Mediterranean Institute of Primary Care, 19, Triq ir-Rand, Attard, ATD1300, Malta.
MD, ICPC Club, Caserta, Piazza Matteotti, 67 81100, Italia.
BMC Prim Care. 2024 Aug 2;25(1):279. doi: 10.1186/s12875-024-02513-2.
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.
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.
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.
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.
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.
共病在医学文献中越来越重要，对诊断、治疗、预后、管理和医疗保健都有越来越大的影响。本研究的目的是在三个家庭医疗人群中衡量初级保健中的偶然共病和因果共病。
这是一项使用过渡项目数据集的纵向观察性研究。荷兰、马耳他和塞尔维亚的过渡项目家庭医生使用电子病历和国际初级保健分类记录了医疗记录中每一次医疗接触的详细信息，收集了医患接触的所有要素的数据，包括诊断（荷兰有 1178178 个，马耳他有 93606 个，塞尔维亚有 405150 个），观察了荷兰的 158370 个患者年，马耳他的 43577 个，塞尔维亚的 72673 个。使用一年数据框中同一患者同时发生或预先存在的两种情况的优势比来衡量共病，而不是使用三个人群中 41 个最常见（联合前 20 个）发病标题之间的这种共同发生的先验概率进行校正，以衡量共病。在不同年龄组中探索了特定的关联，以观察随着年龄的增加，作为时间或生物学梯度的替代，优势比的变化。
观察到的共病频率很高，但在三个人群中，临床和统计学上显著的优势比的一致性都很低，这表明更多的是偶然的关联，而不是因果关系。预计因果关系在不同人群中会更一致地表现出来。即使在两国之间的优势比一致且数值较大的少数情况下，随着患者年龄的增加，这些关联也会减弱。
在应用测试关联因果关系的公认标准后，大多数观察到的初级保健共病是由于偶然，可能是由于疾病多样性的增加。
本研究是在阿姆斯特丹大学全科医学系公开提供的电子患者记录数据集上进行的，不涉及任何患者干预。
