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Lan M, Alemu FW, Ali S. The doctor will not see you now: investigating the social determinants of specialist care using the Canadian Longitudinal Study on Aging (CLSA). Front Public Health 2024; 12:1384604. [PMID: 39399697 PMCID: PMC11468014 DOI: 10.3389/fpubh.2024.1384604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 08/29/2024] [Indexed: 10/15/2024] Open
Abstract
Background The Canada Health Act mandates universal access to medical services for all Canadians. Despite this, there are significant disparities in access based on socioeconomic status, race and ethnicity, immigrant status, and indigeneity. However, there is limited evidence on the use of specialist services among older adults in Canada. The primary objective of this study is to identify the associations of social determinants of health with access to medical specialist services for Canadians aged 45 years and older. The second objective is to identify the reasons for not being able to access the needed specialist care. Methods A cross-sectional analysis of the Canadian Longitudinal Study on Aging survey was conducted. Based on the Andersen's model of health services use, a multivariable logistic regression model was used to evaluate the associations between 'not being able to access the needed specialist service(s) in the last 12 months' and individual-level sociodemographic determinants. Results Approximately 97% of those who required specialist care in the last year were able to visit a specialist. Of the participants who were not able to access the needed specialist services, about half (50.90%) were still waiting for a visit. The following factors were associated with greater difficulty in accessing specialist care: being younger (45-54 years), living in a rural area, having some post-secondary education, having a household income below $50,000 a year, not having a family physician, and having fair or poor perceived general health. Residents of British Columbia and Nova Scotia had a higher likelihood of reporting difficulty compared to those residing in Ontario. Conclusion While a majority of respondents were able to access specialist services when needed, those who had difficulty in accessing care were more likely to come from socially marginalized groups. Targeted policy interventions and improved health system coordination can reduce these barriers to care.
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Affiliation(s)
- Marie Lan
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Feben W. Alemu
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Shehzad Ali
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Health Sciences, University of York, Heslington, York, United Kingdom
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Ottawa, ON, Canada
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
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Varner C. Optimizing postpartum care in Canada as rates of comorbidity in pregnancy rise. CMAJ 2024; 196:E908-E909. [PMID: 39074862 PMCID: PMC11286170 DOI: 10.1503/cmaj.241017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024] Open
Affiliation(s)
- Catherine Varner
- Deputy editor, CMAJ; Schwartz/Reisman Emergency Medicine Institute (Varner); Department of Emergency Medicine (Varner), Sinai Health; Department of Family and Community Medicine (Varner), University of Toronto, Toronto, Ont
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Lundborg L, Ananth CV, Joseph KS, Cnattingius S, Razaz N. Changes in the prevalence of maternal chronic conditions during pregnancy: A nationwide age-period-cohort analysis. BJOG 2024. [PMID: 38899437 DOI: 10.1111/1471-0528.17885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To estimate temporal changes in the prevalence of pre-existing chronic conditions among pregnant women in Sweden and evaluate the extent to which secular changes in maternal age, birth cohorts and obesity are associated with these trends. DESIGN Population-based cross-sectional study. SETTING Sweden, 2002-2019. POPULATION All women (aged 15-49 years) who delivered in Sweden (2002-2019). METHODS An age-period-cohort analysis was used to evaluate the effects of age, calendar periods, and birth cohorts on the observed temporal trends. MAIN OUTCOME MEASURES Pre-existing chronic conditions, including 17 disease categories of physical and psychiatric health conditions recorded within 5 years before childbirth, presented as prevalence rates and rate ratios (RRs) with 95% confidence intervals (CIs). Temporal trends were also adjusted for pre-pregnancy body mass index (BMI) and the mother's country of birth. RESULTS The overall prevalence of at least one pre-existing chronic condition was 8.7% (147 458 of 1 703 731 women). The rates of pre-existing chronic conditions in pregnancy increased threefold between 2002-2006 and 2016-2019 (RR 2.82, 95% CI 2.77-2.87). Rates of psychiatric (RR 3.80, 95% CI 3.71-3.89), circulatory/metabolic (RR 1.62, 95% CI 1.55-1.71), autoimmune/neurological (RR 1.69, 95% CI 1.61-1.78) and other (RR 2.10, 95% CI 1.99-2.22) conditions increased substantially from 2002-2006 to 2016-2019. However, these increasing rates were less pronounced between 2012-2015 and 2016-2019. No birth cohort effect was evident for any of the pre-existing chronic conditions. Adjusting for secular changes in obesity and the mother's country of birth did not affect these associations. CONCLUSIONS The burden of pre-existing chronic conditions in pregnancy in Sweden increased from 2002 to 2019. This increase may be associated with the improved reporting of diagnoses and advancements in chronic condition treatment among women, potentially enhancing their fecundity.
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Affiliation(s)
- Louise Lundborg
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Cande V Ananth
- Division of Epidemiology and Biostatistics, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Cardiovascular Institute of New Jersey, New Brunswick, New Jersey, USA
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - K S Joseph
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
- British Columbia Children's Hospital Research Institute, Vancouver, Canada
| | - Sven Cnattingius
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Neda Razaz
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Ioakeim-Skoufa I, González-Rubio F, Aza-Pascual-Salcedo M, Laguna-Berna C, Poblador-Plou B, Vicente-Romero J, Coelho H, Santos-Mejías A, Prados-Torres A, Moreno-Juste A, Gimeno-Miguel A. Multimorbidity patterns and trajectories in young and middle-aged adults: a large-scale population-based cohort study. Front Public Health 2024; 12:1349723. [PMID: 38818448 PMCID: PMC11137269 DOI: 10.3389/fpubh.2024.1349723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction The presence of multiple chronic conditions, also referred to as multimorbidity, is a common finding in adults. Epidemiologic research can help identify groups of individuals with similar clinical profiles who could benefit from similar interventions. Many cross-sectional studies have revealed the existence of different multimorbidity patterns. Most of these studies were focused on the older population. However, multimorbidity patterns begin to form at a young age and can evolve over time following distinct multimorbidity trajectories with different impact on health. In this study, we aimed to identify multimorbidity patterns and trajectories in adults 18-65 years old. Methods We conducted a retrospective longitudinal epidemiologic study in the EpiChron Cohort, which includes all inhabitants of Aragón (Spain) registered as users of the Spanish National Health System, linking, at the patient level, information from electronic health records from both primary and specialised care. We included all 293,923 patients 18-65 years old with multimorbidity in 2011. We used cluster analysis at baseline (2011) and in 2015 and 2019 to identify multimorbidity patterns at four and eight years of follow-up, and we then created alluvial plots to visualise multimorbidity trajectories. We performed age- and sex-adjusted logistic regression analysis to study the association of each pattern with four- and eight-year mortality. Results We identified three multimorbidity patterns at baseline, named dyslipidaemia & endocrine-metabolic, hypertension & obesity, and unspecific. The hypertension & obesity pattern, found in one out of every four patients was associated with a higher likelihood of four- and eight-year mortality (age- and sex-adjusted odds ratio 1.11 and 1.16, respectively) compared to the unspecific pattern. Baseline patterns evolved into different patterns during the follow-up. Discussion Well-known preventable cardiovascular risk factors were key elements in most patterns, highlighting the role of hypertension and obesity as risk factors for higher mortality. Two out of every three patients had a cardiovascular profile with chronic conditions like diabetes and obesity that are linked to low-grade systemic chronic inflammation. More studies are encouraged to better characterise the relatively large portion of the population with an unspecific disease pattern and to help design and implement effective and comprehensive strategies towards healthier ageing.
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Affiliation(s)
- Ignatios Ioakeim-Skoufa
- Department of Drug Statistics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
- Emerging Technologies Advisory Group, ISACA, Chicago, IL, United States
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Drug Utilisation Work Group, Spanish Society of Family and Community Medicine (semFYC), Barcelona, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Department of Pharmacology, Physiology, and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Francisca González-Rubio
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Drug Utilisation Work Group, Spanish Society of Family and Community Medicine (semFYC), Barcelona, Spain
| | - Mercedes Aza-Pascual-Salcedo
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Primary Care Pharmacy Service Zaragoza III, Aragon Health Service (SALUD), Zaragoza, Spain
| | - Clara Laguna-Berna
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Jorge Vicente-Romero
- Department of Pharmacology, Physiology, and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Helena Coelho
- Tondela-Viseu Hospital Centre, Viseu, Portugal
- Specialised Section for Regulatory Affairs & Quality, Portuguese Society of Health Care Pharmacists (SPFCS), Coimbra, Portugal
| | - Alejandro Santos-Mejías
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Aida Moreno-Juste
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Aragon Health Service (SALUD), Zaragoza, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
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Malecki SL, Heung T, Wodchis WP, Saskin R, Palma L, Verma AA, Bassett AS. Young adults with a 22q11.2 microdeletion and the cost of aging with complexity in a population-based context. Genet Med 2024; 26:101088. [PMID: 38310401 DOI: 10.1016/j.gim.2024.101088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/24/2024] [Accepted: 01/25/2024] [Indexed: 02/05/2024] Open
Abstract
PURPOSE Information about the impact on the adult health care system is limited for complex rare pediatric diseases, despite their increasing collective prevalence that has paralleled advances in clinical care of children. Within a population-based health care context, we examined costs and multimorbidity in adults with an exemplar of contemporary genetic diagnostics. METHODS We estimated direct health care costs over an 18-year period for adults with molecularly confirmed 22q11.2 microdeletion (cases) and matched controls (total 60,459 person-years of data) by linking the case cohort to health administrative data for the Ontario population (∼15 million people). We used linear regression to compare the relative ratio (RR) of costs and to identify baseline predictors of higher costs. RESULTS Total adult (age ≥ 18) health care costs were significantly higher for cases compared with population-based (RR 8.5, 95% CI 6.5-11.1) controls, and involved all health care sectors. At study end, when median age was <30 years, case costs were comparable to population-based individuals aged 72 years, likelihood of being within the top 1st percentile of health care costs for the entire (any age) population was significantly greater for cases than controls (odds ratio [OR], for adults 17.90, 95% CI 7.43-43.14), and just 8 (2.19%) cases had a multimorbidity score of zero (vs 1483 (40.63%) controls). The 22q11.2 microdeletion was a significant predictor of higher overall health care costs after adjustment for baseline variables (RR 6.9, 95% CI 4.6-10.5). CONCLUSION The findings support the possible extension of integrative models of complex care used in pediatrics to adult medicine and the potential value of genetic diagnostics in adult clinical medicine.
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Affiliation(s)
- Sarah L Malecki
- Internal Medicine Residency Program, University of Toronto, Toronto, Ontario, Canada; Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Tracy Heung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Professor, Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Senior Scientist and Research Chair, Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | | | | | - Amol A Verma
- Li Ka Shing Knowledge Institute and Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada; Division of Cardiology, Centre for Mental Health & Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Dean T, Koné A, Martin L, Armstrong J, Sirois C. Understanding the Extent of Polypharmacy and its Association With Health Service Utilization Among Persons With Cancer and Multimorbidity: A Population-Based Retrospective Cohort Study in Ontario, Canada. J Pharm Pract 2024; 37:35-46. [PMID: 35861340 PMCID: PMC10804697 DOI: 10.1177/08971900221117105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Cancer often co-occurs with other chronic conditions, which may result in polypharmacy. Polypharmacy is associated with adverse outcomes, including increased health service utilization. Objectives: This study examines the overall prevalence of polypharmacy (5 or more medications) among adults with cancer and multimorbidity, as well as the association of both minor polypharmacy (5-9 medications) and hyper-polypharmacy (10 or more medications) on high use of emergency room visits and hospitalizations, while controlling for age, sex, and type and stage of cancer. Methods: This retrospective longitudinal study used linked health administrative databases and included persons 18 years and older diagnosed with cancer between April 2010 and March 2013 in Ontario, Canada. Data on the number of health service utilizations at or above the 90th percentile (high users), was collected up to March 2014 and multivariate logistic regression was used to determine the impact of polypharmacy. Results: The prevalence of polypharmacy was 46% prior to cancer diagnosis, and 57% one year after diagnosis. Polypharmacy prior to and after cancer diagnosis increased with the level of multimorbidity, increasing age, but did not differ by sex. It was also highest in persons with lung cancer (52.4%) and those diagnosed with stage 4 cancer (51.3%). Minor polypharmacy increased the odds of being a high user of emergency rooms (1.16; 99% CI: 1.09-1.24) and hospitalizations (1.03; 0.98-1.09) and the odds of high use was greater with hyper-polypharmacy (1.41; 1.33-1.51) and (1.23; 1.17-1.29) respectively. Conclusion: Polypharmacy is highly prevalent and is associated with high health service utilization among adults with cancer and multimorbidity.
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Affiliation(s)
- Tamara Dean
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Anna Koné
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Joshua Armstrong
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Caroline Sirois
- Faculté de pharmacie, Université Laval, Quebec City, QC, Canada
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Brown HK, Fung K, Cohen E, Dennis CL, Grandi SM, Rosella LC, Varner C, Vigod SN, Wodchis WP, Ray JG. Patterns of multiple chronic conditions in pregnancy: Population-based study using latent class analysis. Paediatr Perinat Epidemiol 2024; 38:111-120. [PMID: 37864500 DOI: 10.1111/ppe.13016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Adults with multiple chronic conditions (MCC) are a heterogeneous population with elevated risk of future adverse health outcomes. Yet, despite the increasing prevalence of MCC globally, data about MCC in pregnancy are scarce. OBJECTIVES To estimate the population prevalence of MCC in pregnancy and determine whether certain types of chronic conditions cluster together among pregnant women with MCC. METHODS We conducted a population-based cohort study in Ontario, Canada, of all 15-55-year-old women with a recognised pregnancy, from 2007 to 2020. MCC was assessed from a list of 22 conditions, identified using validated algorithms. We estimated the prevalence of MCC. Next, we used latent class analysis to identify classes of co-occurring chronic conditions in women with MCC, with model selection based on parsimony, clinical interpretability and statistical fit. RESULTS Among 2,014,508 pregnancies, 324,735 had MCC (161.2 per 1000, 95% confidence interval [CI] 160.6, 161.8). Latent class analysis resulted in a five-class solution. In four classes, mood and anxiety disorders were prominent and clustered with one additional condition, as follows: Class 1 (22.4% of women with MCC), osteoarthritis; Class 2 (23.7%), obesity; Class 3 (15.8%), substance use disorders; and Class 4 (22.1%), asthma. In Class 5 (16.1%), four physical conditions clustered together: obesity, asthma, chronic hypertension and diabetes mellitus. CONCLUSIONS MCC is common in pregnancy, with sub-types dominated by co-occurring mental and physical health conditions. These data show the importance of preconception and perinatal interventions, particularly integrated care strategies, to optimise treatment and stabilisation of chronic conditions in women with MCC.
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Affiliation(s)
- Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | | | - Eyal Cohen
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, Toronto, Ontario, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sonia M Grandi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S.H. Leong Centre for Healthy Children, Toronto, Ontario, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Laboratory, Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Varner
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Simone N Vigod
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Walter P Wodchis
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Joel G Ray
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
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Kone AP, Martin L, Scharf D, Gabriel H, Dean T, Costa I, Saskin R, Palma L, Wodchis WP. The impact of multimorbidity on severe COVID-19 outcomes in community and congregate settings. DIALOGUES IN HEALTH 2023; 2:100128. [PMID: 37006909 PMCID: PMC10043958 DOI: 10.1016/j.dialog.2023.100128] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/11/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
Purpose This study examined the impact of multimorbidity on severe COVID-19 outcomes in community and long-term care (LTC) settings, alone and in interaction with age and sex. Methods We conducted a retrospective cohort study of all Ontarians who tested positive for COVID-19 between January-2020 and May-2021 with follow-up until June 2021. We used cox regression to evaluate the adjusted impact of multimorbidity, individual characteristics, and interactions on time to hospitalization and death (any cause). Results 24.5% of the cohort had 2 or more pre-existing conditions. Multimorbidity was associated with 28% to 170% shorter time to hospitalization and death, respectively. However, predictors of hospitalization and death differed for people living in community and LTC. In community, increasing multimorbidity and age predicted shortened time to hospitalization and death. In LTC, we found none of the predictors examined were associated with time to hospitalization, except for increasing age that predicted reduced time to death up to 40.6 times. Sex was a predictor across all settings and outcomes: among male the risk of hospitalization or death was higher shortly after infection (e.g. HR for males at 14 days = 30.3) while among female risk was higher for both outcome in the longer term (e.g. HR for males at 150 days = 0.16). Age and sex modified the impact of multimorbidity in the community. Conclusion Community-focused public health measures should be targeted and consider sociodemographic and clinical characteristics such as multimorbidity. In LTC settings, further research is needed to identify factors that may contribute to improved outcomes.
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Affiliation(s)
- Anna Pefoyo Kone
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
- Health System Performance Network (HSPN), Toronto, ON, Canada
- Centre for Education and Research on Aging and Health (CERAH), Thunder Bay, Canada
- Centre for Rural and Northern Health Research (CraNHR), Thunder Bay, Canada
- ICES, Toronto, ON, Canada
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
- Centre for Education and Research on Aging and Health (CERAH), Thunder Bay, Canada
| | - Deborah Scharf
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
- Department of Psychology, Lakehead University, Thunder Bay, Canada
| | - Helen Gabriel
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
| | - Tamara Dean
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
| | - Idevania Costa
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Centre for Education and Research on Aging and Health (CERAH), Thunder Bay, Canada
- Centre for Rural and Northern Health Research (CraNHR), Thunder Bay, Canada
- School of Nursing, Lakehead University, Thunder Bay, Canada
| | | | | | - Walter P. Wodchis
- Health System Performance Network (HSPN), Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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Rodrigues APDS, Batista SRR, Santos ASEA, Canheta ABDS, Nunes BP, de Oliveira Rezende AT, de Oliveira C, Silveira EA. Multimorbidity and complex multimorbidity in Brazilians with severe obesity. Sci Rep 2023; 13:16629. [PMID: 37789121 PMCID: PMC10547747 DOI: 10.1038/s41598-023-43545-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 09/25/2023] [Indexed: 10/05/2023] Open
Abstract
To investigate the prevalence of multimorbidity and complex multimorbidity and their association with sociodemographic and health variables in individuals with severe obesity. This is a baseline data analysis of 150 individuals with severe obesity (body mass index ≥ 35.0 kg/m2) aged 18-65 years. The outcomes were multimorbidity and complex multimorbidity. Sociodemographic, lifestyle, anthropometric and self-perceived health data were collected. Poisson multiple regression was conducted to identify multimorbidity risk factors. The frequency of two or more morbidities was 90.7%, three or more morbidities was 76.7%, and complex multimorbidity was 72.0%. Living with four or more household residents was associated with ≥ 3 morbidities and complex multimorbidity. Fair and very poor self-perceived health was associated with ≥ 2 morbidities, ≥ 3 morbidities and complex multimorbidity. A higher BMI range (45.0-65.0 kg/m2) was associated with ≥ 2 morbidities and ≥ 3 morbidities. Anxiety (82.7%), varicose veins of lower limbs (58.7%), hypertension (56.0%) were the most frequent morbidities, as well as the pairs and triads including them. The prevalence of multimorbidity and complex multimorbidity in individuals with severe obesity was higher and the risk for multimorbidity and complex multimorbidity increased in individuals living in households of four or more residents, with fair or poor/very poor self-perceived health and with a higher BMI.
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Affiliation(s)
| | - Sandro Rogério Rodrigues Batista
- Department of Internal Medicine, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
- Primary Healthcare Office, Federal District State Health Department, Brasília, Distrito Federal, Brazil
| | | | | | | | | | - Cesar de Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK.
| | - Erika Aparecida Silveira
- Department of Internal Medicine, School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil
- Department of Epidemiology & Public Health, University College London, London, UK
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10
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Im JHB, Bronskill SE, Strauss R, Gruneir A, Guan J, Boblitz A, Lu M, Rochon PA, Savage RD. Sex-based differences in the association between loneliness and polypharmacy among older adults in Ontario, Canada. J Am Geriatr Soc 2023; 71:3099-3109. [PMID: 37338145 DOI: 10.1111/jgs.18477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 05/05/2023] [Accepted: 05/20/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Emerging evidence shows loneliness is associated with polypharmacy and high-risk medications in older adults. Despite notable sex-based differences in the prevalence in each of loneliness and polypharmacy, the role of sex in the relationship between loneliness and polypharmacy is unclear. We explored the relationship between loneliness and polypharmacy in older female and male respondents and described sex-related variations in prescribed medication subclasses. METHODS We performed a cross-sectional analysis of representative data from the Canadian Community Health Survey-Healthy Aging cycle (2008/2009) linked to health administrative databases in Ontario respondents aged 66 years and older. Loneliness was measured using the Three-Item Loneliness Scale, with respondents classified as not lonely, moderately lonely, or severely lonely. Polypharmacy was defined as five or more concurrently-prescribed medications. Sex-stratified multivariable logistic regression models with survey weights were used to assess the relationship between loneliness and polypharmacy. Among those with polypharmacy, we examined the distribution of prescribed medication subclasses and potentially inappropriate medications. RESULTS Of the 2348 individuals included in this study, 54.6% were female respondents. The prevalence of polypharmacy was highest in those with severe loneliness both in female (no loneliness, 32.4%; moderate loneliness, 36.5%; severe loneliness, 44.1%) and male respondents (32.5%, 32.2%, and 42.5%). Severe loneliness was significantly associated with greater adjusted odds of polypharmacy in female respondents (OR = 1.59; 95% CI: 1.01-2.50) but this association was attenuated after adjustment in male respondents (OR = 1.00; 95% CI: 0.56-1.80). Among those with polypharmacy, antidepressants were more commonly prescribed in female respondents with severe loneliness (38.7% [95% CI: 27.3-50.0]) compared to those who were moderately lonely (17.7% [95% CI: 9.3-26.2]). CONCLUSIONS Severe loneliness was independently associated with polypharmacy in older female but not male respondents. Clinicians should consider loneliness as an important risk factor in medication reviews and deprescribing efforts to minimize medication-related harms, particularly in older women.
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Affiliation(s)
- James H B Im
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Andrea Gruneir
- ICES, Toronto, Ontario, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Mindy Lu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Paula A Rochon
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
| | - Rachel D Savage
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Women's Age Lab, Women's College Hospital, Toronto, Ontario, Canada
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11
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Zhang Y, Sun M, Wang Y, Xu T, Ning N, Tong L, He Y, Jin L, Ma Y. Association of cardiovascular health using Life's Essential 8 with noncommunicable disease multimorbidity. Prev Med 2023; 174:107607. [PMID: 37414227 DOI: 10.1016/j.ypmed.2023.107607] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/10/2023] [Accepted: 07/03/2023] [Indexed: 07/08/2023]
Abstract
Cardiovascular health (CVH) is closely associated with various noncommunicable diseases (NCDs) and comorbidity; however, the influence of CVH on NCD multimorbidity was not fully elucidated. We aimed to examine the association between CVH using Life's Essential 8 (LE8) and NCD multimorbidity among adults, males, and females in the United States, conducting a cross-sectional analysis using data involving 24,445 participants from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. LE8 was categorized into low, moderate, and high CVH groups. Multivariate logistic regressions and restricted cubic spline regressions were used to estimate the association between LE8 and NCD multimorbidity. Overall, 6162 participants had NCD multimorbidity, of which 1168 (43.5%), 4343 (25.9%), and 651 (13.4%) had low, moderate, and high CVH, separately. After multivariable adjustment, LE8 was negatively associated with NCD multimorbidity among adults (odds ratio (OR) for per 1 standard deviation (SD) increase in LE8 and 95% confidence interval (CI), 0.67 (0.64, 0.69)), and the top 3 NCDs associated with CVH were emphysema, congestive heart failure, stroke, and the dose-response relationships between LE8 and NCD multimorbidity were observed among adults (overall P < 0.001). Similar patterns were also identified among males and females. Higher CVH measured by the LE8 score was associated with lower odds of NCD multimorbidity among adults, males, and females.
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Affiliation(s)
- Yuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Mengzi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Yanfang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Tong Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Ning Ning
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Liaoning, Shenyang, China.
| | - Li Tong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Yue He
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Liaoning, Shenyang, China.
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12
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Hong HA, Fallah N, Wang D, Cheng CL, Humphreys S, Parsons J, Noonan VK. Multimorbidity in persons with non-traumatic spinal cord injury and its impact on healthcare utilization and health outcomes. Spinal Cord 2023; 61:483-491. [PMID: 37604933 DOI: 10.1038/s41393-023-00915-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
STUDY DESIGN Cross-sectional survey in Canada. OBJECTIVES To explore multimorbidity (the coexistence of two/more health conditions) in persons with non-traumatic spinal cord injury (NTSCI) and evaluate its impact on healthcare utilization (HCU) and health outcomes. SETTING Community-dwelling persons. METHODS Data from the Spinal Cord Injury Community Survey (SCICS) was used. A multimorbidity index (MMI) consisting of 30 secondary health conditions (SHCs), the 7-item HCU questionnaire, the Short Form-12 (SF-12), Life Satisfaction-11 first question, and single-item Quality of Life (QoL) measure were administered. Additionally, participants were grouped as "felt needed healthcare was received" (Group 1, n = 322) or "felt needed healthcare was not received" (Group 2, n = 89) using the HCU question. Associations among these variables were assessed using multivariable analysis. RESULTS 408 of 412 (99%) participants with NTSCI reported multimorbidity. Constipation, spasticity, and fatigue were the most prevalent self-reported SHCs. Group 1 had a higher MMI score compared to Group 2 (p < 0.001). A higher MMI score correlated with the feeling of not receiving needed care (OR 1.4, 95% CI 1.08-1.21), lower SF-12 (physical/mental component summary scores), being unsatisfied with life, and lower QoL (all p < 0.001). Additionally, Group 1 had more females (p < 0.001), non-Caucasians (p = 0.034), and lower personal annual income (p = 0.025). CONCLUSIONS Persons with NTSCI have multimorbidity, and the MMI score was associated with increased HCU and worse health outcomes. This work emphasizes the critical need for improved healthcare and monitoring. Future work determining specific thresholds for the MMI could be helpful for triage screening to identify persons at higher risk of poor outcomes.
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Affiliation(s)
- Heather A Hong
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Di Wang
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | | | - Jessica Parsons
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
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13
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Saito Y, Igarashi A, Nakayama T, Fukuma S. Prevalence of multimorbidity and its associations with hospitalisation or death in Japan 2014-2019: a retrospective cohort study using nationwide medical claims data in the middle-aged generation. BMJ Open 2023; 13:e063216. [PMID: 37160390 PMCID: PMC10173978 DOI: 10.1136/bmjopen-2022-063216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To describe the prevalence of multimorbidity and its associations with clinical outcomes across age groups. DESIGN Retrospective cohort study using nationwide medical claims data. SETTING Carried out in Japan between April 2014 and March 2019. PARTICIPANTS N=246 671 Japanese individuals aged 20-74 enrolled in the health insurance were included into the baseline data set for fiscal year (FY) 2014. Of those, N=181 959 individuals were included into the cohort data set spanning FY2014-FY2018. EXPOSURES Multimorbidity was defined as having ≥2 of 15 chronic conditions according to the International Classification of Diseases 10th Revision codes of the Charlson Comorbidity Index. PRIMARY AND SECONDARY OUTCOMES Primary outcome: the standardised prevalence of multimorbidity across age groups was evaluated using data from FY2014 and extrapolated to the Japanese total population. SECONDARY OUTCOME hospitalisation or death events were traced by month using medical claims data and insurer enrolment data. Associations between multimorbidity and 5-year hospitalisation and/or death events across age groups were analysed using a Cox regression model. RESULTS The standardised prevalence rate of multimorbidity in the nationwide Japanese total population was estimated to 26.1%. The prevalence rate with age was increased, approximately 5% (ages 20-29), 10% (30-39), 20% (40-49), 30% (50-59), 50% (60-69) and 60% (70-74). Compared with individuals aged 20-39 without multimorbidity, those with multimorbidity had a higher incidence of clinical events in any age group (HR=2.43 (95% CI 2.30 to 2.56) in ages 20-39, HR=2.55 (95% CI 2.47 to 2.63) in ages 40-59 and HR=3.41 (95% CI 3.23 to 3.53) in ages ≥60). The difference in the incidence of clinical events between multimorbidity and no multimorbidity was larger than that between age groups. CONCLUSIONS Multimorbidity is already prevalent in the middle-aged generation and is associated with poor clinical outcomes. These findings underscore the significance of multimorbidity and highlight the urgent need for preventive intervention at the public healthcare level.
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Affiliation(s)
- Yoshiyuki Saito
- Department of Health Economics & Outcomes Research, The University of Tokyo, Bunkyo-ku, Japan
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Ataru Igarashi
- Department of Health Economics & Outcomes Research, The University of Tokyo, Bunkyo-ku, Japan
- Unit of Public Health and Preventive Medicine, Yokohama City University, Yokohama, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | - Shingo Fukuma
- Department of Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
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14
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Alarilla A, Mondor L, Knight H, Hughes J, Koné AP, Wodchis WP, Stafford M. Socioeconomic gradient in mortality of working age and older adults with multiple long-term conditions in England and Ontario, Canada. BMC Public Health 2023; 23:472. [PMID: 36906531 PMCID: PMC10008074 DOI: 10.1186/s12889-023-15370-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 03/02/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND There is currently mixed evidence on the influence of long-term conditions and deprivation on mortality. We aimed to explore whether number of long-term conditions contribute to socioeconomic inequalities in mortality, whether the influence of number of conditions on mortality is consistent across socioeconomic groups and whether these associations vary by working age (18-64 years) and older adults (65 + years). We provide a cross-jurisdiction comparison between England and Ontario, by replicating the analysis using comparable representative datasets. METHODS Participants were randomly selected from Clinical Practice Research Datalink in England and health administrative data in Ontario. They were followed from 1 January 2015 to 31 December 2019 or death or deregistration. Number of conditions was counted at baseline. Deprivation was measured according to the participant's area of residence. Cox regression models were used to estimate hazards of mortality by number of conditions, deprivation and their interaction, with adjustment for age and sex and stratified between working age and older adults in England (N = 599,487) and Ontario (N = 594,546). FINDINGS There is a deprivation gradient in mortality between those living in the most deprived areas compared to the least deprived areas in England and Ontario. Number of conditions at baseline was associated with increasing mortality. The association was stronger in working age compared with older adults respectively in England (HR = 1.60, 95% CI 1.56,1.64 and HR = 1.26, 95% CI 1.25,1.27) and Ontario (HR = 1.69, 95% CI 1.66,1.72 and HR = 1.39, 95% CI 1.38,1.40). Number of conditions moderated the socioeconomic gradient in mortality: a shallower gradient was seen for persons with more long-term conditions. CONCLUSIONS Number of conditions contributes to higher mortality rate and socioeconomic inequalities in mortality in England and Ontario. Current health care systems are fragmented and do not compensate for socioeconomic disadvantages, contributing to poor outcomes particularly for those managing multiple long-term conditions. Further work should identify how health systems can better support patients and clinicians who are working to prevent the development and improve the management of multiple long-term conditions, especially for individuals living in socioeconomically deprived areas.
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Affiliation(s)
- Anne Alarilla
- The Health Foundation, 8 Salisbury Square, London, UK.
| | - Luke Mondor
- ICES, Toronto, ON, M4N 3M5, Canada
- Health System Performance Network, Toronto, ON, Canada
| | - Hannah Knight
- The Health Foundation, 8 Salisbury Square, London, UK
| | - Jay Hughes
- The Health Foundation, 8 Salisbury Square, London, UK
| | - Anna Pefoyo Koné
- Health System Performance Network, Toronto, ON, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Walter P Wodchis
- ICES, Toronto, ON, M4N 3M5, Canada
- Health System Performance Network, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Mai Stafford
- The Health Foundation, 8 Salisbury Square, London, UK
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15
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Koné AP, Scharf D, Tan A. Multimorbidity and Complexity Among Patients with Cancer in Ontario: A Retrospective Cohort Study Exploring the Clustering of 17 Chronic Conditions with Cancer. Cancer Control 2023; 30:10732748221150393. [PMID: 36631419 PMCID: PMC9841838 DOI: 10.1177/10732748221150393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Multimorbidity is a concern for people living with cancer, as over 90% have at least one other condition. Multimorbidity complicates care coming from multiple providers who work within separate, siloed systems. Information describing high-risk and high-cost disease combinations has potential to improve the experience, outcome, and overall cost of care by informing comprehensive care management frameworks. This study aimed to identify disease combinations among people with cancer and other conditions, and to assess the health burden associated with those combinations to help healthcare providers more effectively prioritize and coordinate care. METHODS We used a population-based retrospective cohort design including adults with a cancer diagnosis between March-2003 and April-2013, followed-up until March 2018. We used observed disease combinations defined by level of multimorbidity and partitive (k-means) clusters, ie groupings of similar diseases based on the prevalence of each condition. We assessed disease combination-associated health burden through health service utilization, including emergency department visits, primary care visits and hospital admissions during the follow-up period. RESULTS 549,248 adults were included in the study. Anxiety, diabetes mellitus, hypertension, and osteoarthritis co-occurred with cancer 1.1 to 5.3 times more often than expected by chance. Disease combinations varied by cancer type and age but were similar between sexes. The largest partitive cluster included cancer and anxiety, with at least 25% of individuals also having osteoarthritis. Cancer also tended to co-occur with hypertension (8.0%) or osteoarthritis (6.2%). There were differences between clusters in healthcare utilization, regardless of the number of disease combinations or clustering approach used. CONCLUSION Researchers, clinicians, policymakers, and other stakeholders can use the clustering information presented here to improve the healthcare system for people with cancer multimorbidity by developing cluster-specific care management and clinical guidelines for common disease combinations.
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Affiliation(s)
- Anna Péfoyo Koné
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada,Behavioural Research and Northern Community Health Evaluative Services (BRANCHES), Thunder Bay, ON, Canada,Health System Performance Network (HSPN), Toronto, ON, Canada,Centre for Education and Research on Aging and Health (CERAH), Thunder Bay, ON, Canada,Centre for Rural and Northern Health Research (CRaNHR), Thunder Bay, ON, Canada,Anna P. Kone, Department of Health Sciences, Lakehead University, Thunder bay, ON P7B5E1, Canada.
| | - Deborah Scharf
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada,Behavioural Research and Northern Community Health Evaluative Services (BRANCHES), Thunder Bay, ON, Canada,Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Amy Tan
- Division of Palliative Care and Dept of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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16
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Nguyen TN, Kalia S, Hanlon P, Jani BD, Nicholl BI, Christie CD, Aliarzadeh B, Moineddin R, Harrison C, Chow C, Fortin M, Mair FS, Greiver M. Multimorbidity and Blood Pressure Control in Patients Attending Primary Care in Canada. J Prim Care Community Health 2023; 14:21501319231215025. [PMID: 38097504 PMCID: PMC10725138 DOI: 10.1177/21501319231215025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/27/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND There has been conflicting evidence on the association between multimorbidity and blood pressure (BP) control. This study aimed to investigate this associations in people with hypertension attending primary care in Canada, and to assess whether individual long-term conditions are associated with BP control. METHODS This was a cross-sectional study in people with hypertension attending primary care in Toronto between January 1, 2017 and December 31, 2019. Uncontrolled BP was defined as systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg. A list of 11 a priori selected chronic conditions was used to define multimorbidity. Multimorbidity was defined as having ≥1 long-term condition in addition to hypertension. Logistic regression models were used to estimate the association between multimorbidity (or individual long-term conditions) with uncontrolled BP. RESULTS A total of 67 385 patients with hypertension were included. They had a mean age of 70, 53.1% were female, 80.6% had multimorbidity, and 35.7% had uncontrolled BP. Patients with multimorbidity had lower odds of uncontrolled BP than those without multimorbidity (adjusted OR = 0.72, 95% CI 0.68-0.76). Among the long-term conditions, diabetes (aOR = 0.73, 95%CI 0.70-0.77), heart failure (aOR = 0.81, 95%CI 0.73-0.91), ischemic heart disease (aOR = 0.74, 95%CI 0.69-0.79), schizophrenia (aOR = 0.79, 95%CI 0.65-0.97), depression/anxiety (aOR = 0.91, 95%CI 0.86-0.95), dementia (aOR = 0.87, 95%CI 0.80-0.95), and osteoarthritis (aOR = 0.89, 95%CI 0.85-0.93) were associated with a lower likelihood of uncontrolled BP. CONCLUSION We found that multimorbidity was associated with better BP control. Several conditions were associated with better control, including diabetes, heart failure, ischemic heart disease, schizophrenia, depression/anxiety, dementia, and osteoarthritis.
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Affiliation(s)
- Tu N. Nguyen
- University of Sydney, Sydney, NSW, Australia
- University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | | | | | - Clara Chow
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Michelle Greiver
- University of Toronto, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
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17
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Ryan BL, Mondor L, Wodchis WP, Glazier RH, Meredith L, Fortin M, Stewart M. Effect of a multimorbidity intervention on health care utilization and costs in Ontario: randomized controlled trial and propensity-matched analyses. CMAJ Open 2023; 11:E45-E53. [PMID: 36649982 PMCID: PMC9851625 DOI: 10.9778/cmajo.20220006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patients with multimorbidity require coordinated and patient-centred care. Telemedicine IMPACT Plus provides such care for complex patients in Toronto, Ontario. We conducted a randomized controlled trial (RCT) comparing health care utilization and costs at 1-year postintervention for an intervention group and 2 control groups (RCT and propensity matched). METHODS Data for 82 RCT intervention and 74 RCT control participants were linked with health administrative data. We created a second control group using health administrative data-derived propensity scores to match (1:5) intervention participants with comparators. We evaluated 5 outcomes: acute hospital admissions, emergency department visits, costs of all insured health care, 30-day hospital readmissions and 7-day family physician follow-up after hospital discharge using generalized linear models for RCT controls and generalized estimating equations for propensity-matched controls. RESULTS There were no significant differences between intervention participants and either control group. For hospital admissions, emergency department visits, costs and readmissions, the relative differences ranged from 1.00 (95% confidence interval [CI] 0.39-2.60) to 1.67 (95% CI 0.82-3.38) with intervention costs at about Can$20 000, RCT controls costs at around Can$15 000 and propensity controls costs at around Can$17 000. There was a higher rate of follow-up with a family physician for the intervention participants compared with the RCT controls (53.13 v. 21.43 per 100 hospital discharges; relative difference 2.48 [95% CI 0.98-6.29]) and propensity-matched controls (49.94 v. 28.21 per 100 hospital discharges; relative difference 1.81 [95% CI 0.99-3.30]). INTERPRETATION Despite a complex patient-centred intervention, there was no significant improvement in health care utilization or cost. Future research requires larger sample sizes and should include outcomes important to patients and the health care system, and longer follow-up periods. ONTARIO ClinicalTrials.gov : 104191.
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Affiliation(s)
- Bridget L Ryan
- Centre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont.
| | - Luke Mondor
- Centre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Walter P Wodchis
- Centre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Richard H Glazier
- Centre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Leslie Meredith
- Centre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Martin Fortin
- Centre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Moira Stewart
- Centre for Studies in Family Medicine and the Department of Epidemiology and Biostatistics (Ryan), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Health System Performance Network (Mondor); ICES (Mondor, Wodchis); Institute for Better Health, Trillium Health Partners (Wodchis), Mississauga, Ont.; Health System Performance Network and Institute of Health Policy, Management and Evaluation (Wodchis), University of Toronto; Department of Family and Community Medicine (Glazier), University of Toronto, Toronto Ont.; Centre for Studies in Family Medicine, Department of Family Medicine (Meredith), Schulich School of Medicine & Dentistry, Western University, London, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.; Centre for Studies in Family Medicine (Stewart), Schulich School of Medicine & Dentistry, Western University, London, Ont
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18
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Khan R, Salim M, Tanuseputro P, Hsu AT, Coburn N, Hallet J, Talarico R, James PD. Initial treatment is associated with improved survival and end-of-life outcomes for patients with pancreatic cancer: a cohort study. BMC Cancer 2022; 22:1312. [DOI: 10.1186/s12885-022-10342-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
We describe the association between initial treatment and end-of-life (EOL) outcomes among patients with pancreatic ductal adenocarcinoma (PDAC).
Methods
This population-based cohort study included patients with PDAC who died from April 2010–December 2017 in Ontario, Canada using administrative databases. We used multivariable models to explore the association between index cancer treatment (no cancer-directed therapy, radiation, chemotherapy, surgery alone, and surgery and chemotherapy), and primary (mortality, healthcare encounters and palliative care) and secondary outcomes (location of death, hospitalizations, and receipt of chemotherapy within the last 30 days of life).
Results
In our cohort (N = 9950), 56% received no cancer-directed therapy, 5% underwent radiation, 27% underwent chemotherapy, 7% underwent surgery alone, and 6% underwent surgery and chemotherapy. Compared to no cancer-directed therapy, radiation therapy (HR = 0.63), chemotherapy (HR = 0.43) surgery alone (HR = 0.32), and surgery and chemotherapy (HR = 0.23) were all associated with decreased mortality. Radiation (AMD = − 3.64), chemotherapy (AMD = -6.35), surgery alone (AMD = -6.91), and surgery and chemotherapy (AMD = -6.74) were all associated with fewer healthcare encounters per 30 days in the last 6 months of life. Chemotherapy (AMD = -1.57), surgery alone (AMD = -1.65), and surgery and chemotherapy (AMD = -1.67) were associated with fewer palliative care visits (all p-values for estimates above < 0.05). Treatment groups were associated with lower odds of institutional death and hospitalization at EOL, and higher odds of chemotherapy at EOL.
Conclusions
Receiving cancer-directed therapies was associated with higher survival, fewer healthcare visits, lower odds of dying in an institution and hospitalization at EOL, fewer palliative care visits, and higher odds of receiving chemotherapy at EOL.
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19
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Velek P, Luik AI, Brusselle GGO, Stricker BC, Bindels PJE, Kavousi M, Kieboom BCT, Voortman T, Ruiter R, Ikram MA, Ikram MK, de Schepper EIT, Licher S. Sex-specific patterns and lifetime risk of multimorbidity in the general population: a 23-year prospective cohort study. BMC Med 2022; 20:304. [PMID: 36071423 PMCID: PMC9454172 DOI: 10.1186/s12916-022-02487-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Multimorbidity poses a major challenge for care coordination. However, data on what non-communicable diseases lead to multimorbidity, and whether the lifetime risk differs between men and women are lacking. We determined sex-specific differences in multimorbidity patterns and estimated sex-specific lifetime risk of multimorbidity in the general population. METHODS We followed 6,094 participants from the Rotterdam Study aged 45 years and older for the occurrence of ten diseases (cancer, coronary heart disease, stroke, chronic obstructive pulmonary disease, depression, diabetes, dementia, asthma, heart failure, parkinsonism). We visualised participants' trajectories from a single disease to multimorbidity and the most frequent combinations of diseases. We calculated sex-specific lifetime risk of multimorbidity, considering multimorbidity involving only somatic diseases (1) affecting the same organ system, (2) affecting different organ systems, and (3) multimorbidity involving depression. RESULTS Over the follow-up period (1993-2016, median years of follow-up 9.2), we observed 6334 disease events. Of the study population, 10.3% had three or more diseases, and 27.9% had two or more diseases. The most frequent pair of co-occurring diseases among men was COPD and cancer (12.5% of participants with multimorbidity), the most frequent pair of diseases among women was depression and dementia (14.9%). The lifetime risk of multimorbidity was similar among men (66.0%, 95% CI: 63.2-68.8%) and women (65.1%, 95% CI: 62.5-67.7%), yet the risk of multimorbidity with depression was higher for women (30.9%, 95% CI: 28.4-33.5%, vs. 17.5%, 95% CI: 15.2-20.1%). The risk of multimorbidity with two diseases affecting the same organ is relatively low for both sexes (4.2% (95% CI: 3.2-5.5%) for men and 4.5% (95% CI: 3.5-5.7%) for women). CONCLUSIONS Two thirds of people over 45 will develop multimorbidity in their remaining lifetime, with women at nearly double the risk of multimorbidity involving depression than men. These findings call for programmes of integrated care to consider sex-specific differences to ensure men and women are served equally.
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Affiliation(s)
- Premysl Velek
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of General Practice, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Respiratory Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Bruno Ch Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Brenda C T Kieboom
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rikje Ruiter
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Erasmus MC - University Medical Center, Rotterdam, The Netherlands
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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20
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Cheung DC, Bremner KE, Tsui TCO, Croxford R, Lapointe-Shaw L, Giudice LD, Mendlowitz A, Perlis N, Pataky RE, Teckle P, Zeitouny S, Wong WWL, Sander B, Peacock S, Krahn MD, Kulkarni GS, Mulder C. "Bring the Hoses to Where the Fire Is!": Differential Impacts of Marginalization and Socioeconomic Status on COVID-19 Case Counts and Healthcare Costs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1307-1316. [PMID: 35527165 PMCID: PMC9072854 DOI: 10.1016/j.jval.2022.03.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 02/01/2022] [Accepted: 03/24/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Local health leaders and the Director General of the World Health Organization alike have observed that COVID-19 "does not discriminate." Nevertheless, the disproportionate representation of people of low socioeconomic status among those infected resembles discrimination. This population-based retrospective cohort study examined COVID-19 case counts and publicly funded healthcare costs in Ontario, Canada, with a focus on marginalization. METHODS Individuals with their first positive severe acute respiratory syndrome coronavirus 2 test from January 1, 2020 to June 30, 2020, were linked to administrative databases and matched to negative/untested controls. Mean net (COVID-19-attributable) costs were estimated for 30 days before and after diagnosis, and differences among strata of age, sex, comorbidity, and measures of marginalization were assessed using analysis of variance tests. RESULTS We included 28 893 COVID-19 cases (mean age 54 years, 56% female). Most cases remained in the community (20 545, 71.1%) or in long-term care facilities (4478, 15.5%), whereas 944 (3.3%) and 2926 (10.1%) were hospitalized, with and without intensive care unit, respectively. Case counts were skewed across marginalization strata with 2 to 7 times more cases in neighborhoods with low income, high material deprivation, and highest ethnic concentration. Mean net costs after diagnosis were higher for males ($4752 vs $2520 for females) and for cases with higher comorbidity ($1394-$7751) (both P < .001) but were similar across levels of most marginalization dimensions (range $3232-$3737, all P ≥ .19). CONCLUSIONS This study suggests that allocating resources unequally to marginalized individuals may improve equality in outcomes. It highlights the importance of reducing risk of COVID-19 infection among marginalized individuals to reduce overall costs and increase system capacity.
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Affiliation(s)
- Douglas C Cheung
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Teresa C O Tsui
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | - Lauren Lapointe-Shaw
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lisa Del Giudice
- Department of Family and Community Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Mendlowitz
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Reka E Pataky
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Paulos Teckle
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seraphine Zeitouny
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - William W L Wong
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada
| | - Stuart Peacock
- Canadian Centre for Applied Research in Cancer Control, BC Cancer, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada; Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; General Internal Medicine, Toronto General Hospital, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Girish S Kulkarni
- Division of Urology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Surgical Oncology, Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Carol Mulder
- Chiefs of Ontario, Toronto, Ontario, Canada; Queen's University, Kingston, Ontario, Canada.
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21
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Physical multimorbidity predicts the onset and persistence of anxiety: A prospective analysis of the Irish Longitudinal Study on Ageing. J Affect Disord 2022; 309:71-76. [PMID: 35452758 DOI: 10.1016/j.jad.2022.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aims of the present study were to examine prospective associations of multimorbidity (i.e., ≥2 chronic conditions) at baseline with incident and persistent anxiety over a two-year follow-up period among Irish older adults, and to quantify the extent to which sleep, pain, and disability mediate the multimorbidity-anxiety relationship. METHODS Data from The Irish Longitudinal Study on Aging (TILDA) conducted between 2009 and 2011 with a follow-up after two years were analyzed. Anxiety referred to score ≥ 8 on the anxiety section of the Hospital Anxiety and Depression Scale. Lifetime diagnosis of 14 chronic conditions was obtained. Outcomes were incident and persistent anxiety at two-year follow-up. RESULTS Data on 5871 adults aged ≥50 years at baseline were analyzed [Mean (SD) age 63.3 (9.0) years; 51.2% women]. After adjustment for potential confounders, compared to no chronic physical conditions at baseline, ≥3 chronic conditions were associated with a significant 1.89 (95% CI = 1.16-3.08) times higher risk for new onset anxiety at follow-up. Furthermore, having 1, 2, and ≥3 conditions at baseline were associated with significant 1.48 (95% CI 1.02, 2.14), 1.74 (95% CI 1.19, 2.53), and 1.84 (95% CI 1.27, 2.68) times higher risk for persistent anxiety at follow-up. Sleep problems, pain, and disability were identified as significant mediators, explaining 22.9%-37.8% of the associations. CONCLUSION Multimorbidity was associated with both new onset and persistent anxiety among Irish older adults. Future interventional studies should examine whether addressing the identified mediators may lead to lower risk for incident or persistent anxiety among those with physical multimorbidity.
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22
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Freeman S, Banner D, Labron M, Betkus G, Wood T, Branco E, Skinner K. "I see beauty, I see art, I see design, I see love." Findings from a resident-driven, co-designed gardening program in a long-term care facility. Health Promot Chronic Dis Prev Can 2022; 42:288-300. [PMID: 35830218 DOI: 10.24095/hpcdp.42.7.03] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Engagement with the natural environment is a meaningful activity for many people. People living in long-term care facilities can face barriers to going outdoors and engaging in nature-based activities. In response to needs expressed by our long-term care facility resident partners, we examined the feasibility and benefits of a co-designed hydroponic and raised-bed gardening program. METHODS Our team of long-term care facility residents, staff and researchers co-designed and piloted a four-month hydroponic and raised-bed gardening program along with an activity and educational program, in 2019. Feedback was gathered from long-term care facility residents and staff through surveys (N = 23 at baseline; N = 23 at follow-up), through five focus groups (N = 19: n = 10 staff; n = 9 residents) and through photovoice (N = 5). A qualitative descriptive approach was applied to focus group transcripts to capture a rich account of participant experiences within the naturalistic context, and descriptive statistics were calculated. RESULTS While most residents preferred to go outside (91%), few reported going outside every day (30%). Program participants expressed their joy about interacting with nature and watching plants grow. Analyses of focus group data generated the following themes: finding meaning; building connections with others through lifelong learning; impacts on mental health and well-being; opportunities to reminisce; reflection of self in gardening activities; benefits for staff; and enthusiasm for the program to continue. CONCLUSION Active and passive engagement in gardening activities benefitted residents with diverse abilities. This fostered opportunity for discussions, connections and increased interactions with others, which can help reduce social isolation. Gardening programs should be considered a feasible and important option that can support socialization, health and well-being.
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Affiliation(s)
- Shannon Freeman
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Davina Banner
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Meg Labron
- School of Social Work, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Georgia Betkus
- School of Health Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Tim Wood
- School of Nursing, University of Northern British Columbia, Prince George, British Columbia, Canada
| | - Erin Branco
- Northern Health Authority, Prince George, British Columbia, Canada
| | - Kelly Skinner
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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23
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Brown HK, McKnight A, Aker A. Association between pre-pregnancy multimorbidity and adverse maternal outcomes: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221096584. [PMID: 35586034 PMCID: PMC9106308 DOI: 10.1177/26335565221096584] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective We reviewed the literature on the association between pre-pregnancy multimorbidity (co-occurrence of two or more chronic conditions) and adverse maternal outcomes in pregnancy and postpartum. Data sources Medline, EMBASE, and CINAHL were searched from inception to September, 2021. Study selection Observational studies were eligible if they reported on the association between ≥ 2 co-occurring chronic conditions diagnosed before conception and any adverse maternal outcome in pregnancy or within 365 days of childbirth, had a comparison group, were peer-reviewed, and were written in English. Data extraction and synthesis Two reviewers used standardized instruments to extract data and rate study quality and the certainty of evidence. A narrative synthesis was performed. Results Of 6,381 studies retrieved, seven met our criteria. There were two prospective cohort studies, two retrospective cohort studies, and 3 cross-sectional studies, conducted in the United States (n=6) and Canada (n=1), and ranging in size from n=3,110 to n=57,326,681. Studies showed a dose-response relation between the number of co-occurring chronic conditions and risk of adverse maternal outcomes, including severe maternal morbidity or mortality, hypertensive disorders of pregnancy, and acute health care use in the perinatal period. Study quality was rated as strong (n=1), moderate (n=4), or weak (n=2), and the certainty of evidence was very low to moderate. Conclusion Given the increasing prevalence of chronic disease risk factors such as advanced maternal age and obesity, more research is needed to understand the impact of pre-pregnancy multimorbidity on maternal health so that appropriate preconception and perinatal supports can be developed.
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Affiliation(s)
- Hilary K Brown
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Hospital, Toronto, ON, Canada
| | - Anthony McKnight
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Amira Aker
- Department of Health & Society, University of Toronto Scarborough, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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24
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Stafford M, Knight H, Hughes J, Alarilla A, Mondor L, Pefoyo Kone A, Wodchis WP, Deeny SR. Associations between multiple long-term conditions and mortality in diverse ethnic groups. PLoS One 2022; 17:e0266418. [PMID: 35363804 PMCID: PMC8974956 DOI: 10.1371/journal.pone.0266418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multiple conditions are more prevalent in some minoritised ethnic groups and are associated with higher mortality rate but studies examining differential mortality once conditions are established is US-based. Our study tested whether the association between multiple conditions and mortality varies across ethnic groups in England. METHODS AND FINDINGS A random sample of primary care patients from Clinical Practice Research Datalink (CPRD) was followed from 1st January 2015 until 31st December 2019. Ethnicity, usually self-ascribed, was obtained from primary care records if present or from hospital records. Long-term conditions were counted from a list of 32 that have previously been associated with greater primary care, hospital admissions, or mortality risk. Cox regression models were used to estimate mortality by count of conditions, ethnicity and their interaction, with adjustment for age and sex for 532,059 patients with complete data. During five years of follow-up, 5.9% of patients died. Each additional condition at baseline was associated with increased mortality. The direction of the interaction of number of conditions with ethnicity showed a statistically higher mortality rate associated with long-term conditions in Pakistani, Black African, Black Caribbean and Other Black ethnic groups. In ethnicity-stratified models, the mortality rate per additional condition at age 50 was 1.33 (95% CI 1.31,1.35) for White ethnicity, 1.43 (95% CI 1.26,1.61) for Black Caribbean ethnicity and 1.78 (95% CI 1.41,2.24) for Other Black ethnicity. CONCLUSIONS The higher mortality rate associated with having multiple conditions is greater in minoritised compared with White ethnic groups. Research is now needed to identify factors that contribute to these inequalities. Within the health care setting, there may be opportunities to target clinical and self-management support for people with multiple conditions from minoritised ethnic groups.
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Affiliation(s)
| | | | - Jay Hughes
- The Health Foundation, London, United Kingdom
| | | | - Luke Mondor
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Health System Performance Network, Toronto, Ontario, Canada
| | - Anna Pefoyo Kone
- Health System Performance Network, Toronto, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - Walter P Wodchis
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Health System Performance Network, Toronto, Ontario, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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25
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Patient-reported outcomes for medication-related quality of life: A scoping review. Res Social Adm Pharm 2022; 18:3501-3523. [DOI: 10.1016/j.sapharm.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/26/2021] [Accepted: 03/07/2022] [Indexed: 11/20/2022]
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26
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Strum RP, Mowbray FI, Worster A, Tavares W, Leyenaar MS, Correia RH, Costa AP. Examining the association between paramedic transport to the emergency department and hospital admission: a population-based cohort study. BMC Emerg Med 2021; 21:117. [PMID: 34641823 PMCID: PMC8506085 DOI: 10.1186/s12873-021-00507-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Increasing hospitalization rates present unique challenges to manage limited inpatient bed capacity and services. Transport by paramedics to the emergency department (ED) may influence hospital admission decisions independent of patient need/acuity, though this relationship has not been established. We examined whether mode of transportation to the ED was independently associated with hospital admission. Methods We conducted a retrospective cohort study using the National Ambulatory Care Reporting System (NACRS) from April 1, 2015 to March 31, 2020 in Ontario, Canada. We included all adult patients (≥18 years) who received a triage score in the ED and presented via paramedic transport or self-referral (walk-in). Multivariable binary logistic regression was used to determine the association of mode of transportation between hospital admission, after adjusting for important patient and visit characteristics. Results During the study period, 21,764,640 ED visits were eligible for study inclusion. Approximately one-fifth (18.5%) of all ED visits were transported by paramedics. All-cause hospital admission incidence was greater when transported by paramedics (35.0% vs. 7.5%) and with each decreasing Canadian Triage and Acuity Scale level. Paramedic transport was independently associated with hospital admission (OR = 3.76; 95%CI = 3.74–3.77), in addition to higher medical acuity, older age, male sex, greater than two comorbidities, treatment in an urban setting and discharge diagnoses specific to the circulatory or digestive systems. Conclusions Transport by paramedics to an ED was independently associated with hospital admission as the disposition outcome, when compared against self-referred visits. Our findings highlight patient and visit characteristics associated with hospital admission, and can be used to inform proactive healthcare strategizing for in-patient bed management. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-021-00507-2.
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Affiliation(s)
- Ryan P Strum
- Department of Health Research Methods, Evidence and Impact, McMaster University, CRL B106, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Fabrice I Mowbray
- Department of Health Research Methods, Evidence and Impact, McMaster University, CRL B106, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Andrew Worster
- Department of Health Research Methods, Evidence and Impact, McMaster University, CRL B106, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Canada
| | - Walter Tavares
- The Wilson Centre, University of Toronto, Toronto, Canada.,York Region Paramedic and Senior Services, Regional Municipality of York, Newmarket, Canada
| | - Matthew S Leyenaar
- Department of Health Research Methods, Evidence and Impact, McMaster University, CRL B106, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Rebecca H Correia
- Department of Health Research Methods, Evidence and Impact, McMaster University, CRL B106, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence and Impact, McMaster University, CRL B106, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
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Koné AP, Scharf D. Prevalence of multimorbidity in adults with cancer, and associated health service utilization in Ontario, Canada: a population-based retrospective cohort study. BMC Cancer 2021; 21:406. [PMID: 33853565 PMCID: PMC8048167 DOI: 10.1186/s12885-021-08102-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/24/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The majority of people with cancer have at least one other chronic health condition. With each additional chronic disease, the complexity of their care increases, as does the potential for negative outcomes including premature death. In this paper, we describe cancer patients' clinical complexity (i.e., multimorbidity; MMB) in order to inform strategic efforts to improve care and outcomes for people with cancer of all types and commonly occurring chronic diseases. METHODS We conducted a population-based, retrospective cohort study of adults diagnosed with cancer between 2003 and 2013 (N = 601,331) identified in Ontario, Canada healthcare administrative data. During a five to 15-year follow-up period (through March 2018), we identified up to 16 co-occurring conditions and patient outcomes for the cohort, including health service utilization and death. RESULTS MMB was extremely common, affecting more than 91% of people with cancer. Nearly one quarter (23%) of the population had five or more co-occurring conditions. While we saw no differences in MMB between sexes, MMB prevalence and level increased with age. MMB prevalence and type of co-occurring conditions also varied by cancer type. Overall, MMB was associated with higher rates of health service utilization and mortality, regardless of other patient characteristics, and specific conditions differentially impacted these rates. CONCLUSIONS People with cancer are likely to have at least one other chronic medical condition and the presence of MMB negatively affects health service utilization and risk of premature death. These findings can help motivate and inform health system advances to improve care quality and outcomes for people with cancer and MMB.
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Affiliation(s)
- Anna Péfoyo Koné
- Department of Health Sciences, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada.
| | - Deborah Scharf
- Department of Psychology, Lakehead University, 955 Oliver Rd, Thunder Bay, ON, P7B 5E1, Canada
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