Chapman et al identified 5 psychosocial factors which influence the impact of comorbidity on mortality. Psychosocial factors need to be taken into account when evaluating comorbidity. The authors are from the University of Rochester, University of Edinburgh, Columbia University and Harvard University.

Comorbidity analysis: Charlson comorbidity index (CCI)


Outcome: mortality over time


Psychosocial factors that are associated with a better outcome:

(1) income (or wealth)

(2) education

(3) preference for the company of others (communalism)


Psychosocial factors tending to have a negative impact on survival:

(1) type A personality

(2) denial of illness (based on a "lie" scale)


The presence or absence of these psychosocial factors can modify the impact of concurrent comorbidity. It is unclear whether modifying them will alter the patient's trajectory.

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