TY - JOUR
T1 - Multimorbidity Frameworks Impact Prevalence and Relationships with Patient-Important Outcomes
AU - Griffith, Lauren E.
AU - Gilsing, Anne
AU - Mangin, Dee
AU - Patterson, Christopher
AU - van den Heuvel, Edwin
AU - Sohel, Nazmul
AU - St John, Philip
AU - van den Akker, Marjan
AU - Raina, Parminder
N1 - Funding Information:
Financial Disclosure: Dr Griffith is supported by a Canadian Institutes of Health Research New Investigators Award and the McLaughlin Foundation Professorship in Population and Public Health. Dr Raina holds a Tier 1 Canada Research Chair in Geroscience and the Raymond and Margaret Labarge Chair in Research and Knowledge Application for Optimal Aging. Dr Gilsing was supported by a Canadian Institute of Health Research Post-doctoral Fellowship and a Michael G. DeGroote Fellowship Award from McMaster University. Dr Mangin holds the David Braley Nancy Gordon Chair in Family Medicine.
Funding Information:
This research was made possible using the data/biospecimens collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the CLSA is provided by the Government of Canada through the Canadian Institutes of Health Research under grant reference LSA 9447 and the Canada Foundation for Innovation. This research has been conducted using the CLSA data set Baseline Tracking, version 3.1, and Baseline Comprehensive, Version 2.0, under Application No. 150306. The CLSA is led by Drs Parminder Raina, Christina Wolfson, and Susan Kirkland. This study was approved by the Hamilton Integrated Research Ethics Board (Ethics Certificate No. 0164). Financial Disclosure: Dr Griffith is supported by a Canadian Institutes of Health Research New Investigators Award and the McLaughlin Foundation Professorship in Population and Public Health. Dr Raina holds a Tier 1 Canada Research Chair in Geroscience and the Raymond and Margaret Labarge Chair in Research and Knowledge Application for Optimal Aging. Dr Gilsing was supported by a Canadian Institute of Health Research Post-doctoral Fellowship and a Michael G. DeGroote Fellowship Award from McMaster University. Dr Mangin holds the David Braley Nancy Gordon Chair in Family Medicine. Conflict Of Interest: The authors declare no potential conflict of interest. Author Contributions: Study concept and design: Griffith, Gilsing, and Raina. Acquisition of data: Griffith and Raina. Analysis and interpretation of data: Griffith, Gilsing, Mangin, Patterson, van den Heuvel, Sohel, St. John, van den Akker, and Raina. Preparation of the manuscript: Griffith, Gilsing, Mangin, Patterson, van den Heuvel, Sohel, St. John, van den Akker, and Raina. Sponsor's Role: The sponsors had no role in the design, methods, subject recruitment, data collection, analysis, and preparation of the article.
Funding Information:
This research was made possible using the data/biospecimens collected by the Canadian Longitudinal Study on Aging (CLSA). Funding for the CLSA is provided by the Government of Canada through the Canadian Institutes of Health Research under grant reference LSA 9447 and the Canada Foundation for Innovation. This research has been conducted using the CLSA data set Baseline Tracking, version 3.1, and Baseline Comprehensive, Version 2.0, under Application No. 150306. The CLSA is led by Drs Parminder Raina, Chris-tina Wolfson, and Susan Kirkland. This study was approved by the Hamilton Integrated Research Ethics Board (Ethics Certificate No. 0164).
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2019/8
Y1 - 2019/8
N2 - OBJECTIVES To explore how different frameworks and categories of chronic conditions impact multimorbidity (defined as two or more chronic conditions) prevalence estimates and associations with patient-important functional outcomes. DESIGN Baseline data from a population-based cohort study. SETTING National sample of Canadians. PARTICIPANTS A total of 51 338 community-living adults, aged 45 to 85 years. MAIN OUTCOME MEASURES Chronic conditions from three commonly recognized frameworks were categorized as: (1) diseases, (2) risk factors, or (3) symptoms. Estimates of multimorbidity prevalence were compared among frameworks by age and sex. Separate weighted logistic regression models were used to explore the impact of the different frameworks and categories of chronic conditions on odds ratios (ORs) for multimorbidity for four patient-important functional outcomes: disability, social participation restriction, and self-rated physical and mental health. RESULTS One framework included diseases and risk factors, and two frameworks included diseases, risk factors, and symptoms. The prevalence of multimorbidity differed among the frameworks, ranging from 33.5% to 60.6% having two or more chronic conditions. Including risk factors in frameworks increased prevalence estimates, while including symptoms increased prevalence estimates and associations with most patient-important outcomes. The two frameworks that included symptoms had the largest ORs for associations with disability, social participation restriction, and self-rated physical health but not self-rated mental health. Similar results were found when we compared ORs for patient-important outcome for multimorbidity based on three subframeworks: one including diseases only, one including diseases and risk factors, and one including diseases, risk factors, and symptoms. CONCLUSIONS Including risk factors appeared to increase only the prevalence of multimorbidity without significantly altering relationships to outcomes. The inclusion of symptoms increased prevalence and associations with patient-important outcomes. These findings underscore the importance of considering not only the number, but also the category, of conditions included in multimorbidity frameworks, as simply counting the number of diagnoses may reduce sensitivity to outcomes that are important to individuals.
AB - OBJECTIVES To explore how different frameworks and categories of chronic conditions impact multimorbidity (defined as two or more chronic conditions) prevalence estimates and associations with patient-important functional outcomes. DESIGN Baseline data from a population-based cohort study. SETTING National sample of Canadians. PARTICIPANTS A total of 51 338 community-living adults, aged 45 to 85 years. MAIN OUTCOME MEASURES Chronic conditions from three commonly recognized frameworks were categorized as: (1) diseases, (2) risk factors, or (3) symptoms. Estimates of multimorbidity prevalence were compared among frameworks by age and sex. Separate weighted logistic regression models were used to explore the impact of the different frameworks and categories of chronic conditions on odds ratios (ORs) for multimorbidity for four patient-important functional outcomes: disability, social participation restriction, and self-rated physical and mental health. RESULTS One framework included diseases and risk factors, and two frameworks included diseases, risk factors, and symptoms. The prevalence of multimorbidity differed among the frameworks, ranging from 33.5% to 60.6% having two or more chronic conditions. Including risk factors in frameworks increased prevalence estimates, while including symptoms increased prevalence estimates and associations with most patient-important outcomes. The two frameworks that included symptoms had the largest ORs for associations with disability, social participation restriction, and self-rated physical health but not self-rated mental health. Similar results were found when we compared ORs for patient-important outcome for multimorbidity based on three subframeworks: one including diseases only, one including diseases and risk factors, and one including diseases, risk factors, and symptoms. CONCLUSIONS Including risk factors appeared to increase only the prevalence of multimorbidity without significantly altering relationships to outcomes. The inclusion of symptoms increased prevalence and associations with patient-important outcomes. These findings underscore the importance of considering not only the number, but also the category, of conditions included in multimorbidity frameworks, as simply counting the number of diagnoses may reduce sensitivity to outcomes that are important to individuals.
KW - aging
KW - Canadian Longitudinal Study on Aging
KW - functional disability
KW - multimorbidity
KW - self-rated health
KW - social participation
KW - HEALTH-CARE
KW - FUNCTIONAL DISABILITY
KW - DEFINITION
KW - DISEASES
KW - CHALLENGES
KW - SYMPTOMS
KW - ILLNESS
KW - BURDEN
KW - RISK
U2 - 10.1111/jgs.15921
DO - 10.1111/jgs.15921
M3 - Article
C2 - 30957230
SN - 0002-8614
VL - 67
SP - 1632
EP - 1640
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 8
ER -