Original ArticleThe development of a comorbidity index with physical function as the outcome
Introduction
Physical function, health status, and perceived quality of life are important indicators, from the patient's perspective, of the success of medical and surgical interventions. As a result, condition-specific and generic measures of health are used ubiquitously to evaluate medical and surgical interventions [1]. However, in many types of research it is essential to adjust for other diseases, called comorbid diseases, in addition to the disease of concern, which may be related to the outcome(s) of interest. This is of particular importance in research conducted in older populations where many chronic illnesses may be present in the same patient [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14]. Without this adjustment outcomes cannot be attributed to investigative interventions as the patients themselves may differ substantially in prognostic expectations due to their initial comorbid illnesses [2].
Prior comorbidity indices have been developed primarily to predict mortality or administrative outcomes such as length of stay in acute care or disease-specific populations [2], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38]. These indices typically include diagnoses, often asymptomatic, such as hypertension, that are important in predicting mortality, and exclude diagnoses, such as arthritis, that impact physical function but are unlikely to result in short-term mortality. Research using indices designed to predict mortality have concluded that comorbid illnesses have little relationship with physical disability [39], [40], a finding that seems intuitively false but underscores the need to consider the purpose for which an index was designed.
The purpose of this study was to develop a self-administered, general population index of comorbid diseases with physical function as the outcome of interest. The underlying premise was that diagnoses associated with physical function would be, at least in part, different from those associated with mortality, and therefore, an index designed with physical function as the outcome would perform better than indices designed with mortality as the outcome of interest.
Section snippets
Methods
The Functional Comorbidity Index was developed in two stages.
Results
Forty unique diagnoses were identified in both literature review and focus groups (Table 1). Table 2 shows the demographic characteristics of participants in the CaMos and NSN patients. The average age of CaMos participants was 62 years (range 25 to 103 years), while the average age of NSN patients was 49 years (range18 to 97 years). Six thousand seven hundred thirty-four (71.5%) of the CaMos patients and 19,362 (68.3%) of the NSN patients had at least one comorbid illness and the mean number
Discussion
The Functional Comorbidity Index was developed specifically for use in the general population with physical function, not mortality, as the outcome of interest. The Functional Comorbidity Index can be used to adjust for the effect of comorbidity on physical function in the same manner that other indices are used to adjust for the effect of comorbidity on mortality. The Functional Comorbidity Index contains diseases such as visual impairment, osteoporosis, and arthritis, which do not appear in
Acknowledgments
The authors would like to thank the Canadian Multicentre Osteoporosis Study (CaMos) Research Group and the National Spine Network for allowing the use of their databases.
This project was supported by the Canadian Arthritis Network and the Canadian Institutes for Health Research.
References (53)
- et al.
The importance of classifying initial comorbidity in evaluating the outcome of diabetes mellitus
J Chronic Dis
(1974) - et al.
The effect of medical conditions on the functional limitations of Mexican-American elderly
Ann Epidemiol
(1996) - et al.
Predictors of disability in elderly Finnish men—a longitudinal study
J Clin Epidemiol
(1989) - et al.
Risk factors for disability among U.S. adults with arthritis
J CLin Epidemiol
(1991) - et al.
High, usual and impaired functioning in community-dwelling older men and women: findings from the Macarther Foundation Research Network on successful aging
J Clin Epidemiol
(1993) Survival in patients with end-stage renal disease
Am J Kidney Dis
(1991)- et al.
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
J Chronic Dis
(1987) - et al.
Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases
J Clin Epidemiol
(1992) - et al.
A chronic disease score from automated pharmacy data
J Clin Epidemiol
(1992) - et al.
Adapting a clinical comorbidity index for use with ICD-9-CM administrative data: differing perspectives
J Clin Epidemiol
(1993)