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Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life

Fortin Martin, Hudon Catherine, Dubois Marie-France, Almirall José, Lapointe Lise et Soubhi Hassan. (2005). Comparative assessment of three different indices of multimorbidity for studies on health-related quality of life. Health and Quality of Life Outcomes, 3, (74),

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Measures of multimorbidity are often applied to source data, populations or outcomes outside the scope of their original developmental work. As the development of a multimorbidity measure is influenced by the population and outcome used, these influences should be taken into account when selecting a multimorbidity index. The aim of this study was to compare the strength of the association of health-related quality of life (HRQOL) with three multimorbidity indices: the Cumulative Illness Rating Scale (CIRS), the Charlson index (Charlson) and the Functional Comorbidity Index (FCI). The first two indices were not developed in light of HRQOL.


We used data on chronic diseases and on the SF-36 questionnaire assessing HRQOL of 238 adult primary care patients who participated in a previous study. We extracted all the diagnoses for every patient from chart review to score the CIRS, the FCI and the Charlson. Data for potential confounders (age, sex, self-perceived economic status and self-perceived social support) were also collected. We calculated the Pearson correlation coefficients (r) of the SF-36 scores with the three measures of multimorbidity, as well as the coefficient of determination, R2, while controlling for confounders.


The r values for the CIRS (range: -0.55 to -0.18) were always higher than those for the FCI (-0.47 to -0.10) and Charlson (-0.31 to -0.04) indices. The CIRS explained the highest percent of variation in all scores of the SF-36, except for the Mental Component Summary Score where the variation was not significant. Variations explained by the FCI were significant in all scores of SF-36 measuring physical health and in two scales evaluating mental health. Variations explained by the Charlson were significant in only three scores measuring physical health.


The CIRS is a better choice as a measure of multimorbidity than the FCI and the Charlson when HRQOL is the outcome of interest. However, the FCI may provide a good option to evaluate the physical aspect of HRQOL for the ease in its administration and scoring. The Charlson index may not be recommended as a measure of multimorbidity in studies related to either physical or mental aspects of HRQOL.

Type de document:Article publié dans une revue avec comité d'évaluation
Version évaluée par les pairs:Oui
Date:23 Novembre 2005
Sujets:Sciences de la santé
Sciences de la santé > Sciences médicales
Département, module, service et unité de recherche:Départements et modules > Département des sciences de la santé > Unité d'enseignement en physiothérapie
Mots-clés:Cumulative Illness Rating Scale (CIRS), Charlson index (Charlson), Functional Comorbidity Index (FCI), chronic disease, comorbidity, multimorbidity, quality of life
Déposé le:27 oct. 2016 02:00
Dernière modification:25 nov. 2016 15:50
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