The increasing burden and complexity of multimorbidity

Anna J Koné Pefoyo^{1

2

3}, Susan E Bronskill^{4

5}, Andrea Gruneir^{6

7

8

9}, Andrew Calzavara¹⁰, Kednapa Thavorn^{11

12

13}, Yelena Petrosyan¹⁴, Colleen J Maxwell^{15

16}, YuQing Bai^{17

18}, Walter P Wodchis^{19

20

21}

Affiliations

¹ Cancer Screening, Cancer Care Ontario/Action Cancer Ontario, 505 University Avenue, Room 18-14, Toronto, M5G 1X3, Ontario, Canada. Anna.Kone@cancercare.on.ca.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Anna.Kone@cancercare.on.ca.
³ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Anna.Kone@cancercare.on.ca.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. susan.bronskill@ices.on.ca.
⁵ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. susan.bronskill@ices.on.ca.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. gruneir@ualberta.ca.
⁷ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. gruneir@ualberta.ca.
⁸ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. gruneir@ualberta.ca.
⁹ Department of Family Medicine, University of Alberta, Edmonton, AB, Canada. gruneir@ualberta.ca.
¹⁰ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. andrew.calzavara@ices.on.ca.
¹¹ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. kthavorn@ohri.ca.
¹² Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada. kthavorn@ohri.ca.
¹³ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada. kthavorn@ohri.ca.
¹⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. yelena.petrosyan@mail.utoronto.ca.
¹⁵ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. colleen.maxwell@uwaterloo.ca.
¹⁶ Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada. colleen.maxwell@uwaterloo.ca.
¹⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. yuqing.bai@utoronto.ca.
¹⁸ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. yuqing.bai@utoronto.ca.
¹⁹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. walter.wodchis@utoronto.ca.
²⁰ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. walter.wodchis@utoronto.ca.
²¹ Toronto Rehabilitation Institute, Toronto, ON, Canada. walter.wodchis@utoronto.ca.

PMID: 25903064
PMCID: PMC4415224
DOI: 10.1186/s12889-015-1733-2

The increasing burden and complexity of multimorbidity

Anna J Koné Pefoyo et al. BMC Public Health. 2015.

. 2015 Apr 23:15:415.

doi: 10.1186/s12889-015-1733-2.

Authors

Affiliations

¹ Cancer Screening, Cancer Care Ontario/Action Cancer Ontario, 505 University Avenue, Room 18-14, Toronto, M5G 1X3, Ontario, Canada. Anna.Kone@cancercare.on.ca.
² Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. Anna.Kone@cancercare.on.ca.
³ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. Anna.Kone@cancercare.on.ca.
⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. susan.bronskill@ices.on.ca.
⁵ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. susan.bronskill@ices.on.ca.
⁶ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. gruneir@ualberta.ca.
⁷ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. gruneir@ualberta.ca.
⁸ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. gruneir@ualberta.ca.
⁹ Department of Family Medicine, University of Alberta, Edmonton, AB, Canada. gruneir@ualberta.ca.
¹⁰ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. andrew.calzavara@ices.on.ca.
¹¹ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. kthavorn@ohri.ca.
¹² Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada. kthavorn@ohri.ca.
¹³ School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada. kthavorn@ohri.ca.
¹⁴ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. yelena.petrosyan@mail.utoronto.ca.
¹⁵ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. colleen.maxwell@uwaterloo.ca.
¹⁶ Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada. colleen.maxwell@uwaterloo.ca.
¹⁷ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. yuqing.bai@utoronto.ca.
¹⁸ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. yuqing.bai@utoronto.ca.
¹⁹ Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. walter.wodchis@utoronto.ca.
²⁰ Institute for Clinical Evaluative Sciences, Toronto, ON, Canada. walter.wodchis@utoronto.ca.
²¹ Toronto Rehabilitation Institute, Toronto, ON, Canada. walter.wodchis@utoronto.ca.

PMID: 25903064
PMCID: PMC4415224
DOI: 10.1186/s12889-015-1733-2

Abstract

Background: Multimorbidity, the co-occurrence of two or more chronic conditions, is common among older adults and is known to be associated with high costs and gaps in quality of care. Population-based estimates of multimorbidity are not readily available, which makes future planning a challenge. We aimed to estimate the population-based prevalence and trends of multimorbidity in Ontario, Canada and to examine patterns in the co-occurrence of chronic conditions.

Methods: This retrospective cohort study includes all Ontarians (aged 0 to 105 years) with at least one of 16 common chronic conditions. Descriptive statistics were used to examine and compare the prevalence of multimorbidity by age and number of conditions in 2003 and 2009. The co-occurrence of chronic conditions among individuals with multimorbidity was also explored.

Results: The prevalence of multimorbidity among Ontarians rose from 17.4% in 2003 to 24.3% in 2009, a 40% increase. This increase over time was evident across all age groups. Within individual chronic conditions, multimorbidity rates ranged from 44% to 99%. Remarkably, there were no dominant patterns of co-occurring conditions.

Conclusion: The high prevalence of multimorbidity and numerous combinations of conditions suggests that single, disease-oriented management programs may be less effective or efficient tools for high quality care compared to person-centered approaches.

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Figures

**Figure 1**
Distribution of the number of individuals with multimorbidity in Ontario across ages, by number of common chronic conditions and year.

**Figure 2**
Distribution of the proportion of individuals with multimorbidity in Ontario, within common chronic conditions and by year.

See this image and copyright information in PMC

References

1. Statistics Canada. Tables by subject: Diseases and health conditions. http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/ind01/l3_2966_1887-.... Accessed July 2nd 2014.
1. The Chief Public Health Officer . Annual Report on the State of Public Health in Canada, 2010. Ottawa: Public Health Agency of Canada; 2010.
1. World Health Organization . Global status report on noncommunicable diseases. Geneva: WHO; 2010. - PubMed
1. Canadian Institute for Health Information . Seniors and the health care system: what is the impact of multiple Chronic Conditions? Toronto: CIHI; 2011.
1. Boyd CM, Fortin M. Future of multimorbidity research: How should understanding of multimorbidity inform health system design? Public Health Rev. 2010;32:451–74.

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The increasing burden and complexity of multimorbidity

Affiliations

The increasing burden and complexity of multimorbidity

Authors

Affiliations

Abstract

Figures

References

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LinkOut - more resources

Full Text Sources

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