title: Disability weights for comorbidity and their influence on health-adjusted life expectancy.
abstract: BACKGROUND
  Comorbidity complicates estimations of health-adjusted life expectancy (HALE) using disease prevalences and disability weights from Burden of Disease studies. Usually, the exact amount of comorbidity is unknown and no disability weights are defined for comorbidity.
  
  
  METHODS
  Using data of the Dutch national burden of disease study, the effects of different methods to adjust for comorbidity on HALE calculations are estimated. The default multiplicative adjustment method to define disability weights for comorbidity is compared to HALE estimates without adjustment for comorbidity and to HALE estimates in which the amount of disability in patients with multiple diseases is solely determined by the disease that leads to most disability (the maximum adjustment method). To estimate the amount of comorbidity, independence between diseases is assumed.
  
  
  RESULTS
  Compared to the multiplicative adjustment method, the maximum adjustment method lowers HALE estimates by 1.2 years for males and 1.9 years for females. Compared to no adjustment, a multiplicative adjustment lowers HALE estimates by 1.0 years for males and 1.4 years for females.
  
  
  CONCLUSIONS
  The differences in HALE caused by the different adjustment methods demonstrate that adjusting for comorbidity in HALE calculations is an important topic that needs more attention. More empirical research is needed to develop a more general theory as to how comorbidity influences disability.
authors.affiliation: National Institute for Public Health and the Environment, Bilthoven, The Netherlands. pieter.van.baal@rivm.nl
authors.forename: Pieter H M
authors.initials: PH
authors.lastname: van Baal
authors.forename: Nancy
authors.initials: N
authors.lastname: Hoeymans
authors.forename: Rudolf T
authors.initials: RT
authors.lastname: Hoogenveen
authors.forename: G Ardine
authors.initials: GA
authors.lastname: de Wit
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert