Anja Frei1, Patrick Muggensturm2, Nirupama Putcha3, Lara Siebeling4, Marco Zoller5, Cynthia M Boyd6, Gerben ter Riet4, Milo A Puhan7. 1. Institute of Social and Preventive Medicine, Department of Epidemiology, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland; Institute of General Practice and Health Services Research, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland. Electronic address: Anja.Frei@ifspm.uzh.ch. 2. Horten Centre for Patient-Oriented Research, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland. 3. Division of Pulmonary & Critical Care Medicine, Department of Medicine, Johns Hopkins Hospital, 5501 Hopkins Bayview Circle JHAAC 4B.74, Baltimore, MD, 21224 USA. 4. Department of General Practice, Academic Medical Centre, University of Amsterdam, Meibergdreef 15, 1105 AZ, Amsterdam, The Netherlands. 5. Institute of General Practice and Health Services Research, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland. 6. Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Center on Aging and Health 5200 Eastern Avenue Center Tower, 7th Floor, Mason F. Lord Building, Baltimore, MD, 21224 USA. 7. Institute of Social and Preventive Medicine, Department of Epidemiology, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe St, Room E6153, Baltimore, MD, 21205 USA.
Abstract
OBJECTIVE: This study aimed to identify those comorbidities with greatest impact on patient-reported health status in patients with chronic obstructive pulmonary disease (COPD) and to develop a comorbidity index that reflects their combined impact. STUDY DESIGN AND SETTING: We included 408 Swiss and Dutch primary care patients with COPD from the International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts (ICE COLD ERIC) in this cross-sectional analysis. Primary outcome was the Feeling Thermometer, a patient-reported health status instrument. We assessed the impact of comorbidities at five cohort assessment times using multiple linear regression adjusted for FEV1, retaining comorbidities with associations P ≤ 0.1. We developed an index that reflects strength of association of comorbidities with health status. RESULTS: Depression (prevalence: 13.0%; regression coefficient: -9.00; 95% CI: -13.52, -4.48), anxiety (prevalence: 11.8%; regression coefficient: -5.53; 95% CI -10.25, -0.81), peripheral artery disease (prevalence: 6.4%; regression coefficient: -5.02; 95% CI-10.64, 0.60), cerebrovascular disease (prevalence: 8.8%; regression coefficient: -4.57; 95% CI -9.43, 0.29), and symptomatic heart disease (prevalence: 20.3%; regression coefficient: -3.81; 95% CI -7.23, -0.39) were most strongly associated with the Feeling Thermometer. These five comorbidities, weighted, compose the COMorbidities in Chronic Obstructive Lung Disease (COMCOLD) index. CONCLUSION: The COMCOLD index reflects the combined impact of five important comorbidities from patients' perspective and complements existing comorbidity indices that predict death. It may help clinicians focus on comorbidities affecting patients' health status the most.
OBJECTIVE: This study aimed to identify those comorbidities with greatest impact on patient-reported health status in patients with chronic obstructive pulmonary disease (COPD) and to develop a comorbidity index that reflects their combined impact. STUDY DESIGN AND SETTING: We included 408 Swiss and Dutch primary care patients with COPD from the International Collaborative Effort on Chronic Obstructive Lung Disease: Exacerbation Risk Index Cohorts (ICE COLD ERIC) in this cross-sectional analysis. Primary outcome was the Feeling Thermometer, a patient-reported health status instrument. We assessed the impact of comorbidities at five cohort assessment times using multiple linear regression adjusted for FEV1, retaining comorbidities with associations P ≤ 0.1. We developed an index that reflects strength of association of comorbidities with health status. RESULTS:Depression (prevalence: 13.0%; regression coefficient: -9.00; 95% CI: -13.52, -4.48), anxiety (prevalence: 11.8%; regression coefficient: -5.53; 95% CI -10.25, -0.81), peripheral artery disease (prevalence: 6.4%; regression coefficient: -5.02; 95% CI-10.64, 0.60), cerebrovascular disease (prevalence: 8.8%; regression coefficient: -4.57; 95% CI -9.43, 0.29), and symptomatic heart disease (prevalence: 20.3%; regression coefficient: -3.81; 95% CI -7.23, -0.39) were most strongly associated with the Feeling Thermometer. These five comorbidities, weighted, compose the COMorbidities in Chronic Obstructive Lung Disease (COMCOLD) index. CONCLUSION: The COMCOLD index reflects the combined impact of five important comorbidities from patients' perspective and complements existing comorbidity indices that predict death. It may help clinicians focus on comorbidities affecting patients' health status the most.
Authors: Hemalkumar B Mehta; Shan Yong; Sneha D Sura; Byron D Hughes; Yong-Fang Kuo; Stephen B Williams; Douglas S Tyler; Taylor S Riall; James S Goodwin Journal: Health Serv Res Date: 2019-10-01 Impact factor: 3.402
Authors: Carlos H Martinez; Alejandro A Diaz; Amit D Parulekar; Stephen I Rennard; Richard E Kanner; Nadia N Hansel; David Couper; Kristen E Holm; Karin F Hoth; Jeffrey L Curtis; Fernando J Martinez; Nicola A Hanania; Elizabeth A Regan; Robert Paine; Christine T Cigolle; MeiLan K Han Journal: Chest Date: 2015-12-17 Impact factor: 9.410