Rev. Méd. RosaRio 91: 245-247, 2025
REVISTA MÉDICA DE ROSARIO 245
FROM DISEASE TO PERSON OR FROM PERSON TO DISEASE
albeRto Ruiz CanteRo
1
*
1 Medical specialist in Internal Medicine
Former Head of the Internal Medicine Department, Hospital de la Serranía, Ronda (Málaga), Spain.
Once the dilemma is posed, it can be answered from
a teaching perspective in two scenarios:
Scenario 1: A 78-year-old college-educated
professional with a history of chronic heart failure, type
2 diabetes mellitus with diabetic retinopathy, high blood
pressure, and chronic obstructive pulmonary disease
(COPD). Barthel, 60 points. He lives in a residential
neighborhood, on the third oor of a building with
an elevator. His wife, assisted by their daughter, is the
caregiver.
Scenario 2: A 78-year-old with primary education
and a history of chronic heart failure, type 2 diabetes
mellitus with diabetic retinopathy, high blood pressure,
and COPD. Barthel score: 60. She lives alone in a
gentrifying neighborhood, on the third oor of a
building without an elevator.
We persist in healthcare based on linear models:
disease-centered or patient-centered care. In the rst
case, Evidence-Based Medicine (EBM), with the
development of protocols, clinical pathways, clinical
practice guides... In the second, the patient, Picker’s
eight Principles. e Pan-Hispanic Dictionary of
Medical Terms (DPTM) denes patient as “a person
who receives or is going to receive medical care, either
for a disease or for preventive purposes” and goes on to
say that “it is often used loosely as if it were synonymous
with sickness.”
We know that with advancing age,
1
there is a loss of
multisystem and functional reserve, rooted in biological
determinants and associated with a greater susceptibility
to chronic diseases. is becomes clinically evident as
the presence of multiple chronic diseases in the same
person. When a certain threshold of deterioration is
reached, it leads to poor quality of life, disability, drug
interactions, drug-disease interactions, hospitalization,
and mortality. us, we know
2
that people over 80 years
of age may have eight or more chronic diseases.
In Lee’s study,
3
11,113 individuals aged ≥65
years (representing 37.1 million Americans) were
interviewed; 75% were aged ≥76 years, and 58% were
female. Five highly prevalent conditions were present:
three diseases (ischemic heart disease, heart failure, and
diabetes mellitus) and two geriatric syndromes (urinary
incontinence and injurious falls). 56% had at least one
condition, ≥2 additional conditions (20%–55%), and
23% had ≥2 conditions. e prole with the most
conditions was advanced age, female, living alone, or
residing in a nursing home. erefore, a comprehensive
and coordinated approach to concomitant diseases and
geriatric syndromes is essential.
In this situation, a dilemma arises: comorbidity
or multimorbidity. Comorbidity
4,5
is dened as any
clinical entity that has existed or could occur during the
clinical course of a patient with an index disease under
study. Multimorbidity, dened by the World Health
Organization (WHO) as the presence of two or more
chronic conditions. e problem with multimorbidity
is that dierent authors and institutions
6,7
dene it
dierently, so the studies are not comparable. Even
so, it is more assertive to speak of multimorbidity,
pluripathology or multiple diseases or chronic
conditions than of comorbidity. is leads to a more
* Dirección de correo electrónico: aruizc@telefonica.net
Rev. Méd. RosaRio 91: 245-247, 2025
REVISTA MÉDICA DE ROSARIO246
holistic, integrative and generalist vision. Comorbidity
is a specialist vision, which entails problems
when a person is treated by several specialists in a
multidisciplinary manner (each acting independently),
and its consequences are an increase in the number of
diagnostic and therapeutic errors and polypharmacy.
3
We must strive for interdisciplinary care (assisted by
several professionals in a coordinated manner and with
a common goal). Another added problem is the use
of EBM, which uses dierent guidelines for dierent
diseases, which can lead to contradictions, especially
regarding treatments, since they are linked to the disease.
In both scenarios, both individuals present the
same diseases, but some relevant factors, among
others, dierentiate them, such as the following: a)
Educational level,
8,9,10
which directly inuences life
expectancy and health. e higher this level, the
longer the life expectancy and better the health. b)
Loneliness,
11,12
has signicant implications for several
physical and mental illnesses such as depression,
alcoholism, cardiovascular problems, sleep diculties,
immune system disorders, Alzheimer’s disease, general
health status, and early mortality. c) Socioeconomic
status,
13,14,15
is a largely unrecognized risk factor in the
primary prevention of cardiovascular diseases (CVD).
Risk scores that exclude socioeconomic deprivation as
a covariate underestimate and overestimate risk in the
most and least disadvantaged individuals, respectively.
is study highlights the importance of incorporating
socioeconomic deprivation into risk assessment systems
to ultimately reduce inequalities in health service
provision for CVD. Socioeconomic status (SES) has
a measurable and signicant impact on cardiovascular
health. Biological, behavioral, and psychosocial risk
factors prevalent among disadvantaged individuals
accentuate the link between SES and CVD. Four
measures have been consistently associated with CVD
in high-income countries: income level, educational
attainment, employment status, and neighborhood
socioeconomic factors.
us, if attention is focused on diseases or on the
patients themselves, the living conditions that make
them dierent will be overlooked. e rst approach
will expand a transversal view
16
in which everyone is
equal, and the second (social determinants of health)
will showcase an individual perspective, which is what
makes us human.
“It is more important to know what sort of person has
a disease than to know what sort of disease a person has ”
(quote attributed to Hippocrates, 460-377 BC).
RefeRences
1. Fabbri E, Zoli M, Gonzalez-Freire M, et al. Aging and
Multimorbidity: New Tasks, Priorities, and Frontiers for
Integrated Gerontological and Clinical Research. J Am
Med Dir Assoc. Aug 1;16(8):640-7. 2015 doi: 10.1016/j.
jamda.2015.03.013.
2. Barnett K, Mercer SW, Norbury M, et al. Epidemiology
of multimorbidity and implications for health care,
research, and medical education: a cross-sectional study.
Lancet. Jul 7;380(9836):37-43. 2012 doi: 10.1016/
S0140-6736(12)60240-2.
3. Lee PG, Cigolle C, Blaum C. e co-occurrence of
chronic diseases and geriatric syndromes: the health and
retirement study. J Am Geriatr Soc. Mar;57(3):511-6.
2009 doi: 10.1111/j.1532-5415.2008.02150.x.
4. Feinstein AR. Clinical epidemiology. 3. e clinical
design of statistics in therapy. Ann Intern Med.
Dec;69(6):1287-312. 1968 doi: 10.7326/0003-4819-
69-6-1287.
5. Feinstein AR. THE PRE-THERAPEUTIC
CLASSIFICATION OF CO-MORBIDITY IN
CHRONIC DISEASE. J Chronic Dis. Dec;23(7):455-
68. 1970 doi: 10.1016/0021-9681(70)90054-8.
6. Le Reste JY, Nabbe P, Rivet C, et al. e European general
practice research network presents the translations
of its comprehensive denition of multimorbidity in
family medicine in ten European languages. PLoS One.
Jan 21;10(1):e0115796. 2015 doi: 10.1371/journal.
pone.0115796.
7. Multimorbidity: clinical assessment and management.
NICE guideline (NG56).
https://www.nice.org.uk/guidance/ng56
8. Blanes A, Trías Llimós S. Vivir menos y con peor salud:
FRoM disease to PeRson oR FRoM PeRson to disease
REVISTA MÉDICA DE ROSARIO 247
el peaje de la población menos instruida de España.
Perspectives Demogràques. Julio. Nº 024. 2021
https://ced.cat/PD/PerspectivesDemografiques_024_
ESP.pdf Consultado 27 de enero de 2025.
9. Roy B, Kiefe CI, Jacobs DR, et al. Education, Race/
Ethnicity, and Causes of Premature Mortality Among
Middle-Aged Adults in 4 US Urban Communities:
Results From CARDIA, 1985–2017. Am J Public
Health. Apr;110(4):530-536. 2020 doi: 10.2105/
AJPH.2019.305506.
10. Vilhelmsson A, Östergren PO. Reducing health
inequalities with interventions targeting behavioral
factors among individuals with low levels of education
- A rapid review. PLoS One. Apr 16;13(4):e0195774.
2018 doi: 10.1371/journal.pone.0195774.
11. Rico-Uribe LA, Caballero FF, Martín-María N, et al.
Association of loneliness with all-cause mortality: A
meta-analysis. PLoS One. Jan 4;13(1):e0190033. 2018
doi: 10.1371/journal.pone.0190033.
12. Measuring loneliness: guidance for use of the national
indicators on surveys.
Methodological guidance on how to use the recommen-
ded loneliness questions for adults and children and how
to interpret and report the ndings. Oce of National
Statistics. UK. Última revisión 5 de diciembre de 2018.
https://www.ons.gov.uk/peoplepopulationandcommunity/
wellbeing/methodologies/measuringlonelinessguidance-
foruseofthenationalindicatorsonsurveys Consultado 27
de enero de 2025.
13. Kimenai DM, Pirondini L, Gregson J, et al. Socioeconomic
Deprivation: An Important, Largely Unrecognized Risk
Factor in Primary Prevention of Cardiovascular Disease.
Circulation. Jul 19;146(3):240-248. 2022 doi: 10.1161/
CIRCULATIONAHA.122.060042.
14. Schultz WM, Kelli HM, Lisko JC, et al. Socioeconomic
Status and Cardiovascular Outcomes: Challenges and
Interventions. Circulation. May 15;137(20):2166-2178.
2018 doi: 10.1161/CIRCULATIONAHA.117.029652.
15. Sabio R, Valdez P, Nachón MN, et al. Position of the
international forum of internal medicine on habits,
lifestyle changes and a healthy environment for the
prevention of cardiovascular diseases. Medicina (B
Aires). Jan 10;83 Suppl 1:1-53. 2023 English. PMID:
38290428.
16. Ruiz Cantero A, Cámera LA. Medicine with our head
in the clouds or our feet on the ground. Rev Clin Esp
(Barc). Dec;221(10):598-599. 2021 doi: 10.1016/j.
rceng.2021.03.004.
