Multimorbidity frameworks impact prevalence and relationships with patient-important outcomes

Lauren E. Griffith (Corresponding author), Anne Gilsing, Dee Mangin, Christopher Patterson, Edwin R. van den Heuvel, Nazmul Sohel, Philip St. John, Marjan van den Akker, Parminder Raina

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

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. J Am Geriatr Soc 67:1632–1640, 2019.

Original languageEnglish
Pages (from-to)1632-1640
Number of pages9
JournalJournal of the American Geriatrics Society
Volume67
Issue number8
DOIs
Publication statusPublished - Aug 2019

Fingerprint

Comorbidity
Social Participation
Odds Ratio
Mental Health
Logistic Models
Cohort Studies
Health
Population

Keywords

  • aging
  • Canadian Longitudinal Study on Aging
  • functional disability
  • multimorbidity
  • self-rated health
  • social participation

Cite this

Griffith, Lauren E. ; Gilsing, Anne ; Mangin, Dee ; Patterson, Christopher ; van den Heuvel, Edwin R. ; Sohel, Nazmul ; St. John, Philip ; van den Akker, Marjan ; Raina, Parminder. / Multimorbidity frameworks impact prevalence and relationships with patient-important outcomes. In: Journal of the American Geriatrics Society. 2019 ; Vol. 67, No. 8. pp. 1632-1640.
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title = "Multimorbidity frameworks impact prevalence and relationships with patient-important outcomes",
abstract = "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. J Am Geriatr Soc 67:1632–1640, 2019.",
keywords = "aging, Canadian Longitudinal Study on Aging, functional disability, multimorbidity, self-rated health, social participation",
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Griffith, LE, Gilsing, A, Mangin, D, Patterson, C, van den Heuvel, ER, Sohel, N, St. John, P, van den Akker, M & Raina, P 2019, 'Multimorbidity frameworks impact prevalence and relationships with patient-important outcomes', Journal of the American Geriatrics Society, vol. 67, no. 8, pp. 1632-1640. https://doi.org/10.1111/jgs.15921

Multimorbidity frameworks impact prevalence and relationships with patient-important outcomes. / Griffith, Lauren E. (Corresponding author); Gilsing, Anne; Mangin, Dee; Patterson, Christopher; van den Heuvel, Edwin R.; Sohel, Nazmul; St. John, Philip; van den Akker, Marjan; Raina, Parminder.

In: Journal of the American Geriatrics Society, Vol. 67, No. 8, 08.2019, p. 1632-1640.

Research output: Contribution to journalArticleAcademicpeer-review

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 R.

AU - Sohel, Nazmul

AU - St. John, Philip

AU - van den Akker, Marjan

AU - Raina, Parminder

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. J Am Geriatr Soc 67:1632–1640, 2019.

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. J Am Geriatr Soc 67:1632–1640, 2019.

KW - aging

KW - Canadian Longitudinal Study on Aging

KW - functional disability

KW - multimorbidity

KW - self-rated health

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