The development of a comorbidity index with physical function as the outcome

Groll, Dianne; To, Teresa; Bombardier, Claire; Wright, James G.

doi:10.1016/j.jclinepi.2004.10.018

Cited by 997 publications

(865 citation statements)

References 48 publications

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“…23 Comorbid health status was measured by the Functional Comorbidity Index, which is a summary measure of comorbid diseases selected and weighted according to their association with physical functioning. 25 Sonographic examinations were performed by trained physicians who were unaware of the participant's clinical and laboratory characteristics. Liver ultrasound was performed using a 5 MHz transducer and a high-resolution instrument (Vingmed VST Gateway, Santa Clara, CA).…”

Section: Methodsmentioning

confidence: 99%

Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl transpeptidase levels

et al. 2009

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The aim of the present study was to investigate the association of serum gamma-glutamyltransferase (GGT) levels with all-cause mortality and to assess the impact of ultrasonographic findings of hepatic hyperechogenicity in that association. We used data from 4,160 subjects (2,044 men and 2,116 women) recruited for the population-based Study of Health in Pomerania (SHIP) without baseline hepatitis B and C infections or liver cirrhosis. GGT was divided into age-and sex-dependent quintiles to calculate overall and sex-specific crude incidence mortality rates. Hepatic steatosis was defined by elevated GGT levels (>80%) and the presence of hyperechogenic liver ultrasound. We used multiple-adjusted Cox proportional hazards regression models, first, to assess the direct effect of GGT on all-cause mortality, second, to stratify according to the ultrasonographic finding, and third, to investigate potential mediating effects of cardiometabolic risk factors. During 29,810 person-years (7.3 years, median) of follow-up, 307 individuals (7.5%) died, resulting in a death rate of 0.86 deaths per 1000 person-years. Elevated GGT levels were associated with increased risk of mortality in men (hazard ratio [HR] 1.49; 95% confidence interval [CI], 1.08-2.05), but not in women (HR 1.30; 95% CI, 0.80-2.12). This association was even stronger in men with hepatic steatosis (HR 1.98; 95% CI, 1.21-3.27). Cause-specific mortality analysis by cardiovascular disease deaths confirmed the sex-specific association. Adjustment for cardiometabolic risk factors did not affect the estimates. Conclusion: In the case of increased GGT levels, liver ultrasound should be performed, not only for diagnosis, but also for further risk stratification.

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Section: Methodsmentioning

confidence: 99%

Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl transpeptidase levels

et al. 2009

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“…Comorbid conditions. The Functional Comorbidity Index (FCI) (22), an 18-item list of diagnoses (Table 1), was modified as a basis for selecting medical comorbidities for analysis. The main modifications included the exclusion of arthritis, and due to insufficient information, peripheral vascular disease, hearing impairment, and visual impairment.…”

Section: Significance and Innovationsmentioning

confidence: 99%

“…The main modifications included the exclusion of arthritis, and due to insufficient information, peripheral vascular disease, hearing impairment, and visual impairment. To reflect current literature on comorbidities in psoriasis without arthritis, PsA, and other chronic inflammatory rheumatic diseases (1,3,18,(22)(23)(24)(25)(26), we also determined the occurrence of hyperlipidemia and hypertension, cancer, autoimmune disorders, liver disease, and infections. The clinical database was used to identify comorbid conditions in both psoriasis without arthritis and PsA patients.…”

Section: Significance and Innovationsmentioning

confidence: 99%

Cardiovascular and other comorbidities in patients with psoriatic arthritis: A comparison with patients with psoriasis

Husted¹,

Thavaneswaran²,

Chandran³

et al. 2011

Arthritis Care & Research

226

177

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Objective. To determine whether the presence of psoriatic arthritis (PsA) is associated with greater comorbidity, in particular cardiovascular morbidity, compared to psoriasis without arthritis. Methods. Six hundred eleven patients with PsA were recruited from the University of Toronto Psoriatic Arthritis Clinic and 449 psoriasis without arthritis patients were recruited from the University of Toronto Psoriasis Cohort. The clinical database was used to identify the prevalence of cardiovascular and other comorbidities in both PsA and psoriasis without arthritis patients. Univariate and multivariate logistic regression analyses were conducted to estimate odds ratios (ORs), comparing the odds of ever having a given comorbid disease in PsA patients with those in psoriasis without arthritis patients. Covariates included age, sex, education, smoking status, severity and duration of psoriasis, medication status, and other comorbidities. Results. The prevalence of hypertension, obesity, hyperlipidemia, type 2 diabetes mellitus, and at least 1 cardiovascular event in PsA patients was 37.1%, 30.0%, 20.7%, 12.0%, and 8.2%, respectively. This was significantly higher than in psoriasis without arthritis patients, with unadjusted ORs ranging from 1.54 to 2.59. In the multivariate analyses, hypertension remained significantly elevated (adjusted OR 2.17). PsA was also significantly associated with infections not treated with antibiotics (presumably viral), neurologic conditions, gastrointestinal disorders, and liver disease (adjusted ORs 2.83, 4.76, 21.53, and 7.74, respectively). Infections treated with antibiotics and depression/anxiety were relatively common in PsA, with a prevalence of 30.5% and 20.7%, respectively. However, this was not significantly different from psoriasis without arthritis after multivariate adjustments. Conclusion. The results suggest that inflammatory joint disease may play a role in both cardiovascular and noncardiovascular morbidity in PsA.

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“…This finding is also in agreement with previous studies. In a random sampling of Canadian adults and a sample of US adults seeking treatment for spine ailments, Groll et al showed the FCI outperformed CCI in correlating with physical function, as measured by the physical function subscale of the Short Form 36 Health Survey (7).…”

Section: Discussionmentioning

confidence: 99%

“…However, not all comorbid diseases have the same impact on the outcome of interest. Thus, more complex comorbidity indices were created to select and weight specific comorbid illnesses to more accurately measure the burden and impact of overall comorbidity (6)(7)(8)(9)(10)(11). Of these different comorbidity indices, the 2 most widely used in medical literature are the Charlson Comorbidity Index (CCI) (6) and Elixhauser Comorbidity Score (ECS) (11).…”

Section: Introductionmentioning

confidence: 99%

Validation of the Rheumatic Disease Comorbidity Index

England

Sayles

Mikuls

et al. 2015

Arthritis Care & Research

197

156

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Objective. There is no consensus on which comorbidity index is optimal for rheumatic health outcomes research. We compared a new Rheumatic Disease Comorbidity Index (RDCI) with the Charlson-Deyo Index (CDI), Functional Comorbidity Index (FCI), Elixhauser Total Score (ETS), Elixhauser Point System (EPS), and a simple comorbidity count (COUNT) using a US cohort of rheumatoid arthritis (RA) patients. Methods. Using administrative diagnostic codes and patient self-reporting, we tested predictive values of the RDCI, CDI, FCI, ETS, EPS, and COUNT for 2 outcomes: all-cause mortality and physical functioning. Indices were compared using 3 models: bare (consisting of age, sex, and race), administrative (bare plus visit frequency, body mass index, and treatments), and clinic (administrative plus erythrocyte sedimentation rate, nodules, rheumatoid factor positivity, and patient activity scale). Results. The ETS and RDCI best predicted death, with FCI performing the worst. The FCI best predicted function, with ETS and RDCI performing nearly as well. CDI predicted function poorly. The order of indices remained relatively unchanged in the different models, though the magnitude of improvement in Akaike's information criterion decreased in the administrative and clinic models. Conclusion. The RDCI and ETS are excellent indices as a means of accounting for comorbid illness when the RArelated outcomes of death and physical functioning are studied using administrative data. The RDCI is a versatile index and appears to perform well with self-report data as well as administrative data. Further studies are warranted to compare these indices using other outcomes in diverse study populations.

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The development of a comorbidity index with physical function as the outcome

Cited by 997 publications

References 48 publications

Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl transpeptidase levels

Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl transpeptidase levels

Cardiovascular and other comorbidities in patients with psoriatic arthritis: A comparison with patients with psoriasis

Validation of the Rheumatic Disease Comorbidity Index

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