title: Comorbidity Cohort (2C) study: cardiovascular disease severity and comorbid osteoarthritis in primary care.
abstract: BACKGROUND
  Two of the commonest chronic diseases experienced by older people in the general population are cardiovascular diseases and osteoarthritis. These conditions also commonly co-occur, which is only partly explained by age. Yet, there have been few studies investigating specific a priori hypotheses in testing the comorbid interaction between two chronic diseases and related health and healthcare outcomes. It is also unknown whether the stage or severity of the chronic disease influences the comorbidity impact. The overall plan is to investigate the interaction between cardiovascular severity groups (hypertension, ischaemic heart disease and heart failure) and osteoarthritis comorbidity, and their longitudinal impact on health and healthcare outcomes relative to either condition alone.
  
  
  METHODS
  From ten general practices participating in a research network, adults aged 40 years and over were sampled to construct eight exclusive cohort groups (n = 9,676). Baseline groups were defined on the basis of computer clinical diagnostic data in a 3-year time-period (between 2006 and 2009) as: (i) without cardiovascular disease or osteoarthritis (reference group), (ii) index cardiovascular disease groups (hypertension, ischaemic heart disease and heart failure) without osteoarthritis, (iii) index osteoarthritis group without cardiovascular disease, and (vi) index cardiovascular disease groups comorbid with osteoarthritis. There were three main phases to longitudinal follow-up. The first (survey population) was to invite cohorts to complete a baseline postal health questionnaire, with 10 monthly brief interval health questionnaires, and a final 12-month follow-up questionnaire. The second phase (linkage population) was to link the collected survey data to patient clinical records with consent for the 3-year time-period before baseline, during the 12-month survey period and the 12 months after final questionnaire (total 5 years). The third phase (denominator population) was to construct an anonymised clinical data archive for the study five year period for the total baseline cohorts, linking clinical information such as diagnosis, prescriptions and referrals.
  
  
  CONCLUSIONS
  The outcomes of the study will result in the determination of the specific interaction between cardiovascular severity and osteoarthritis comorbidity on the change and progression of physical health status in individuals and on the linked and associated clinical-decision making process in primary care.
authors.affiliation: Health Services Research Unit, Innovation Centre 1, Keele University Science & Business Park, Keele University, Staffordshire ST5 5NB, UK. j.a.prior@keele.ac.uk
authors.forename: James A
authors.initials: JA
authors.lastname: Prior
authors.forename: Claire A
authors.initials: CA
authors.lastname: Rushton
authors.forename: Kelvin P
authors.initials: KP
authors.lastname: Jordan
authors.forename: Umesh T
authors.initials: UT
authors.lastname: Kadam
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003376:Counseling; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis / Q000453:epidemiology*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D057566:Self Report; D012720:Severity of Illness Index; D012923:Social Class; D011795:Surveys and Questionnaires