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"Cooke, Tim"
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Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey
Background
Studies on the prevalence of multimorbidity, defined as having two or more chronic conditions, have predominantly focused on the elderly. We estimated the prevalence and specific patterns of multimorbidity across different adult age groups. Furthermore, we examined the associations of multimorbidity with socio-demographic factors.
Methods
Using data from the Health Quality Council of Alberta (HQCA) 2010 Patient Experience Survey, the prevalence of self reported multimorbidity was assessed by telephone interview among a sample of 5010 adults (18 years and over) from the general population. Logistic regression analyses were performed to determine the association between a range of socio-demographic factors and multimorbidity.
Results
The overall age- and sex-standardized prevalence of multimorbidity was 19.0% in the surveyed general population. Of those with multimorbidity, 70.2% were aged less than 65 years. The most common pairing of chronic conditions was chronic pain and arthritis. Age, sex, income and family structure were independently associated with multimorbidity.
Conclusions
Multimorbidity is a common occurrence in the general adult population, and is not limited to the elderly. Future prevention programs and practice guidelines should take into account the common patterns of multimorbidity.
Journal Article
Health-related quality of life and healthcare utilization in multimorbidity: results of a cross-sectional survey
Purpose We assessed the associations between multi-morbidity and health-related quality of life (HRQL), and healthcare utilization, based on 16 common self-reported chronic conditions. Methods A cross-sectional questionnaire survey including the EQ-5D was conducted in a sample of the general population of adults (≥18 years) living in Alberta, Canada. Multiple linear and logistic regressions were used to assess the association between multiple chronic conditions and HRQL, hospitalization and emergency department (ED) use. Results A total of 4,946 respondents reported their HRQL, noting problems mostly with pain or discomfort (48.0 %). All chronic conditions were associated with a clinically important reduction in HRQL, the highest burden with anxiety or depression (−0.19, 95 % CI −0.21, −0.16) and chronic pain (−0.19, 95 % CI −0.21, −0.17). Multi-morbidity was associated with a clinically important reduction in the EQ-5D index score (−0.12, 95 % CI −0.14, −0.11) and twice the likelihood of being hospitalized (OR = 2.2, 95 % CI 1.7, 2.9) or having an ED visit (OR = 1.8, 95 % CI 1.4, 2.2). Conclusions Pain or discomfort is a common problem in people living with chronic conditions, and the existence of multimorbidity in these individuals is associated with a reduction in the HRQL as well as frequent hospitalization and emergency department visits.
Journal Article
Multimorbidity prevalence in the general population: the role of obesity in chronic disease clustering
Background
The role of obesity in the prevalence and clustering of multimorbidity, the occurrence of two or more chronic conditions, is understudied. We estimated the prevalence of multimorbidity by obesity status, and the interaction of obesity with other predictors of multimorbidity.
Methods
Data from adult respondents (18 years and over) to the Health Quality Council of Alberta 2012 Patient Experience Survey were analyzed. Multivariable regression models were fitted to test for associations.
Results
The survey sample included 4803 respondents; 55.8% were female and the mean age was 47.8 years (SD, 17.1). The majority (62.0%) of respondents reported having at least one chronic condition. The prevalence of multimorbidity, including obesity, was 36.0% (95% CI, 34.8 – 37.3). The prevalence of obesity alone was 28.1% (95% CI 26.6 – 29.5). Having obesity was associated with more than double the odds of multimorbidity (odds ratio = 2.2, 95% CI 1.9 – 2.7) compared to non-obese.
Conclusions
The prevalence of multimorbidity in the general population is high, but even higher in obese than non-obese persons. These findings may be relevant for surveillance, prevention and management strategies for multimorbidity.
Journal Article
The exploration of North America
Young readers learn about the history of North American discovery and exploration, detailing all of the successes, hardships, dangers, and accomplishments of key figures in exploration history. From the mighty Mississippi to the Rockies, up to Canada and down to Mexico, readers will learn about Columbus, Lewis and Clark, Smith, and many more.
Book
EQ-5D-derived health utilities and minimally important differences for chronic health conditions: 2011 Commonwealth Fund Survey of Sicker Adults in Canada
Purpose The purpose of the study is to estimate the EQ-5D-derived health utilities associated with selected chronic conditions (hypertension, heart disease, arthritis, asthma or COPD, cancer, diabetes, chronic back pain, and anxiety or depression) and to estimate minimally important differences (MID) based on the Commonwealth Fund Survey of Sicker Adults in Canada. Methods We used a cross-sectional survey of 3765 sick adults in Canada conducted in 2011 by the Commonwealth Fund. Health utilities were calculated for the entire sample and for each of the eight chronic health conditions. An ordinary least squares regression was used to estimate the utility decrement associated with these conditions with and without adjustment for socio-demographic factors. The MIDs were estimated using the anchor- and distribution based methods. Results The adjusted utility decrement varied from 0.028 (95 % confidence interval (CI) –0.049, –0.008) for diabetes to 0.124 (95 % CI –0.142, –0.105) for anxiety or depression. The anchor-based MID for the entire group was 0.044 (95 % CI 0.025, 0.062), and the distribution-based MID for the entire group was 0.091. The condition-specific MIDs using the distribution-based method ranged from 0.089 for cancer to 0.108 for asthma or COPD. Conclusions The MID estimated by the distribution-based method was larger than the MID estimated by the anchor-based method, indicating that the choice of method matters. The impact of arthritis, anxiety or depression, and chronic back pain on health utility was substantial, all exceeding or approximating the MID estimated using either anchor- or distribution-based methods.
Journal Article
Maps and mapping the world
A look at the history of maps of the world and how they were created and used.
P_MAP
Comparing the EQ-5D 3L and 5L: measurement properties and association with chronic conditions and multimorbidity in the general population
Background
Studies comparing the measurement properties of EQ-5D 3L (3L) and EQ-5D 5L (5L) are limited to specific patient populations with small sample sizes. Using a general population sample, we compared 3L and 5L in terms of their measurement properties and association with number of chronic conditions, including multimorbidity – the concurrent occurrence of two or more chronic conditions.
Methods
Data were available from two consecutive cycles of a cross-sectional telephone interview survey using 3L (2010 cycle) and 5L (2012 cycle), in the general population of adults (age ≥ 18 years) in Alberta, Canada. Measurement properties were compared by determining their feasibility, ceiling effect, and discriminatory power (Shannon indices) for 3L and 5L. Linear regression models were fitted to test the associations between multimorbidity and EQ-5D index score.
Results
Data were available for 4946 (2010) and 4752 (2012) survey respondents with information on HRQL. Compared to 3L, 5L showed lower ceiling effect (32.3% versus 42.1%), higher absolute discriminatory power (Shannon index, mean 0.79 versus 0.52) and higher relative discriminatory power (Shannon Evenness index, mean 0.09 versus 0.06 for 3L). Despite these differences, similar relationships of lower HRQL with greater multimorbidity were observed for the 3L (ß = −0.13, 95% CI −0.15; −0.11) and 5L (ß = −0.12, 95% CI −0.13; −0.11).
Conclusions
Using a general population sample, the EQ-5D 5L showed better measurement properties than the EQ-5D 3L. Nonetheless, clinically important differences in HRQL associated with multimorbidity were similar in magnitude using both versions of EQ-5D.
Journal Article