Multimorbilidad: bases conceptuales, modelos epidemiológicos y retos de su medición

Abstract

Contribución de los autores:Ambos autores contribuyeron a la concepción y el diseño del ensayo, el análisis y la interpretación de las fuentes originales, así como a la redacción y la aprobación de la versión final. Multimorbilidad: bases conceptuales, modelos epidemiológicos y retos de su mediciónJulián A. Fernández-Niño 1 , Eduardo Bustos-Vázquez 2 1 Centro de Información para Decisiones en Salud Pública, Instituto Nacional de Salud Pública, Cuernavaca, México 2 Escuela de Salud Pública de México, Instituto Nacional de Salud Pública, Cuernavaca, México El incremento continuo de pacientes con perfiles clínicos complejos debidos a enfermedades crónicas ha favorecido el uso cada vez más extendido del término multimorbilidad. Es indispensable disponer de una medición apropiada de esta condición, dado que representa un reto para el manejo clínico de los pacientes, los sistemas de salud y la investigación epidemiológica. En este ensayo se revisan las propuestas conceptuales subyacentes a la medición de la multimorbilidad y se discuten los retos metodológicos involucrados, tomando como referencia las definiciones clásicas de comorbilidad, sus diferencias con el concepto de multimorbilidad y su papel en los estudios epidemiológicos, así como los distintos modelos conceptuales de los que se derivan las definiciones operativas y las estrategias de medición de dicha variable. Se pudo determinar que hay una brecha importante entre el desarrollo del concepto de multimorbilidad y las definiciones operativas, a pesar del significativo avance teórico que ha permitido trascender la concepción clásica de comorbilidad para llegar al concepto actual de multimorbilidad. Sin embargo, las estrategias de medición no se han desarrollado al mismo ritmo del concepto, por lo que se requieren nuevas propuestas metodológicas que permitan obtener información sobre su verdadero impacto en la salud de las personas y sus implicaciones para la salud pública.Palabras clave: comorbilidad, enfermedad crónica, modelos teóricos, estudios epidemiológicos, sesgo (epidemiología), envejecimiento. doi: http://dx.doi.org/10.7705/biomedica.v36i2.2710 Multimorbidity: conceptual basis, epidemiological models and measurement challengesThe growing number of patients with complex clinical profiles related to chronic diseases has contributed to the increasingly widespread use of the term 'multimorbidity'. A suitable measurement of this condition is essential to epidemiological studies considering that it represents a challenge for the clinical management of patients as well as for health systems and epidemiological investigations. In this context, the present essay reviews the conceptual proposals behind the measurement of multimorbidity including the epidemiological and methodological challenges it involves. We discuss classical definitions of comorbidity, how they differ from the concept of multimorbidity, and their roles in epidemiological studies. The various conceptual models that contribute to the operational definitions and strategies to measure this vari...

Work status, retirement, and depression in older adults: An analysis of six countries based on the Study on Global Ageing and Adult Health (SAGE)

“…The presence of multimorbidity was determined according to self-reports of having a medical diagnosis of illnesses from a list of 8 primary chronic diseases (arthritis, cerebrovascular event, angina, diabetes, chronic obstructive pulmonary disease, asthma, hypertension, and cataracts). This variable was characterized as: none or only one morbidity, two morbidities, or three or more (the standard definition of multimorbidity) ( Fernández-Niño & Bustos-Vázquez, 2016 ). Lastly, the history of accidents or physical injuries over the previous 12 months was dichotomized (yes=1 and no =0).…”

Prevalence of multimorbidity in subjects aged ≥60 years in a developing country

“… 2 , 20 Additionally, the prevalence of simultaneous chronic diseases increases, 2 which is known as multimorbidity. Based on a systematic review of the scientific literature, the European General Practice Research Network identified 132 definitions in 416 papers and established the following definition: “Multimorbidity is defined as any combination of a chronic disease with at least one other disease (acute or chronic) or with a psychosocial factor (associated or not) or with a somatic factor.” 3 Increased multimorbidity leads to polypharmacy, which is the greater use of medical and social services as well as restrictions on activity, making it a public health problem. 4 …”

Association of tuberculosis with multimorbidity and social networks

“…Tuberculosis has been reported in association with malnutrition, diabetes, smoking, alcoholism, chronic pulmonary disease, and HIV infection. 13 , 14 The combination of tuberculosis with other diseases, which is now known as “multimorbidity,” 15 is important because it can complicate clinical treatment and increase costs, among other reasons. 14 Given that previous social network analyses of individuals with tuberculosis have not addressed the topic of multimorbidity, the objective of the present study was to explore possible associations between the number of contacts and multimorbidity.…”