Defining Comorbidity: Implications for Understanding Health and Health Services

Abstract 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 concept...

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Bibliographic Details
Published in:Annals of family medicine 2009-07, Vol.7 (4), p.357-363
Main Authors: Valderas, Jose M., MD, PhD, MPH, Starfield, Barbara, MD, MPH, Sibbald, Bonnie, MSc, PhD, Salisbury, Chris, MB, ChB, MSc, FRCGP, Roland, Martin, CBE, DM, FRCGP, FRCP, FMedSci
Format: Article
Language:English
Subjects:
Chronic Disease - epidemiology
Comorbidity
Health Care Costs
Health Services
Humans
Internal Medicine
Medicare - economics
Patient Care Management - economics
Patient Care Management - methods
Sickness Impact Profile
Theory
Treatment Outcome
United States - epidemiology
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Summary:Abstract 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.
ISSN:1544-1709
1544-1717
DOI:10.1370/afm.983