://tromsoundersokelsen.uit.no/webview/
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