Globally, co-morbidity is associated with worse health outcomes, more complex clinical management, and increased health care costs. There is a lack of awareness and skills at the HCP level in specific specialties to handle co-morbidities related to other diseases.
ACCORD (Association of Co-morbidities and Rare Diseases) is one such association created to develop content, awareness, knowledge dissemination, and education on management and treatment modalities for co-morbidities and rare diseases. This association would have subject matter experts from various specialties and their knowledge and experience would be an integral part of education on the treatment modalities of co-morbidities.
The term comorbidity was first introduced by Feinstein in 1970 to denote those cases in which a ‘distinct additional clinical entity’ occurred during the clinical course of a patient having an index disease. The word has been practiced loosely in history to imply either “coexisting” diseases or “cooccurring” diseases. In an Indian study, data analyzed from the National Family and Health Survey 2015-16 (NFHS-4 survey) determined that the prevalence of comorbidity is highest in older age groups, females, and rural areas. Although the prevalence may be higher in these categories, comorbidities exist in an individual irrespective of age, gender, education, and residing area.
The majority of the prevalent disease conditions, for example; cardiovascular, diabetes, asthma, or epilepsy, to name a few, have strong guidance for the management of disease through consensus decisions taken by the Indian Association of Clinical Cardiologists, Research Society for the Study of Diabetes in India, Indian Chest Society and National College of Chest Physicians, and Indian Academy of Neurology, respectively. However, the coexistence of two or more diseases in the same individual raises two major clinical questions: whether there is an underlying common etiological pathway, and/or what is their impact on clinical care?
For example; osteoporosis may be caused due to chronic inflammatory bowel disease, chronic inflammatory joint disease, celiac disease, breast cancer, prostate cancer, diabetes, depression, or renal failure. In this, celiac disease is one of the examples of a rare disease. In clinical practice, these causative factors and rare diseases should be taken into account while evaluating the comorbidity and making treatment decisions.
Therefore, it becomes essential for physicians of different specialties (cardiologists, orthopedics, endocrinologists, neurologists, nephrologists, gastroenterologists, chest physicians, and rare disease experts, etc) to collaborate and create content that addresses the co-morbidities through their experience and treatment modalities.
