Comments of Complex Chronic Disease Taxonomy

1.2.1. Co-morbidity

MeSH: Comorbidity http://www.nlm.nih.gov/cgi/mesh/2008/MB_cgi?mode=&term=Comorbidity&field=entry

The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. As an example, an individual could live with multiple chronic conditions such as paralysis, incontinence, dementia and pain, all stemming from a single disease like multiple sclerosis.

Comordibity could be classified in three groups depending on the relation between the index disease and the accompanying conditions:

  1. Random. These are the comorbidities that occur together with a frequency no different than the individual prevalences multiplied together, that is to say the associations occur by chance. An example in our practice is the co-existence of hand warts and osteoarthritis.
  2. Consequential (classified in the literature as casual or complicated co-morbidity). These are conditions that are pathophysiologically part of the same process. it is no surprise to find that diabetes and hypertension occur together more than by chance, so these co morbidities, though interesting, are predictable.
  3. Cluster co-morbidity is the non random clustering of health conditions without an evident underlying pathophysiological cause. Here is the opportunity for new discoveries - either new understandings of pathophysiology, or a new appreciation of the nature of complexity.

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