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 analysed from National Family and Health Survey 2015-16(NFHS-4 survey) determined that 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.
Majority of the prevalent disease condition, for example; cardiovascular, diabetes, asthma or epilepsy to name a few have a strong guidance for management of disease through consensus decision taken by 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. But, 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 factor and rare disease should be taken into account while evaluating the comorbidity and making treatment decisions.
Therefore, it becomes essential for physicians of different speciality (cardiologist, orthopaedics, endocrinologist, neurologist, nephrologist, gastroenterologist, chest physician and rare disease expert etc) to collaborate and create content which addresses the co-morbidities through their experience and treatment modalities.
ACCORD (Association of Co-morbidities and Rare diseases) is one such association created to develop content, awareness, knowledge dissemination, education on management and treatment modalities for co-morbidities and rare disease. This association would have subject matter experts from various speciality and their knowledge and experience would be integral part for education on the treatment modalities of co-morbidities.