Defining Comorbidity: Implications for Understanding Health and Health Services

被引:1093
作者
Valderas, Jose M. [1 ]
Starfield, Barbara [2 ]
Sibbald, Bonnie [1 ]
Salisbury, Chris [3 ]
Roland, Martin [1 ]
机构
[1] Univ Manchester, Sch Primary Care Res, Natl Inst Hlth Res, Manchester M13 9PL, Lancs, England
[2] Johns Hopkins Univ, Dept Hlth Policy & Management, Johns Hopkins Bloomberg Sch Publ Hlth, Baltimore, MD 21218 USA
[3] Univ Bristol, Natl Inst Hlth Res, Sch Primary Care Res, Bristol, Avon, England
关键词
Comorbidity; multimorbidity; chronic disease; etiology; CO-MORBIDITY; GENERAL-PRACTICE; CARE; CLASSIFICATION; PREVALENCE; DISEASES; MODEL; MULTIMORBIDITIES; COMPLEXITY; CHALLENGES;
D O I
10.1370/afm.983
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Comorbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is no agreement, however, on the meaning of the term, and related constructs, such as multimorbidity, morbidity burden, and patient complexity, are not well conceptualized. in this article, we review definitions of comorbidity and their relationship to related constructs. We show that the value of a given construct lies in its ability to explain a particular phenomenon of interest within the domains of (1) clinical care, (2) epidemiology, or (3) health services planning and financing. Mechanisms that may underlie the coexistence of 2 or more conditions in a patient (direct causation, associated risk factors, heterogeneity, independence) are examined, and the implications for clinical care considered. We conclude that the more precise use of constructs, as proposed in this article, would lead to improved research into the phenomenon of ill health in clinical care, epidemiology, and health services.
引用
收藏
页码:357 / 363
页数:7
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