Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2013:2013:192782.
doi: 10.1155/2013/192782. Epub 2013 Sep 25.

The conceptualization and measurement of comorbidity: a review of the interprofessional discourse

Salimah H Meghani  1 , Harleah G Buck, Victoria Vaughan Dickson, Marilyn J Hammer, Eneida Rejane Rabelo-Silva, Robyn Clark, Mary D Naylor
Affiliations
Review

The conceptualization and measurement of comorbidity: a review of the interprofessional discourse

Salimah H Meghani et al. Nurs Res Pract. 2013.

Abstract

Background. Chronic medical conditions often occur in combination. Understanding underlying mechanisms causing diseases and their interactions may make it possible to address multiple complex conditions with single or consolidated treatment approaches and improve patients' health outcomes while reducing costs. Objectives. We present a synthesis of the current interprofessional discourse on the issues surrounding comorbidities. Methods. A targeted review of the literature was conducted using published editorials, commentaries, and review articles. Results. Errors in conceptualization and measurement plague our current understanding of comorbidities. Two potential paths to generating knowledge involve the use of etiological or epidemiological approach. An etiological approach investigates the risk factors and underlying mechanisms potentially leading to consolidation of diagnosis and treatments. Because of the rudimentary stage of knowledge development in this area, this approach will require time and significant research investments. In contrast, the epidemiological approach relies on statistical identification of disease entities that cooccur beyond random chance; this approach carries an accompanying risk of diagnostic and treatment proliferation. Discussion. The concept of comorbidity, its nature, and measurement is in need of meaningful debate by the scientific and clinical communities. Recommendations in the domains of conceptualization, research, and measurement are discussed.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Multimorbidity versus comorbidity (illustration of conceptual problem no. 1).
Figure 2
Figure 2
The relation between nosology, chronology and evolving science (illustration of conceptual problem no. 2).
Figure 3
Figure 3
Dynamicity: patterns of relationships and complexities (illustration of conceptual problem no. 3).
Figure 4
Figure 4
Closing the gap: translation of comorbidity science.
See this image and copyright information in PMC

References

    1. Feinstein AR. The pre-therapeutic classification of comorbidity in chronic disease. Journal of Chronic Diseases. 1970;23(7):455–468. - PubMed
    1. Meehl PE. Comorbidity and taxometrics. Clinical Psychology: Science and Practice. 2001;8(4):507–519.
    1. Parekh AK, Barton MB. The challenge of multiple comorbidity for the us health care system. The Journal of the American Medical Association. 2010;303(13):1303–1304. - PubMed
    1. Starfield B. Threads and yarns: weaving the tapestry of comorbidity. Annals of Family Medicine. 2006;4(2):101–103. - PMC - PubMed
    1. Holroyd KA. Disentangling the gordion knot of migraine comorbidity. Headache. 2007;47(6):876–877. - PubMed

LinkOut - more resources