title: Influence of chronic diseases on long-term change in physical health: a consultation-survey linkage cohort study in general practice.
abstract: OBJECTIVE
  To investigate the influence of disease severity within cardiovascular disease (CVD) and musculoskeletal (MSK) disorder spectrums on physical health change over 3 years.
  
  
  METHODS
  Consultation records of 4,672 patients aged 50 years and above from six general practices were linked to their baseline and 3-year Short-Form-12 (SF-12) physical component summary (PCS) scores. Associations between exclusive diagnostic categories and comorbid counts with physical health change over 3 years were examined.
  
  
  RESULTS
  There were 1,371 (29.3%) CVD and 1,972 (42.2%) MSK consulters. Adjusted additional change in PCS scores relative to hypertension ranged from -0.43 (95% confidence interval -2.5, 1.7) for atrial fibrillation to -2.09 (-4.2, 0.0) for heart failure. In the MSK spectrum, changes relative to soft tissue disorder ranged from -0.63 (-3.0, 1.8) for soft tissue pain to -1.09 (-4.1, 2.0) for inflammatory polyarthropathy. A trend in association between increasing disease severity and deterioration in physical health was only observed within the CVD spectrum, and this trend was retained in those with CVD and higher levels of comorbidity.
  
  
  CONCLUSIONS
  CVD severity with higher levels of comorbidity was associated with greater relative deterioration in long-term physical health. Such findings were not found for the MSK cohorts, suggesting the differing health impact of different chronic diseases.
authors.affiliation: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Staffordshire, ST5 5BG, UK. j.a.prior@cphc.keele.ac.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Prior
authors.forename: K P
authors.initials: KP
authors.lastname: Jordan
authors.forename: U T
authors.initials: UT
authors.lastname: Kadam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies / Q000295:instrumentation; D005260:Female; D058006:General Practice; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases; D011788:Quality of Life; D012017:Referral and Consultation