Journal of chronic diseases
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Comparative Study
A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.
The objective of this study was to develop a prospectively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies. A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients. The 1-yr mortality rates for the different scores were: "0", 12% (181); "1-2", 26% (225); "3-4", 52% (71); and "greater than or equal to 5", 85% (82). ⋯ The new index performed similarly to a previous system devised by Kaplan and Feinstein. The method of classifying comorbidity provides a simple, readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies. Further work in larger populations is still required to refine the approach because the number of patients with any given condition in this study was relatively small.
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Comparative Study
A comparative cost analysis of terminal cancer care in home hospice patients and controls.
A comparison is made between the expenditure during the last 90 days of life on 98 terminal cancer patients cared for by a home based hospice service and that on matched patients dying without the home hospice service. The control patients were matched for site of primary cancer, age and sex. The individual records of both groups of patients were analyzed and costed. It was found that the costs of providing 24 hour comprehensive medical and nursing care at home to those dying of cancer and support for their families was no more expensive than traditional institutional care.
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Assessing time relationships in cancer epidemiology involves linking exposure and cancer incidence or mortality on a time scale. The traditional approach is to make some exposure criterion the referent point, such as date of first exposure. However, the time relationships between exposure and cancer may also be usefully explored using the date of diagnosis (or death) as the referent point in time. ⋯ Both measures are mathematically related (by constants) to a measure of the fraction of excess case exposure dose achieved in each time window, where "excess" means beyond that expected on the basis of non-cases or controls. This particular measure, the retrospective excess exposure fraction (REEF) in time windows, may be valuable in exploring time relationships between exposure and cancer. It is concluded that retrospective measures between cancer occurrence and exposure warrant further attention to maximize the informativeness of cancer epidemiology studies.