Journal of Clinical Epidemiology
Volume 54, Issue 7 , Pages 661-674 , July 2001

Causes and consequences of comorbidity: A review

  • Ronald Gijsen

      Affiliations

    • National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
    • Corresponding Author InformationCorresponding author. Tel.: +31 30 2743950; fax: +31 30 2744450.(R. Gijsen)
  • ,
  • Nancy Hoeymans

      Affiliations

    • National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
  • ,
  • François G. Schellevis

      Affiliations

    • Netherlands Institute of Primary Health Care (NIVEL), Utrecht, The Netherlands
  • ,
  • Dirk Ruwaard

      Affiliations

    • National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
  • ,
  • William A. Satariano

      Affiliations

    • School of Public Health, University of California at Berkeley, Berkeley CA, USA
  • ,
  • Geertrudis A.M. van den Bos

      Affiliations

    • National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands
    • Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

Received 8 September 1999 ,Revised 5 October 2000 ,Accepted 14 November 2000.

References 

  1. US Bureau of the Census . International Population Reports, An Aging World II. P25, 92-3. Washington, DC: US Government Printing Office; 1992;
  2. Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chron Dis. 1970;23:455–469
  3. Satariano WA. Comorbidities and cancer. In:  Hunter CP,  Johnson KA,  Muss HB editor. Cancer in the elderly. New York: Marcel Dekker; 2000;p. 477–499
  4. Akker M van den, Buntinx F, Roos S, Knottnerus JA. Methodology and analysis in comorbidity and multimorbidity research. In: Akker M van den. Multimorbidity in a general practice population. Prevalence, incidence and determinants of multiple pathology (thesis). Maastricht: Unigraphic, 1999.
  5. Coebergh JWW, Janssen-Heijnen MLG, Post PN, Razenberg PPA. Serious co-morbidity among unselected cancer patients newly diagnosed in the Southeastern part of the Netherlands in 1993–1996. J Clin Epidemiol. 1999;52:1131–1136
  6. Fillenbaum GG, Pieper CF, Cohen HJ, Cornoni-Huntley JC, Guralnik JM. Comorbidity of five chronic health conditions in elderly community residents (determinants and impact on mortality). J Gerontol Med Sci. 2000;55A:M84–M89
  7. Schellevis FG, Bos GAM van den, Tijssen JGP, Grobbee DE, Heinsbroek RPW. Comorbidity and chronic diseases. Report of the workshop ‘Comorbidity and Chronic Diseases.’ The Hague: Netherlands Organisation for Scientific Research (NWO), 1997.
  8. Bos GAM van den. The burden of chronic diseases in terms of disability, use of health care and healthy life expectancies. Eur J Public Health 1995;5:29–34.
  9. Nusselder WJ, Bos GAM van den, Lenior ME, Sonsbeek JLA van, Velden J van der. The elimination of selected chronic diseases in a population: the compression and expansion of morbidity. Am J Public Health 1996;86:187–94.
  10. Schellevis FG. Comorbidity—definitions and methodological aspects. In: Chronic diseases in general practice. Comorbidity and quality of care (thesis). Nijmegen: Katholieke Universiteit Nijmegen, 1993.
  11. Gilmer TP, O'Connor PJ, Manning WG, Rush WA. The cost to health plans of poor glycemic control. Diabetes Care. 1997;20:1847–1853
  12. Ottman R, Lipton RB, Comorbidity of migraine and epilepsy . Neurology. 1994;44:2105–2110
  13. Ottman R, Lipton RB. Is the comorbidity of epilepsy and migraine due to a shared genetic susceptibility?. Neurology. 1996;47:918–924
  14. Peroutka SJ, Price SC, Jones KW. The comorbid association of migraine with osteoarthritis and hypertension (complement C3F and Berkson's bias). Cephalagia. 1997;17:23–26
  15. Perna G, Bertani A, Politi E, Colombo G, Bellodi L. Asthma and panic attacks. Biol Psychiatry. 1997;42:625–630
  16. Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med. 1994;120:104–110
  17. West DW, Satariano WA, Ragland DR, Hiatt RA. Comorbidity and breast cancer survival (a comparison between black and white women). Ann Epidemiol. 1996;6:413–419
  18. Newschaffer CJ, Bush TL, Penberthy LT. Comorbidity measurement in elderly female breast cancer patients with administrative and medical records data. J Clin Epidemiol. 1997;50:725–733
  19. Koperna T, Kisser M, Schulz F. Emergency surgery for colon cancer in the aged. Arch Surg. 1997;132:1032–1037
  20. Liu SK, Church JM, Lavery IC, Fazio VW. Operation in patients with incurable colon cancer—is it worthwhile?. Dis Colon Rectum. 1997;40:11–14
  21. Payne JE, Meyer HJ. Independently predictive prognostic variables after resection for colorectal carcinoma. Aust N Z J Surg. 1997;67:849–853
  22. Zincke H, Bergstralh EJ, Blute ML, Myers RP, Barrett DM, Lieber MM, et al. Radical prostatectomy for clinically localized prostate cancer (long-term results of 1,143 patients from a single institution). J Clin Oncol. 1994;12:2254–2263
  23. Albertsen PC, Fryback DG, Storer BE, Kolon TF, Fine J. The impact of co-morbidity on life expectancy among men with localized prostate cancer. J Urol. 1996;156:127–132
  24. Fowler JE, Terrell FL, Renfroe DL. Co-morbidities and survival of men with localized prostate cancer treated with surgery or radiation therapy. J Urol. 1996;156:1714–1718
  25. Marcelli D, Spotti D, Conte F, Tagliaferro A, Limido A, Lonati F, et al. Prognosis of diabetic patients on dialysis (analysis of Lombardy Registry data). Nephrol Dial Transplant. 1995;20:1895–9100
  26. Medina RA, Pugh JA, Monterrosa A, Cornell J. Minority advantage in diabetic end-stage renal disease survival on hemodialysis (due to different proportions of diabetic type?). Am J Kidney Dis. 1996;28:226–234
  27. Lavery LA, Van Houtum WH, Armstrong DG. Institutionalization following diabetes-related lower extremity amputation. Am J Med. 1997;103:383–388
  28. Fava S, Azzopardi J, Muscat HA, Fenech FF. Factors that influence outcome in diabetic subjects with myocardial infarction. Diabetes Care. 1993;16:1615–1618
  29. Svensson LG, Cruz H, Sun J, D'Agostino S, Williamson WA, Shahian DM. Timing of surgery after acute myocardial infarction. J Cardiovasc Surg Torino. 1996;37:467–470
  30. Capewell S, Kendrick S, Boyd J, Cohen G, Juszczak E, Clarke J. Measuring outcomes (one month survival after acute myocardial infarction in Scotland). Heart. 1996;76:70–75
  31. Juszczak E, Boyd J. Measuring outcomes (one month survival after acute myocardial infarcion in Scotland). Heart. 1997;77:88
  32. Mickelson JK, Blum CM, Geraci JM. Acute myocardial infarction (clinical characteristics, management and outcome in a metropolitan Veterans Affairs Medical Center teaching hospital). J Am Coll Cardiol. 1997;29:915–925
  33. Localio AR, Hamory BH, Fisher AC, TenHave TR. The public release of hospital and physician mortality data in Pennsylvania. A case study. Med Care. 1997;35:272–286
  34. D'Hoore W, Bouckaert A, Tilquin C. Practical considerations on the use of the Charlson comorbidity index with administrative data bases. J Clin Epidemiol. 1996;49:1429–1433
  35. Ghali WA, Hall RE, Rosen AK, Ash AS, Moskowitz MA. Searching for an improved clinical comorbidity index for use with ICD-9-CM administrative data. J Clin Epidemiol. 1996;49:273–278
  36. Flameng WJ, Herijgers P, Szecsi J, Sergeant PT, Daenen WJ, Scheys I. Determinants of early and late results of combined valve operations and coronary artery bypass grafting. Ann Thorac Surg. 1996;61:621–628
  37. Sergeant P, Blackstone E, Meyns B. Validation and interdependence with patient-variables of the influence of procedural variables on early and late survival after CABG. K.U. Leuven Coronary Surgery Program. Eur J Cardiothorac Surg. 1997;12:1–19
  38. D'Hoore W, Sicotte C, Tilquin C. Risk adjustment in outcome assessment (the Charlson comorbidity index). Methods Inf Med. 1993;32:382–387
  39. Chin MH, Goldman L. Correlates of early hospital readmission or death in patients with congestive heart failure. Am J Cardiol. 1997;79:1640–1644
  40. Davis RB, Iezzoni LI, Phillips RS, Reiley P, Coffman GA, Safran C. Predicting in-hospital mortality. The importance of functional status information. Med Care. 1995;33:906–921
  41. Lai SM, Alter M, Friday G, Sobel E. Prognosis for survival after an initial stroke. Stroke. 1995;26:2011–2015
  42. Stukenborg GJ. Comparison of carotid endarterectomy outcomes from randomized controlled trials and Medicare administrative databases. Arch Neurol. 1997;54:826–832
  43. Evans BA, Sicks JD, Whisnant JP. Factors affecting survival and occurrence of stroke in patients with transient ischemic attacks. Mayo Clin Proc. 1994;69:416–421
  44. Panneton JM, Lassonde J, Laurendeau F. Ruptured abdominal aortic aneurysm (impact of comorbidity and postoperative complications on outcome). Ann Vasc Surg. 1995;9:535–541
  45. Halpern VJ, Kline RG, D'Angelo AJ, Cohen JR. Factors that affect the survival rate of patients with ruptured abdominal aortic aneurysms. J Vasc Surg. 1997;26:939–945
  46. Katz DJ, Stanley JC, Zelenock GB. Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan (an eleven-year statewide experience). J Vasc Surg. 1994;19:804–815
  47. Steyerberg EW, Kievit J, de Mol Van Otterloo JC, van Bockel JH, Eijkemans MJ, Habbema JD. Perioperative mortality of elective abdominal aortic aneurysm surgery. A clinical prediction rule based on literature and individual patient data. Arch Intern Med 1995;155:1998–2004.
  48. Feinglass J, Cowper D, Dunlop D, Slavensky R, Martin GJ, Pearce WH. Late survival risk factors for abdominal aortic aneurysm repair (experience from fourteen Department of Veterans Affairs hospitals). Surgery. 1995;118:16–24
  49. Kemp K von, van den Brande P, Peterson T, Waegeneers S, Scheerlinck T, Danau W, van Tussenbroek F, Debing E, Staelens I. Screening for concomitant diseases in peripheral vascular patients. Results of a systematic approach. Int Angiol 1997;16:114–22.
  50. Antonelli Incalzi R, Fuzo L, De Rosa M, Forastiere F, Rapiti E, Nardecchia B, et al. Co-morbidity contributes to predict mortality of patients with chronic obstructive pulmonary disease. Eur Respir J. 1997;10:2794–2800
  51. Pincus T, Brooks RH, Callahan LF. Prediction of long-term mortality in patients with rheumatoid arthritis according to simple questionnaire and joint count measures. Ann Intern Med. 1994;120:26–34
  52. Lindsey AM, Larson PJ, Dodd MJ, Brecht ML, Packer A. Comorbidity, nutritional intake, social support, weight, and functional status over time in older cancer patients receiving radiotherapy. Cancer Nurs. 1994;17:113–124
  53. Schag CA, Ganz PA, Wing DS, Sim MS, Lee JJ. Quality of life in adult survivors of lung, colon and prostate cancer. Qual Life Res. 1994;3:127–141
  54. Kurtz ME, Kurtz JC, Given CW, Given B. Loss of physical functioning among patients with cancer (a longitudinal view). Cancer Pract. 1993;1:275–281
  55. Johnson JA, Nowatzki TE, Coons SJ. Health-related quality of life of diabetic Pima Indians. Med Care. 1996;34:97–102
  56. Glasgow RE, Ruggiero L, Eakin EG, Dryfoos J, Chobanian L. Quality of life and associated characteristics in a large national sample of adults with diabetes. Diabetes Care. 1997;20:562–567
  57. Jacobson AM, de Groot M, Samson JA. The effects of psychiatric disorders and symptoms on quality of life in patients with type I and type II diabetes mellitus. Qual Life Res. 1997;6:11–20
  58. Kuhn W, Heye N, Muller T, Kraus P, Klotz P, Friedrich B, et al. The motor performance test series in Parkinson's disease is influenced by depression. J Neural Transm. 1996;103:349–354
  59. Sherbourne CD, Wells KB, Meredith LS, Jackson CA, Camp P. Comorbid anxiety disorder and the functioning and well-being of chronically ill patients of general medical providers. Arch Gen Psychiatry. 1996;53:889–895
  60. Chen AY, Daley J, Thibault GE. Angina patients' ratings of current health and health without angina (associations with severity of angina and comorbidity). Med Decis Making. 1996;16:169–177
  61. Kwa VI, Limburg M, de Haan RJ. The role of cognitive impairment in the quality of life after ischaemic stroke. J Neurol. 1996;243:599–604
  62. King RB. Quality of life after stroke. Stroke. 1996;27:1467–1472
  63. Liu M, Domen K, Chino N. Comorbidity measures for stroke outcome research (a preliminary study). Arch Phys Med Rehabil. 1997;78:166–172
  64. Nakayama H, Jorgensen HS, Pedersen PM, Raaschou HO, Olsen TS. Prevalence and risk factors of incontinence after stroke. The Copenhagen Stroke Study. Stroke. 1997;28:58–62
  65. Ween JE, Alexander MP, D'Eposito M, Roberts M. Factors predictive of stroke outcome in a rehabilitation setting. Neurology. 1996;47:388–392
  66. Feinglass J, McCarthy WJ, Slavensky R, Manheim LM, Martin GJ. Effect of lower extremity blood pressure on physical functioning in patients who have intermittent claudication. The Chicago Claudication Outcomes Research Group. J Vasc Surg. 1996;24:503–511
  67. Bussing R, Halfon N, Benjamin B, Wells KB. Prevalence of behavior problems in US children with asthma. Arch Pediatr Adolesc Med. 1995;149:565–572
  68. Ferrer M, Alonso J, Morera J, Marrades RM, Khalaf A, Aguar MC, et al. Chronic obstructive pulmonary disease stage and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group. Ann Intern Med. 1997;127:1072–1079
  69. Hopman Rock M, Odding E, Hofman A, Kraaimaat FW, Bijlsma JW. Differences in health status of older adults with pain in the hip or knee only and with additional mobility restricting conditions. J Rheumatol. 1997;24:2416–2423
  70. Schaardenburg D van, Brande KJ van den, Ligthart GJ, Breedveld FC, Hazes JM. Musculoskeletal disorders and disability in persons aged 85 and over: a community survey. Ann Rheum Dis 1994;53:807–11.
  71. Katz PP, Yelin EH. Prevalence and correlates of depressive symptoms among persons with rheumatoid arthritis. J Rheumatol. 1993;20:790–796
  72. Belza BL, Henke CJ, Yelin EH, Epstein WV, Gilliss CL. Correlates of fatigue in older adults with rheumatoid arthritis. Nurs Res. 1993;42:93–99
  73. Talamo J, Frater A, Gallivan S, Young A. Use of the short form 36 (SF36) for health status measurement in rheumatoid arthritis. Br J Rheumatol. 1997;36:463–469
  74. Verbrugge LM. Women, men, and osteoarthritis. Arthritis Care Res. 1995;8:212–220
  75. Ettinger WH, Davis MA, Neuhaus JM, Mallon KP. Long-term physical functioning in persons with knee osteoarthritis from NHANES. I (Effects of comorbid medical conditions). J Clin Epidemiol. 1994;47:809–815
  76. Taplin SH, Barlow W, Urban N, Mandelson MT, Timlin DJ, Ichikawa L, et al. Stage, age, comorbidity, and direct costs of colon, prostate, and breast cancer care. J Natl Cancer Inst. 1995;87:417–426
  77. Shwartz M, Iezzoni LI, Moskowitz MA, Ash AS, Sawitz E. The importance of comorbidities in explaining differences in patient costs. Med Care. 1996;34:767–782
  78. Matsui K, Goldman L, Johnson PA, Kuntz KM, Cook EF, Lee TH. Comorbidity as a correlate of length of stay for hospitalized patients with acute chest pain. J Gen Intern Med. 1996;11:262–268
  79. Monane M, Kanter DS, Glynn RJ, Avorn J. Variability in length of hospitalization for stroke. The role of managed care in an elderly population. Arch Neurol. 1996;53:875–880
  80. Ward MM, Rao R. Interruptions in rheumatology subspecialty care among patients with rheumatoid arthritis. J Rheumatol. 1995;22:2319–2326
  81. Smith TJ, Penberthy L, Desch CE, Whittemore M, Newschaffer C, Hillner BE, et al. Differences in initial treatment patterns and outcomes of lung cancer in the elderly. Lung Cancer. 1995;13:235–252
  82. August DA, Rea T, Sondak VK. Age-related differences in breast cancer treatment. Ann Surg Oncol. 1994;1:45–52
  83. Nicolucci A, Mainini F, Penna A, Scorpiglione N, Grilli R, Angiolini C, et al. The influence of patient characteristics on the appropriateness of surgical treatment for breast cancer patients. Ann Oncol. 1993;4:133–140
  84. Newschaffer CJ, Penberthy L, Desch CE, Retchin SM, Whittemore M. The effect of age and comorbidity in the treatment of elderly women with nonmetastatic breast cancer. Arch Intern Med. 1996;156:85–90
  85. Hilner BE, Penberthy L, Desch CE, McDonald MK, Smith TJ, Retchin SM. Variation in staging and treatment of local and regional breast cancer in the elderly. Breast Cancer Res Treat. 1996;40:75–86
  86. Krumholz HM, Radford MJ, Ellerbeck EF, Hennen J, Meehan TP, Petrillo M, et al. Aspirin in the treatment of acute myocardial infarction in elderly Medicare beneficiaries. Patterns of use and outcomes. Circulation. 1995;92:2841–2847
  87. McLaughlin TJ, Soumerai SB, Willison DJ, Gurwitz JH, Gao X, Borbas C, et al. The effect of comorbidity on use of thrombolysis or aspirin in patients with acute myocardial infarction eligible for treatment. J Gen Intern Med. 1997;12:1–6
  88. Geraci JM, Ashton CM, Kuykendall DH, Johnson ML, Wu L. In-hospital complications among survivors of admission for congestive heart failure, chronic obstructive pulmonary disease, or diabetes mellitus. J Gen Intern Med. 1995;10:307–314
  89. Ryan T, McCarthy JF, Rady MY, Serkey J, Gordon S, Starr NJ, et al. Early bloodstream infection after cardiopulmonary bypass (frequency rate, risk factors, and implications). Crit Care Med. 1997;25:2009–2014
  90. Rigdon EE, Monajjem N, Rhodes RS. Is carotid endarterectomy justified in patients with severe chronic renal insufficiency?. Ann Vasc Surg. 1997;11:115–119
  91. Piotrowski JJ, Ripepi AJ, Yuhas JP, Alexander JJ, Brandt CP. Colonic ischemia (the Achilles heel of ruptured aortic aneurysm repair). Am Surg. 1996;62:557–560
  92. Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA. Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum. 1995;38:1819–1825
  93. Krumholz HM, Parent EM, Tu N, Vaccarino V, Wang Y, Radford MJ, et al. Readmission after hospitalization for congestive heart failure among Medicare beneficiaries. Arch Intern Med. 1997;157:99–104
  94. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies (Development and validation). J Chron Dis. 1987;40:373–383
  95. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619
  96. Romano PS, Roos LL, Jollis JG. Adapting a clinical comorbidity index for use with ICD-9-CM administrative data (differing perspectives). J Clin Epidemiol. 1993;46:1075–1079
  97. Greenfield S, Apolone G, McNeil BJ, Cleary PD. The importance of coexistent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacement (comorbidity and outcomes after hip replacement). Med Care. 1993;31:141–154
  98. Kessler RC. Epidemiology of psychiatric comorbidity. In:  Tsung MT,  Tohen M,  Zahner GEP editor. Textbook in psychiatric epidemiology. New York: Wiley-Liss, Inc; 1995;
  99. Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry. 1998;173:11–53
  100. Bruce ML, Leaf PJ. Psychiatric disorders and 15-month mortality in a community sample of older adults. Am J Public Health. 1989;79:727–730
  101. Bruce ML, Leaf PJ, Rozal GP, Florio L, Hoff RA. Psychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area Study. Am J Psychiatry. 1994;151:716–721
  102. Kouzis A, Eaton WW, Leaf PJ. Psychopathology and mortality in the general population. Soc-Psychiatry Psychiatr Epidemiol. 1995;30:165–170
  103. Vaillant GE. A long-term follow-up of male alcohol abuse. Arch Gen Psychiatry. 1996;53:243–249
  104. Akker M van den, Buntinx F, Knottnerus JA. Comorbidity or multimorbidity: what's in a name? A review of literature. Eur J Gen Pract 1996;2:65–70.
  105. McGee D, Cooper R, Liao Y, Durazo Arvizu R. Patterns of comorbidity and mortality risk in blacks and whites. Ann Epidemiol. 1996;6:381–385
  106. Poses RM, McClish DK, Smith WR, Bekes C, Scott WE. Prediction of survival of critically ill patients by admission comorbidity. J Clin Epidemiol. 1996;49:743–747
  107. Christakis NA, Escarce JJ. Survival of Medicare patients after enrollment in hospice programs. N Engl J Med. 1996;335:172–178
  108. Incalzi RA, Capparella O, Gemma A, Landi F, Bruno E, DiMeo F, et al. The interaction between age and comorbidity contributes to predicting the mortality of geriatric patients in the acute-care hospital. J Intern Med. 1997;242:291–298
  109. Chapleski EE, Lichtenberg PA, Dwyer JW, Youngblade LM, Tsai PF. Morbidity and comorbidity among Great Lakes American Indians (predictors of functional ability). Gerontologist. 1997;37:588–597
  110. Haan MN, Weldon M. The influence of diabetes, hypertension, and stroke on ethnic differences in physical and cognitive functioning in an ethnically diverse older population. Ann Epidemiol. 1996;6:392–398
  111. Poli L, Pich A, Zanocchi M, Fonte G, Bo M, Fabris F. Autopsy and multiple pathology in the elderly. Gerontology. 1993;39:55–63
  112. Verbrugge LM, Lepkowski JM, Imanaka Y. Comorbidity and its impact on disability. Milbank Q. 1989;67:450–484
  113. Fried LP, Bandeen-Roche K, Kasper JD, Guralnik JM. Association of comorbidity with disability in older women (the Women's Health and Aging Study). J Clin Epidemiol. 1999;52:27–37
  114. Newschaffer CJ, Bush TL, Penberthy LE, Bellantoni M, Helzlsour K, Diener-West M. Does comorbid disease interact with cancer? An epidemiologic analysis of mortality in a cohort of elderly breast cancer patients. J Gerontol. 1998;53A:M372–M378

PII: S0895-4356(00)00363-2

Journal of Clinical Epidemiology
Volume 54, Issue 7 , Pages 661-674 , July 2001