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Comparison of the Charlson Comorbidity Index derived from self-report and medical record review in Asian patients with rheumatic diseases

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Abstract

The aim of the study was to compare the agreement between self-report Charlson Comorbidity Index (SR-CCI) and the medical record-based CCI (MR-CCI) and to examine the impact of both instruments on health-related quality of life (HRQoL) amongst Asian patients with rheumatic diseases. This cross-sectional study surveyed a convenience sample of patients seen at rheumatology specialty outpatient clinics. Patients completed the SR-CCI and Short Form 36, while two research assistants completed the MR-CCI. Item-level agreement between the SR-CCI and MR-CCI was evaluated using kappa coefficients. Adjusted linear regression models evaluated the independent effect of the SR-CCI/MR-CCI on HRQoL. The study included 301 patients (median age 51, range 21–79, 61.5 % female, 68.8 % Chinese, 17.6 % Indian, 6.0 % Malay). Kappa statistics for cerebrovascular disease (0.433), chronic pulmonary disease (0.509), connective tissue disease/rheumatoid arthritis (0.506), ulcer disease (0.461), and tumour (0.541) reflected moderate agreement between the SR-CCI and MR-CCI (all p < 0.0001). There was substantial agreement in the reporting of diabetes (0.764, p < 0.0001) but poor/fair agreement for that of myocardial infarction (0.359, p < 0.0001) and diabetes with end-organ damage (0.189, p = 0.0002). Increases in SR-CCI were associated with significant reductions in both physical (β coefficient −2.56, p < 0.0001) and mental HRQoL (β coefficient −1.24, p = 0.044). However, such associations were not observed with the MR-CCI. The SR-CCI demonstrated moderate concordance with the MR-CCI, and the SR-CCI but not MR-CCI scores were associated with lower HRQoL. Assessment of comorbidities amongst rheumatology patients remains complex, and more efficient methods of quantifying these conditions are needed for clinical and research purposes.

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References

  1. Gabriel SE, Michaud K (2009) Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 11(3):229. doi:10.1186/ar2669

    Article  PubMed Central  PubMed  Google Scholar 

  2. Gabriel SE, Crowson CS, O’Fallon WM (1999) Comorbidity in arthritis. J Rheumatol 26(11):2475–2479

    CAS  PubMed  Google Scholar 

  3. Michaud K, Wolfe F (2007) Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 21(5):885–906. doi:10.1016/j.berh.2007.06.002

    Article  PubMed  Google Scholar 

  4. Wasko MC (2004) Comorbid conditions in patients with rheumatic diseases: an update. Curr Opin Rheumatol 16(2):109–113. doi:10.1097/00002281-200403000-00006

    Article  PubMed  Google Scholar 

  5. Rupp I, Boshuizen HC, Jacobi CE, Dinant HJ, van den Bos G (2004) Comorbidity in patients with rheumatoid arthritis: effect on health-related quality of life. J Rheumatol 31(1):58–65

    PubMed  Google Scholar 

  6. Mok CC, Lok EY, Cheung EF (2012) Concurrent psychiatric disorders are associated with significantly poorer quality of life in patients with rheumatoid arthritis. Scand J Rheumatol 41(4):253–259. doi:10.3109/03009742.2012.664648

    Article  CAS  PubMed  Google Scholar 

  7. Baser O, Burkan A, Baser E, Koselerli R, Ertugay E, Altinbas A (2013) Direct medical costs associated with rheumatoid arthritis in Turkey: analysis from National Claims Database. Rheumatol Int 33(10):2577–2584. doi:10.1007/s00296-013-2782-4

    Article  PubMed  Google Scholar 

  8. Wolfe F, Michaud K, Li T, Katz RS (2010) Chronic conditions and health problems in rheumatic diseases: comparisons with rheumatoid arthritis, noninflammatory rheumatic disorders, systemic lupus erythematosus, and fibromyalgia. J Rheumatol 37(2):305–315. doi:10.3899/jrheum.090781

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  10. Katz JN, Chang LC, Sangha O, Fossel AH, Bates DW (1996) Can comorbidity be measured by questionnaire rather than medical record review? Med Care 34(1):73–84

    Article  CAS  PubMed  Google Scholar 

  11. Corser W, Sikorskii A, Olomu A, Stommel M, Proden C, Holmes-Rovner M (2008) Concordance between comorbidity data from patient self-report interviews and medical record documentation. BMC Health Serv Res 8:85. doi:10.1186/1472-6963-8-85

    Article  PubMed Central  PubMed  Google Scholar 

  12. Merkin SS, Cavanaugh K, Longenecker JC, Fink NE, Levey AS, Powe NR (2007) Agreement of self-reported comorbid conditions with medical and physician reports varied by disease among end-stage renal disease patients. J Clinical Epidemiol 60(6):634–642. doi:10.1016/j.jclinepi.2006.09.003

    Article  Google Scholar 

  13. Habbous S, Chu KP, Harland LT, La Delfa A, Fadhel E, Sun B, Xu W, Wong A, Howell D, Ringash J, Waldron J, O’Sullivan B, Goldstein D, Huang SH, Liu G (2013) Validation of a one-page patient-reported Charlson comorbidity index questionnaire for upper aerodigestive tract cancer patients. Oral Oncol 49(5):407–412. doi:10.1016/j.oraloncology.2012.11.010

    Article  PubMed  Google Scholar 

  14. Susser SR, McCusker J, Belzile E (2008) Comorbidity information in older patients at an emergency visit: self-report vs. administrative data had poor agreement but similar predictive validity. J Clinical Epidemiol 61(5):511–515. 10.1016/j.jclinepi.2007.07.009

  15. Ware JE Jr (2000) SF-36 health survey update. Spine 25(24):3130–3139. doi:10.1097/00007632-200012150-00008

    Article  PubMed  Google Scholar 

  16. Thumboo J, Fong KY, Machin D, Chan SP, Leon KH, Feng PH, Thio ST, Boe ML (2001) A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore. Qual Life Res 10(2):175–188

    Article  CAS  PubMed  Google Scholar 

  17. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174

    Article  CAS  PubMed  Google Scholar 

  18. Fayers P, Machin D (2007) Scores and measurement: validity, reliability, sensitivity. Quality of life: the assessment, analysis and interpertation of patient-reported outcomes, 2nd edn. Wiley, Chichester, UK, pp 77–107

    Chapter  Google Scholar 

  19. Cohen J (1988) Statistical power for behavioral science, 2nd edn. Erlbaum Associates, Hillsdale, New Jersey

    Google Scholar 

  20. Loza E, Lajas C, Andreu JL, Balsa A, Gonzalez-Alvaro I, Illera O, Jover JA, Mateo I, Orte J, Rivera J, Rodriguez Heredia JM, Romero F, Martinez-Lopez JA, Ortiz AM, Toledano E, Villaverde V, Carmona L, Castaneda S (2015) Consensus statement on a framework for the management of comorbidity and extra-articular manifestations in rheumatoid arthritis. Rheumatol Int 35(3):445–458. doi:10.1007/s00296-014-3196-7

    Article  PubMed  Google Scholar 

  21. Okura Y, Urban LH, Mahoney DW, Jacobsen SJ, Rodeheffer RJ (2004) Agreement between self-report questionnaires and medical record data was substantial for diabetes, hypertension, myocardial infarction and stroke but not for heart failure. J Clinical Epidemiol 57(10):1096–1103. doi:10.1016/j.jclinepi.2004.04.005

    Article  Google Scholar 

  22. Walitt BT, Constantinescu F, Katz JD, Weinstein A, Wang H, Hernandez RK, Hsia J, Howard BV (2008) Validation of self-report of rheumatoid arthritis and systemic lupus erythematosus: the Women’s Health Initiative. J Rheumatol 35(5):811–818

    PubMed Central  PubMed  Google Scholar 

  23. Kvien TK, Glennas A, Knudsrod OG, Smedstad LM (1996) The validity of self-reported diagnosis of rheumatoid arthritis: results from a population survey followed by clinical examinations. J Rheumatol 23(11):1866–1871

    CAS  PubMed  Google Scholar 

  24. Barlow JH, Turner AP, Wright CC (1998) Comparison of clinical and self-reported diagnoses for participants on a community-based arthritis self-management programme. Br J Rheumatol 37(9):985–987

    Article  CAS  PubMed  Google Scholar 

  25. Ministry of Health Singapore Health Facts. Disease Burden. www.moh.gov.sg/content/moh_web/home/statistics/Health_Facts_Singapore/Disease_Burden.html. Accessed 28 Dec 2013

  26. Solomon DH, Massarotti E, Garg R, Liu J, Canning C, Schneeweiss S (2011) Association between disease-modifying antirheumatic drugs and diabetes risk in patients with rheumatoid arthritis and psoriasis. JAMA 305(24):2525–2531. doi:10.1001/jama.2011.878

    Article  CAS  PubMed  Google Scholar 

  27. Kriegsman DM, Penninx BW, van Eijk JT, Boeke AJ, Deeg DJ (1996) Self-reports and general practitioner information on the presence of chronic diseases in community dwelling elderly. A study on the accuracy of patients’ self-reports and on determinants of inaccuracy. J Clin Epidemiol 49(12):1407–1417

  28. Tuominen U, Blom M, Hirvonen J, Seitsalo S, Lehto M, Paavolainen P, Hietanieni K, Rissanen P, Sintonen H (2007) The effect of co-morbidities on health-related quality of life in patients placed on the waiting list for total joint replacement. Health Qual Life Outcomes 5:16. doi:10.1186/1477-7525-5-16

    Article  PubMed Central  PubMed  Google Scholar 

  29. Selim AJ, Fincke G, Ren XS, Lee A, Rogers WH, Miller DR, Skinner KM, Linzer M, Kazis LE (2004) Comorbidity assessments based on patient report: results from the Veterans Health Study. J Ambul Care Manage 27(3):281–295

    Article  PubMed  Google Scholar 

  30. Baumeister H, Balke K, Harter M (2005) Psychiatric and somatic comorbidities are negatively associated with quality of life in physically ill patients. J Clin Epidemiol 58(11):1090–1100. doi:10.1016/j.jclinepi.2005.03.011

    Article  PubMed  Google Scholar 

  31. Bayliss EA, Ellis JL, Steiner JF (2005) Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument. Health Qual Life Outcomes 3:51. doi:10.1186/1477-7525-3-51

    Article  PubMed Central  PubMed  Google Scholar 

  32. Byrt T (1992) Problems with kappa. J Clinical Epidemiol 45(12):1452

    Article  CAS  Google Scholar 

  33. Elewaut D, Goodson N, Fleischmann R (2013) Should we be morbid about comorbidities in the rheumatic diseases? Rheumatology 52(1):1–2. doi:10.1093/rheumatology/kes361

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors wish to thank the staff nurses and clinic assistants at the Specialist Outpatient Clinic, Singapore General Hospital, for their kind help.

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical standard

Written informed consent was obtained from all participants of this study.

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Authors and Affiliations

  1. Department of Pharmaceutical Health Services Research, University of Maryland Baltimore, Baltimore, MD, USA

    Xinyi Ng

  2. Department of Rheumatology and Immunology, Singapore General Hospital, The Academia, 20 College Road, Singapore, Singapore

    Andrea Hsiu Ling Low & Julian Thumboo

  3. Duke-NUS Graduate Medical School, Singapore, Singapore

    Andrea Hsiu Ling Low & Julian Thumboo

  4. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Andrea Hsiu Ling Low & Julian Thumboo

Authors
  1. Xinyi Ng
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  2. Andrea Hsiu Ling Low
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  3. Julian Thumboo
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Corresponding author

Correspondence to Julian Thumboo.

Additional information

This work was initiated while XN was employed by the Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, and completed while she was a PhD student at the University of Maryland Baltimore.

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Ng, X., Low, A.H.L. & Thumboo, J. Comparison of the Charlson Comorbidity Index derived from self-report and medical record review in Asian patients with rheumatic diseases. Rheumatol Int 35, 2005–2011 (2015). https://doi.org/10.1007/s00296-015-3296-z

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  • DOI: https://doi.org/10.1007/s00296-015-3296-z

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