Multimorbidity frameworks impact prevalence and relationships with patient-important outcomes

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

doi:10.1111/jgs.15921

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 journal › Article › Academic › peer-review

55 Citations (Scopus)

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 language	English
Pages (from-to)	1632-1640
Number of pages	9
Journal	Journal of the American Geriatrics Society
Volume	67
Issue number	8
DOIs	https://doi.org/10.1111/jgs.15921
Publication status	Published - Aug 2019

Funding

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). 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.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

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

Access to Document

10.1111/jgs.15921

Cite this

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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.",

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author = "Griffith, \{Lauren E.\} and Anne Gilsing and Dee Mangin and Christopher Patterson and \{van den Heuvel\}, \{Edwin R.\} and Nazmul Sohel and \{St. John\}, Philip and \{van den Akker\}, Marjan and Parminder Raina",

year = "2019",

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doi = "10.1111/jgs.15921",

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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

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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.

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KW - Canadian Longitudinal Study on Aging

KW - functional disability

KW - multimorbidity

KW - self-rated health

KW - social participation

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Multimorbidity frameworks impact prevalence and relationships with patient-important outcomes

Abstract

Funding

UN SDGs

Keywords

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