Skip to main content
SpringerLink
Log in

Comorbidity and Multimorbidity

  • Chapter
  • First Online:
The Epidemiology of Aging

Abstract

Older adults often carry several chronic health conditions with varying degrees of severity and duration, and the combined effect can influence health outcomes. Conditions that co-occur with an index condition of interest are considered to be “comorbid” with the index condition, with the combination referred to as comorbidity. The term multimorbidity has recently been used to describe the totality of conditions. Methods for assessing comorbidity and understanding its impact are critical for the study of the epidemiology of aging. The presence of conditions in an individual can be based on self-reported diagnosis, administrative data or direct examination, each with its own strengths and limitations. Comorbid conditions are typically assessed as contributors to a health outcome, or as confounders or effect modifiers of a primary association. Some methods combine conditions into a single variable or index, including a simple tally or a weighted sum of conditions, which can be used to describe an individual’s overall health status and compare individuals or groups for degree of disease burden. Regarding impact in older adults, comorbidity (both clinical and subclinical) is associated with greater disability. When analyzing comorbidity data, the analysis of each condition and their interactions can provide greater insight into the pathways of the associations involved.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ADL:

Activity of Daily Living

CES-D:

Centers for the Epidemiologic Study of Depression

COPD:

Chronic Obstructive Pulmonary Disease

DRG:

Diagnosis-Related Group

DXA:

Dual-energy X-ray Absorptiometry

ECG:

Electrocardiogram

GI:

Gastrointestinal

Health ABC:

Health, Aging and Body Composition

ICD:

International Classification of Diseases

ICD-9:

International Classification of Diseases, Ninth Revision

LASA:

Longitudinal Aging Study – Amsterdam

MI:

Myocardial Infarction

References

  1. Wolff JL, Starfield B, Anderson G (2002) Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 162(20):2269–2276

    Article  PubMed  Google Scholar 

  2. Fried LP, Storer DJ, King DE et al (1991) Diagnosis of illness presentation in the elderly. J Am Geriatr Soc 39(2):117–123

    PubMed  CAS  Google Scholar 

  3. Boyd CM, Darer J, Boult C et al (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294(6):716–724

    Article  PubMed  CAS  Google Scholar 

  4. de Groot V, Beckerman H, Lankhorst GJ et al (2003) How to measure comorbidity. A critical review of available methods. J Clin Epidemiol 56(3):221–229

    Article  PubMed  Google Scholar 

  5. Feinstein A (1970) The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis 23:455–468

    Article  Google Scholar 

  6. Kaplan MH, Feinstein AR (1974) The importance of classifying initial co-morbidity in evaluatin the outcome of diabetes mellitus. J Chronic Dis 27(7–8):387–404

    Article  PubMed  CAS  Google Scholar 

  7. van den Akker M, Buntinx F, Knottnerus JA (1996) Comorbidity or multimorbidity. Eur J Gen Pract 2(2):65–70

    Article  Google Scholar 

  8. Karlamangla A, Tinetti M, Guralnik J et al (2007) Comorbidity in older adults: nosology of impairment, diseases, and conditions. J Gerontol A Biol Sci Med Sci 62A(3):M296–M300

    Article  Google Scholar 

  9. Newman AB, Boudreau RM, Naydeck BL et al (2) A physiologic index of comorbidity: relationship to mortality and disability. J Gerontol A Biol Sci Med Sci 63A(6):M603–M609

    Google Scholar 

  10. Centers for Disease Control and Prevention: National Center for Health Statistics, Health Data Interactive. Centers for Disease Control and Prevention Web site 2010; Available from: http://www.cdc.gov/NCHS/hdi.htm. Accessed 12 Dec 2011

  11. Fried LP, Kasper JD, Williamson JD et al (1995) Disease ascertainment algorithms. In: Guralnik JM FL, Simonsick EM, Kasper JD, Lafferty ME (eds) The Women’s Health and Aging Study: health and social characteristics of older women with disability. National Institute on Aging, Bethesda

    Google Scholar 

  12. Penninx BW, Kritchevsky SB, Yaffe K et al (2003) Inflammatory markers and depressed mood in older persons: results from the Health, Aging and Body Composition study. Biol Psychiatry 54(5):566–572

    Article  PubMed  CAS  Google Scholar 

  13. Psaty BM, Kuller LH, Bild D et al (1995) Methods of assessing prevalent cardiovascular disease in the Cardiovascular Health Study. Ann Epidemiol 5(4):270–277

    Article  PubMed  CAS  Google Scholar 

  14. Waterer GW, Wan JY, Kritchevsky SB et al (2001) Airflow limitation is underrecognized in well-functioning older people. J Am Geriatr Soc 49(8):1032–1038

    Article  PubMed  CAS  Google Scholar 

  15. Miller MR, Quanjer PH, Swanney MP et al (2011) Interpreting lung function data using 80% predicted and fixed thresholds misclassifies more than 20% of patients. Chest 139(1):52–59

    Article  PubMed  Google Scholar 

  16. Heckbert SR, Kooperberg C, Safford MM et al (2004) Comparison of self-report, hospital discharge codes, and adjudication of cardiovascular events in the women’s health initiative. Am J Epidemiol 160(12):1152–1158

    Article  PubMed  Google Scholar 

  17. The Criteria Committee of the New York Heart Association (1964) Diseases of the heart and blood vessels: nomenclature and criteria for diagnosis, 6th edn. Little, Brown and Co, Boston

    Google Scholar 

  18. Bellamy N, Buchanan WW, Goldsmith CH et al (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840

    PubMed  CAS  Google Scholar 

  19. Newman AB, Naydeck BL, Sutton-Tyrrell K et al (2001) The role of comorbidity in the assessment of intermittent claudication in older adults. J Clin Epidemiol 54(3):294–300

    Article  PubMed  CAS  Google Scholar 

  20. Whitworth JA (2003) 2003 World Health Organiza­tion (WHO)/International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 21(11):1983–1992

    Article  PubMed  Google Scholar 

  21. Charlson ME, Sax FL, MacKenzie CR et al (1987) Morbidity during hospitalization: can we predict it? J Chronic Dis 40(7):705–712

    Article  PubMed  CAS  Google Scholar 

  22. Deyo RA, Cherkin DC, Ciol MA (1992) Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 45(6):613–619

    Article  PubMed  CAS  Google Scholar 

  23. Iezzoni LI, Foley SM, Daley J et al (1992) Comorbidities, complications, and coding bias. Does the number of diagnosis codes matter in predicting in-hospital mortality? JAMA 267(16):2197–2203

    Article  PubMed  CAS  Google Scholar 

  24. Hsia DC, Krushat WM, Fagan AB et al (1988) Accuracy of diagnostic coding for Medicare patients under the prospective-payment system. N Engl J Med 318(6):352–355

    Article  PubMed  CAS  Google Scholar 

  25. Winkelmayer WC, Schneeweiss S, Mogun H et al (2005) Identification of individuals with CKD from Medicare claims data: a validation study. Am J Kidney Dis 46(2):225–232

    Article  PubMed  Google Scholar 

  26. Hennessy S, Leonard CE, Freeman CP et al (2010) Validation of diagnostic codes for outpatient-originating sudden cardiac death and ventricular arrhythmia in Medicaid and Medicare claims data. Pharmacoepidemiol Drug Saf 19(6):555–562

    Article  PubMed  Google Scholar 

  27. Abraham NS, Cohen DC, Rivers B et al (2006) Validation of administrative data used for the diagnosis of upper gastrointestinal events following nonsteroidal anti-inflammatory drug prescription. Aliment Pharmacol Ther 24(2):299–306

    Article  PubMed  CAS  Google Scholar 

  28. Losina E, Barrett J, Baron JA et al (2003) Accuracy of Medicare claims data for rheumatologic diagnoses in total hip replacement recipients. J Clin Epidemiol 56(6):515–519

    Article  PubMed  Google Scholar 

  29. Kim SY, Servi A, Polinski JM et al (2011) Validation of rheumatoid arthritis diagnoses in health care utilization data. Arthritis Res Ther 13(1):R32

    Article  PubMed  Google Scholar 

  30. Folstein MF, Robins LN, Helzer JE (1983) The mini-mental state examination. Arch Gen Psychiatry 40(7):812

    Article  PubMed  CAS  Google Scholar 

  31. Teng EL, Chui HC (1987) The Modified Mini-Mental State (3MS) examination. J Clin Psychiatry 48(8):314–318

    PubMed  CAS  Google Scholar 

  32. O’Connor EA, Whitlock EP, Gaynes B et al (2009) Screening for depression in adults and older adults in primary care: an updated systematic review. Evidence synthesis No. 75. AHRQ publication no. 10-05143-EF-1. Agency for Healthcare Research and Quality, Rockville

    Google Scholar 

  33. Orme JG, Reis J, Herz EJ (1986) Factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale. J Clin Psychol 42(1):28–33

    Article  PubMed  CAS  Google Scholar 

  34. Vinkers DJ, Gussekloo J, Stek ML et al (2004) The 15-item Geriatric Depression Scale (GDS-15) detects changes in depressive symptoms after a major negative life event. The Leiden 85-plus study. Int J Geriatr Psychiatry 19(1):80–84

    Article  PubMed  Google Scholar 

  35. Diederichs C, Berger K, Bartels DB (2011) The measurement of multiple chronic diseases–a systematic review on existing multimorbidity indices. J Gerontol A Biol Sci Med Sci 66A(3):M301–M311

    Article  Google Scholar 

  36. Kriegsman DM, Deeg DJ, Stalman WA (2004) Comorbidity of somatic chronic diseases and decline in physical functioning: the Longitudinal Aging study Amsterdam. J Clin Epidemiol 57(1):55–65

    Article  PubMed  Google Scholar 

  37. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  PubMed  CAS  Google Scholar 

  38. Quan H, Sundararajan V, Halfon P et al (2005) Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care 43(11):1130–1139

    Article  PubMed  Google Scholar 

  39. Quan H, Li B, Couris CM et al (2011) Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682

    Article  PubMed  Google Scholar 

  40. Walter LC, Brand RJ, Counsell SR et al (2001) Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 285(23):2987–2994

    Article  PubMed  CAS  Google Scholar 

  41. Lee SJ, Lindquist K, Segal MR et al (2006) Develop­ment and validation of a prognostic index for 4-year mortality in older adults. JAMA 295(7):801–808

    Article  PubMed  CAS  Google Scholar 

  42. Guralnik JM, LaCroix A, Everett DF et al (1989) Aging in the eighties: the prevalence of comorbidity and its association with disability. Natl Vital Stat Rep 170:1–8

    Google Scholar 

  43. Guralnik JM, LaCroix AZ, Abbott RD et al (1993) Maintaining mobility in late life. I. Demographic characteristics and chronic conditions. Am J Epidemiol 137(8):845–857

    PubMed  CAS  Google Scholar 

  44. Cesari M, Onder G, Russo A et al (2006) Comorbidity and physical function: results from the aging and longevity study in the Sirente geographic area (ilSIRENTE study). Gerontology 52(1):24–32

    Article  PubMed  Google Scholar 

  45. Marengoni A, Rizzuto D, Wang HX et al (2009) Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc 57(2):225–230

    Article  PubMed  Google Scholar 

  46. Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56A(3):M146–M156

    Article  Google Scholar 

  47. Sanders JL, Boudreau RM, Fried LP et al (2011) Measurement of organ structure and function enhances understanding of the physiological basis of frailty: the Cardiovascular Health Study. J Am Geriatr Soc 59(9):1581–1588

    Article  PubMed  Google Scholar 

  48. Lash TL, Mor V, Wieland D et al (2007) Methodology, design, and analytic techniques to address measurement of comorbid disease. J Gerontol A Biol Sci Med Sci 62A(3):M281–M285

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

    Anne B. Newman M.D., MPH (Chair)

  2. Center for Aging and Population Health, University of Pittsburgh, Pittsburgh, PA, USA

    Anne B. Newman M.D., MPH (Director)

  3. Medicine and Clinical & Translational Science, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Anne B. Newman M.D., MPH (Professor of Epidemiology)

Authors
  1. Anne B. Newman M.D., MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anne B. Newman M.D., MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne B. Newman M.D., MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Anne B. Newman M.D., MPH .

Editor information

Editors and Affiliations

  1. , Graduate School of Public Health, University of Pittsburgh, A527 Crabtree Hall, DeSoto Street 130, Pittsburgh, 15261, Pennsylvania, USA

    Anne B. Newman

  2. Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, DeSoto Street, A510 Crabtree 130, Pittsburgh, 15261, Pennsylvania, USA

    Jane A. Cauley

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Newman, A.B., Newman, A.B., Newman, A.B. (2012). Comorbidity and Multimorbidity. In: Newman, A., Cauley, J. (eds) The Epidemiology of Aging. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-5061-6_8

Download citation

Publish with us

Policies and ethics

Search

Navigation