背景:合并症在医学文献中越来越重要,对诊断的影响越来越大,治疗,预后,管理和医疗保健。这项研究的目的是在三个家庭实践人群中测量初级保健中的偶然和因果合并症。
方法:这是一项使用过渡项目数据集的纵向观察研究。荷兰的过渡项目家庭医生,马耳他和塞尔维亚使用电子病历和国际初级保健分类记录了护理结构中所有患者接触者的详细信息,收集关于医患关系的所有要素的数据,包括诊断(荷兰1,178,93,606在马耳他,405,150在塞尔维亚),在荷兰观察了158,370个病人年,43,577在马耳他,塞尔维亚的72,673。在一年的数据帧中,使用同一患者中两种情况都是偶然发生或最普遍的比值比来测量合并症,而不是,校正了这种共现的先验概率,在这三个人群中41个联合最普遍(联合前20名)的剧集标题之间。在不同年龄组中探索了特定的关联,以观察随着年龄的增长作为时间或生物梯度的替代,赔率比的变化。
结果:观察到的合并症的频率高,在人群中临床和统计学上显著的比值比的一致性低,表明与因果关联相比更随意。因果关系预计将在人群中更加一致地表现出来。即使在少数国家之间的赔率比一致且数值较大的情况下,观察到这些关联随着患者年龄的增加而减弱.
结论:应用公认的检验关联因果关系的标准后,最观察到的初级保健合并症是偶然的,可能是疾病多样性增加的结果。
背景:这项研究是在阿姆斯特丹大学全科医学系公开提供的电子病历数据集上进行的,并且不涉及任何患者干预。
BACKGROUND: Comorbidity is increasingly important in the medical literature, with ever-increasing implications for diagnosis, treatment, prognosis, management and health care. The objective of this study is to measure casual versus causal comorbidity in primary care in three family practice populations.
METHODS: This is a longitudinal observational study using the Transition Project datasets. Transition Project family doctors in the Netherlands, Malta and Serbia recorded details of all patient contacts in an episode of care structure using electronic medical records and the International Classification of Primary Care, collecting data on all elements of the doctor-patient encounter, including diagnoses (1,178,178 in the Netherlands, 93,606 in Malta, 405,150 in Serbia), observing 158,370 patient years in the Netherlands, 43,577 in Malta, 72,673 in Serbia. Comorbidity was measured using the odds ratio of both conditions being incident or rest-prevalent in the same patient in one-year dataframes, as against not, corrected for the prior probability of such co-occurrence, between the 41 joint most prevalent (joint top 20) episode titles in the three populations. Specific associations were explored in different age groups to observe the changes in odds ratios with increasing age as a surrogate for a temporal or biological gradient.
RESULTS: The high frequency of observed comorbidity with low consistency in both clinically and statistically significant odds ratios across populations indicates more casual than causal associations. A causal relationship would be expected to be manifest more consistently across populations. Even in the minority of cases where odds ratios were consistent between countries and numerically larger, those associations were observed to weaken with increasing patient age.
CONCLUSIONS: After applying accepted criteria for testing the causality of associations, most observed primary care comorbidity is due to chance, likely as a result of increasing illness diversity.
BACKGROUND: This study was performed on electronic patient record datasets made publicly available by the University of Amsterdam Department of General Practice, and did not involve any patient intervention.