Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity

Debra Ann Heller, Frank Martin Ahern, Kristine E. Pringle, Theresa V. Brown

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Objective: To examine the impact of changes in comorbidity-as measured by the Charlson comorbidity index-on self-rated health in a large sample of community-dwelling elderly over a 1-year period, and to examine the differential effects of changes in specific Charlson diagnostic categories. Study Design and Setting: Longitudinal survey data on self-rated health were linked with Medicare inpatient, outpatient, and physician visit data for 30,535 U.S. elderly residing in Pennsylvania. Multivariate logistic regression with fractional polynomials was used to model relationships involving baseline and changing Charlson comorbidity with self-rated health decline, and to evaluate covariate interactions. Results: Comorbidity change was associated with greater likelihood of worsened self-rated health, but the relationship was nonlinear and was moderated by age and baseline comorbidity. The impact of comorbidity change appeared to be less among older individuals and those with higher baseline comorbidity. Declines in self-rated health were most likely following new diagnoses for metastatic tumors, paralysis, and dementia. Conclusion: Self-rated health is responsive to changes in Charlson comorbidity, but nonlinearity and interactions suggest complexity in how elderly respond to comorbidity change. Younger individuals and those with initially low comorbidity are more likely to reduce self-ratings of health following new diagnoses for chronic conditions.

Original languageEnglish (US)
Pages (from-to)177-187
Number of pages11
JournalJournal of Clinical Epidemiology
Volume62
Issue number2
DOIs
StatePublished - Feb 1 2009

Fingerprint

Comorbidity
Health
Independent Living
Medicare
Paralysis
Longitudinal Studies
Dementia
Inpatients
Outpatients
Logistic Models
Physicians

All Science Journal Classification (ASJC) codes

  • Epidemiology

Cite this

Heller, Debra Ann ; Ahern, Frank Martin ; Pringle, Kristine E. ; Brown, Theresa V. / Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity. In: Journal of Clinical Epidemiology. 2009 ; Vol. 62, No. 2. pp. 177-187.
@article{cd70b4329dff4609bc192d9325806c9e,
title = "Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity",
abstract = "Objective: To examine the impact of changes in comorbidity-as measured by the Charlson comorbidity index-on self-rated health in a large sample of community-dwelling elderly over a 1-year period, and to examine the differential effects of changes in specific Charlson diagnostic categories. Study Design and Setting: Longitudinal survey data on self-rated health were linked with Medicare inpatient, outpatient, and physician visit data for 30,535 U.S. elderly residing in Pennsylvania. Multivariate logistic regression with fractional polynomials was used to model relationships involving baseline and changing Charlson comorbidity with self-rated health decline, and to evaluate covariate interactions. Results: Comorbidity change was associated with greater likelihood of worsened self-rated health, but the relationship was nonlinear and was moderated by age and baseline comorbidity. The impact of comorbidity change appeared to be less among older individuals and those with higher baseline comorbidity. Declines in self-rated health were most likely following new diagnoses for metastatic tumors, paralysis, and dementia. Conclusion: Self-rated health is responsive to changes in Charlson comorbidity, but nonlinearity and interactions suggest complexity in how elderly respond to comorbidity change. Younger individuals and those with initially low comorbidity are more likely to reduce self-ratings of health following new diagnoses for chronic conditions.",
author = "Heller, {Debra Ann} and Ahern, {Frank Martin} and Pringle, {Kristine E.} and Brown, {Theresa V.}",
year = "2009",
month = "2",
day = "1",
doi = "10.1016/j.jclinepi.2008.05.009",
language = "English (US)",
volume = "62",
pages = "177--187",
journal = "Journal of Clinical Epidemiology",
issn = "0895-4356",
publisher = "Elsevier USA",
number = "2",

}

Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity. / Heller, Debra Ann; Ahern, Frank Martin; Pringle, Kristine E.; Brown, Theresa V.

In: Journal of Clinical Epidemiology, Vol. 62, No. 2, 01.02.2009, p. 177-187.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity

AU - Heller, Debra Ann

AU - Ahern, Frank Martin

AU - Pringle, Kristine E.

AU - Brown, Theresa V.

PY - 2009/2/1

Y1 - 2009/2/1

N2 - Objective: To examine the impact of changes in comorbidity-as measured by the Charlson comorbidity index-on self-rated health in a large sample of community-dwelling elderly over a 1-year period, and to examine the differential effects of changes in specific Charlson diagnostic categories. Study Design and Setting: Longitudinal survey data on self-rated health were linked with Medicare inpatient, outpatient, and physician visit data for 30,535 U.S. elderly residing in Pennsylvania. Multivariate logistic regression with fractional polynomials was used to model relationships involving baseline and changing Charlson comorbidity with self-rated health decline, and to evaluate covariate interactions. Results: Comorbidity change was associated with greater likelihood of worsened self-rated health, but the relationship was nonlinear and was moderated by age and baseline comorbidity. The impact of comorbidity change appeared to be less among older individuals and those with higher baseline comorbidity. Declines in self-rated health were most likely following new diagnoses for metastatic tumors, paralysis, and dementia. Conclusion: Self-rated health is responsive to changes in Charlson comorbidity, but nonlinearity and interactions suggest complexity in how elderly respond to comorbidity change. Younger individuals and those with initially low comorbidity are more likely to reduce self-ratings of health following new diagnoses for chronic conditions.

AB - Objective: To examine the impact of changes in comorbidity-as measured by the Charlson comorbidity index-on self-rated health in a large sample of community-dwelling elderly over a 1-year period, and to examine the differential effects of changes in specific Charlson diagnostic categories. Study Design and Setting: Longitudinal survey data on self-rated health were linked with Medicare inpatient, outpatient, and physician visit data for 30,535 U.S. elderly residing in Pennsylvania. Multivariate logistic regression with fractional polynomials was used to model relationships involving baseline and changing Charlson comorbidity with self-rated health decline, and to evaluate covariate interactions. Results: Comorbidity change was associated with greater likelihood of worsened self-rated health, but the relationship was nonlinear and was moderated by age and baseline comorbidity. The impact of comorbidity change appeared to be less among older individuals and those with higher baseline comorbidity. Declines in self-rated health were most likely following new diagnoses for metastatic tumors, paralysis, and dementia. Conclusion: Self-rated health is responsive to changes in Charlson comorbidity, but nonlinearity and interactions suggest complexity in how elderly respond to comorbidity change. Younger individuals and those with initially low comorbidity are more likely to reduce self-ratings of health following new diagnoses for chronic conditions.

UR - http://www.scopus.com/inward/record.url?scp=58149087858&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=58149087858&partnerID=8YFLogxK

U2 - 10.1016/j.jclinepi.2008.05.009

DO - 10.1016/j.jclinepi.2008.05.009

M3 - Article

VL - 62

SP - 177

EP - 187

JO - Journal of Clinical Epidemiology

JF - Journal of Clinical Epidemiology

SN - 0895-4356

IS - 2

ER -