Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians

doi:10.17269/s41997-021-00474-y

. 2021 Aug;112(4):737-747.

doi: 10.17269/s41997-021-00474-y. Epub 2021 Apr 13.

Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians

Anna Pefoyo Kone^{1

2

3}, Luke Mondor^{4

5}, Colleen Maxwell^{4

5

6

7}, Umme Saika Kabir⁸, Laura C Rosella^{9

4

5

10}, Walter P Wodchis^{9

4

5

10}

Affiliations

¹ Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada. akone@lakeheadu.ca.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. akone@lakeheadu.ca.
³ Health System Performance Network (HSPN), Toronto, ON, Canada. akone@lakeheadu.ca.
⁴ Health System Performance Network (HSPN), Toronto, ON, Canada.
⁵ ICES, Toronto, ON, Canada.
⁶ School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
⁷ School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada.
⁸ Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada.
⁹ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁰ Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.

PMID: 33847995
PMCID: PMC8043089
DOI: 10.17269/s41997-021-00474-y

Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians

Anna Pefoyo Kone et al. Can J Public Health. 2021 Aug.

. 2021 Aug;112(4):737-747.

doi: 10.17269/s41997-021-00474-y. Epub 2021 Apr 13.

Authors

Anna Pefoyo Kone^{1

2

3}, Luke Mondor^{4

5}, Colleen Maxwell^{4

5

6

7}, Umme Saika Kabir⁸, Laura C Rosella^{9

4

5

10}, Walter P Wodchis^{9

4

5

10}

Affiliations

¹ Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada. akone@lakeheadu.ca.
² Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. akone@lakeheadu.ca.
³ Health System Performance Network (HSPN), Toronto, ON, Canada. akone@lakeheadu.ca.
⁴ Health System Performance Network (HSPN), Toronto, ON, Canada.
⁵ ICES, Toronto, ON, Canada.
⁶ School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.
⁷ School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada.
⁸ Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada.
⁹ Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
¹⁰ Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.

PMID: 33847995
PMCID: PMC8043089
DOI: 10.17269/s41997-021-00474-y

Erratum in

Correction to: Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians.
Kone AP, Mondor L, Maxwell C, Kabir US, Rosella LC, Wodchis WP. Kone AP, et al. Can J Public Health. 2021 Aug;112(4):786. doi: 10.17269/s41997-021-00533-4. Can J Public Health. 2021. PMID: 33954925 Free PMC article. No abstract available.

Abstract
in English, French

Objective: This study aimed to provide population-level data regarding trends in multimorbidity over 13 years.

Methods: We linked provincial health administrative data in Ontario, Canada, to create 3 cross-sectional panels of residents of any age in 2003, 2009, and 2016 to describe: (i) 13-year trends in multimorbidity prevalence and constellations among residents and across age, sex, and income; and (ii) chronic condition clusters. Multimorbidity was defined as having at least any 2 of 18 selected conditions, and further grouped into levels of 2, 3, 4, or 5 or more conditions. Age-sex standardized multimorbidity prevalence was estimated using the 2009 population as the standard. Clustering was defined using the observed combinations of conditions within levels of multimorbidity.

Results: Standardized prevalence of multimorbidity increased over time (26.5%, 28.8%, and 30.0% across sequential panels), across sex, age, and area-based income. Females, older adults and those living in lower income areas exhibited higher rates in all years. However, multimorbidity increased relatively more among males, younger adults, and those with 4 or 5 or more conditions. We observed numerous and increasing diversity in disease clusters, namely at higher levels of multimorbidity.

Conclusion: Our study provides relevant and needed population-based information on the growing burden of multimorbidity, and related socio-demographic risk factors. Multimorbidity is markedly increasing among younger age cohorts. Also, there is an increasing complexity and lack of common clustering patterns at higher multimorbidity levels.

RéSUMé: OBJECTIF: Cette étude a pour but d’offrir des données populationnelles sur la multimorbidité et les tendances sur 13 années. MéTHODES: Cette étude transversale utilise des données administratives provinciales, incluant trois panels d’individus de tous âges, en 2003, 2009 et 2016, pour décrire : (i) les tendances de la multimorbidité en Ontario, et les différences entre âge, sexe et niveaux de revenus; ainsi que (ii) les combinaisons de maladies chroniques. La multimorbidité a été définie comme ayant au moins deux des 18 maladies chroniques sélectionnées, et ensuite groupée par niveau de 2, 3, 4 ou 5 maladies ou plus. Les taux de prévalence standardisés ont été estimés à partir de la population de 2009. Les combinaisons fréquentes de maladies chroniques observées par niveau de multimorbidité sont également arborées. RéSULTATS: La prévalence standardisée de multimorbidité a augmenté au fil des années (26,5 %, 28,8 % et 30,0 %). Elle était plus élevée chez les femmes, les personnes âgées, et celles vivant dans les endroits à faible revenus, peu importe l’année. Toutefois l’augmentation dans le temps était plus importante chez les hommes, les jeunes adultes, et pour les niveaux élevés de multimorbidité (4, 5 ou plus). Nous avons observé un nombre élevé de combinaisons de maladies, et une diversité grandissante spécialement pour les niveaux de multimorbidité élevés. CONCLUSION: Cette étude fournit des données épidémiologiques probantes sur le problème grandissant de la multimorbidité, notamment au sein des jeunes cohortes, et les facteurs sociodémographiques associés. Il existe également une complexité grandissante et pas de profils communs dans les combinaisons de maladies, aux niveaux élevés de multimorbidité.

Keywords: Administrative data; Disease clusters; Multimorbidity; Ontario; Socio-demographics; Trends.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

**Fig. 1**
Ontario population (gray) and distribution of multimorbidity level by age and index year (2003, 2009, and 2016)

**Fig. 2**
Relative differences from 2003 to 2016 in multimorbidity prevalence, by age, sex, and multimorbidity level

**Fig. 3**
Age-sex standardized prevalence of multimorbidity by area-level income quintiles and index year (2003, 2009, and 2016)

See this image and copyright information in PMC

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References

1. Alamian A, Paradis G. Clustering of chronic disease behavioral risk factors in Canadian children and adolescents. Preventive Medicine. 2009;48(5):493–499. doi: 10.1016/j.ypmed.2009.02.015. - DOI - PubMed
1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed
1. Boyd CM, Fortin M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Reviews. 2010;32(2):451–474. doi: 10.1007/BF03391611. - DOI
1. Buajitti E, Chiodo S, Rosella LC. Agreement between area- and individual-level income measures in a population-based cohort: implications for population health research. SSM - Population Health. 2020;10:100553. doi: 10.1016/j.ssmph.2020.100553. - DOI - PMC - PubMed
1. Canizares M, Hogg-Johnson S, Gignac MAM, Glazier RH, Badley EM. Increasing trajectories of multimorbidity over time: birth cohort differences and the role of changes in obesity and income. The Journals of Gerontology: Series B. 2018;73(7):1303–1314. doi: 10.1093/geronb/gbx004. - DOI - PubMed

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[1] Alamian A, Paradis G. Clustering of chronic disease behavioral risk factors in Canadian children and adolescents. Preventive Medicine. 2009;48(5):493–499. doi: 10.1016/j.ypmed.2009.02.015. - DOI - PubMed

[2] Alamian A, Paradis G. Clustering of chronic disease behavioral risk factors in Canadian children and adolescents. Preventive Medicine. 2009;48(5):493–499. doi: 10.1016/j.ypmed.2009.02.015. - DOI - PubMed

[3] Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed

[4] Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43. doi: 10.1016/S0140-6736(12)60240-2. - DOI - PubMed

[5] Boyd CM, Fortin M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Reviews. 2010;32(2):451–474. doi: 10.1007/BF03391611. - DOI

[6] Boyd CM, Fortin M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Reviews. 2010;32(2):451–474. doi: 10.1007/BF03391611. - DOI

[7] Buajitti E, Chiodo S, Rosella LC. Agreement between area- and individual-level income measures in a population-based cohort: implications for population health research. SSM - Population Health. 2020;10:100553. doi: 10.1016/j.ssmph.2020.100553. - DOI - PMC - PubMed

[8] Buajitti E, Chiodo S, Rosella LC. Agreement between area- and individual-level income measures in a population-based cohort: implications for population health research. SSM - Population Health. 2020;10:100553. doi: 10.1016/j.ssmph.2020.100553. - DOI - PMC - PubMed

[9] Canizares M, Hogg-Johnson S, Gignac MAM, Glazier RH, Badley EM. Increasing trajectories of multimorbidity over time: birth cohort differences and the role of changes in obesity and income. The Journals of Gerontology: Series B. 2018;73(7):1303–1314. doi: 10.1093/geronb/gbx004. - DOI - PubMed

[10] Canizares M, Hogg-Johnson S, Gignac MAM, Glazier RH, Badley EM. Increasing trajectories of multimorbidity over time: birth cohort differences and the role of changes in obesity and income. The Journals of Gerontology: Series B. 2018;73(7):1303–1314. doi: 10.1093/geronb/gbx004. - DOI - PubMed

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Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians

Affiliations

Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians

Authors

Affiliations

Erratum in

Abstract
in English, French

Conflict of interest statement

Figures

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Cited by

References

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Medical

Erratum in

Abstract in English, French

Conflict of interest statement

Figures

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Cited by

References

Publication types

MeSH terms

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Full Text Sources

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Medical

Abstract
in English, French