Lauren Griffith McMaster University

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Transcription:

The Impact of Chronic Condition List on Prevalence and the Relationship between MCCs and Disability, Social Participation, and Self- Rated Health: Data from the Canadian Longitudinal Study on Aging Lauren Griffith McMaster University CAG Meeting Vancouver, British Columbia October 19, 2018 1

Methodologic Issues Multimorbidity prevalence estimates vary widely (3.5%-98.5%) 1 Harrison et al. 2 if MM operationalization impacted prevalence estimates Impact of which diseases are included in MM list Impact of MM definition: 2+ or 3+ chronic conditions Population-based patient cohort Did not examine effect of sex Only examined at prevalence 2

Objectives We aimed to build on this work using weighted data from all 51,338 CLSA participants Compare prevalence estimates of a larger group of MM lists/definition (by age and sex) Examine the association between MM list/ definition and person-important outcomes: Disability Social Participation Restriction Self-rated Health 3

Methods Self-Reported Chronic Conditions Lasting (or expecting to last) 6 months Diagnosed by health professional Definitions: Disability: Needing help with or unable to do any of 7 ADLs or 7 IADLs Social Participation Restriction: Prevented from participating in social activity because of health condition/limitation Self-rated health: physical, mental, and healthy aging on 5 pt Likert scale (excellent poor) 4

Multimorbidity Lists Disease System 5 CLSA Chronic Conditions Diederichs 3 Fortin-20 4 Fortin-Prev1 Willadsen 5 [12 most prevalent] Diseases Risk Factor Symptom Osteoarthritis Musculoskeletal Rheumatoid arthritis Osteoporosis Respiratory Asthma COPD Heart disease (including CHF) Cardiac Angina Myocardial infarction Vascular Hypertension Peripheral vascular disease Endocrine-Metabolic Diabetes Hypo-/Hyperthyroidism Stroke or CVA Transient ischemic attack Neurological Parkinsonism/disease Multiple Sclerosis Epilepsy Migraine headaches Intestinal or stomach ulcer Gastrointestinal Bowel disorder (Upper and Lower) Bowel incontinence Genitourinary Urinary incontinence Ophthalmologic Cataracts, Glaucoma, Macular Degeneration Mood disorder (depression) Psychiatric Anxiety Alzheimer's disease/dementia Renal Kidney disease Cancer* Cancer Obesity Other Risk Overweight Factors/Symptoms Back problems 5

Multimorbidity Lists Disease System 5 CLSA Chronic Conditions Diederichs 3 Fortin-20 4 Fortin-Prev1 Willadsen 5 [12 most prevalent] Diseases Risk Factor Symptom Osteoarthritis Musculoskeletal Rheumatoid arthritis Osteoporosis Respiratory Asthma COPD Heart disease (including CHF) Cardiac Angina Myocardial infarction Vascular Hypertension Peripheral vascular disease Endocrine-Metabolic Diabetes Hypo-/Hyperthyroidism Stroke or CVA Transient ischemic attack Neurological Parkinsonism/disease Multiple Sclerosis Epilepsy Migraine headaches Intestinal or stomach ulcer Gastrointestinal Bowel disorder (Upper and Lower) Bowel incontinence Genitourinary Urinary incontinence Ophthalmologic Cataracts, Glaucoma, Macular Degeneration Mood disorder (depression) Psychiatric Anxiety Alzheimer's disease/dementia Renal Kidney disease Cancer* Cancer Obesity Other Risk Overweight Factors/Symptoms Back problems 6

Multimorbidity Lists Disease System 5 CLSA Chronic Conditions Diederichs 3 Fortin-20 4 Fortin-Prev1 Willadsen 5 [12 most prevalent] Diseases Risk Factor Symptom Osteoarthritis Musculoskeletal Rheumatoid arthritis Osteoporosis Respiratory Asthma COPD Heart disease (including CHF) Cardiac Angina Myocardial infarction Vascular Hypertension Peripheral vascular disease Endocrine-Metabolic Diabetes Hypo-/Hyperthyroidism Stroke or CVA Transient ischemic attack Neurological Parkinsonism/disease Multiple Sclerosis Epilepsy Migraine headaches Intestinal or stomach ulcer Gastrointestinal Bowel disorder (Upper and Lower) Bowel incontinence Genitourinary Urinary incontinence Ophthalmologic Cataracts, Glaucoma, Macular Degeneration Mood disorder (depression) Psychiatric Anxiety Alzheimer's disease/dementia Renal Kidney disease Cancer* Cancer Obesity Other Risk Overweight Factors/Symptoms Back problems 7

Multimorbidity Lists Disease System 5 CLSA Chronic Conditions Diederichs 3 Fortin-20 4 Fortin-Prev1 Willadsen 5 [12 most prevalent] Diseases Risk Factor Symptom Osteoarthritis Musculoskeletal Rheumatoid arthritis Osteoporosis Respiratory Asthma COPD Heart disease (including CHF) Cardiac Angina Myocardial infarction Vascular Hypertension Peripheral vascular disease Endocrine-Metabolic Diabetes Hypo-Hyperthyroidism Stroke or CVA Transient ischemic attack Neurological Parkinsonism/disease Multiple Sclerosis Epilepsy Migraine headaches Intestinal or stomach ulcer Gastrointestinal Bowel disorder (Upper and Lower) Bowel incontinence Genitourinary Urinary incontinence Ophthalmologic Cataracts, Glaucoma, Macular Degeneration Mood disorder (depression) Psychiatric Anxiety Alzheimer's disease/dementia Renal Kidney disease Cancer* Cancer Obesity Other Risk Overweight Factors/Symptoms Back problems 8

Results Proportion of Canadians with 2+ and 3+ CCs Using Different Disease Lists 80 70 60 50 40 30 2+ 3 + 20 10 0 Diederichs 1 Fortin 2 Fortin 3(12) 4 5 6 List List Prevalence (n=9) (n=19) (n=12) 9

Results Proportion of Canadians with 2+ and 3+ CCs Using Different Disease Lists 80 70 60 50 40 30 2+ 3 + 20 10 0 Diederichs 1 Fortin 2 Fortin 3 Diseases 4 Diseases 5 + Diseases 6 + Risk List List Prevalence Only Risk Factors Factors + Symptoms (n=9) (n=19) (n=12) (n=10) (n=14) (n=19) Willadsen 10

Results Multimorbidity Prevalence (2+ and 3+ CCs) by Age Group and Sex Diederichs any chronic conditions Diederichs any diseases 100 90 80 70 60 50 40 30 20 100 90 80 70 60 50 40 30 20 10 10 0 45-54 55-64 65-74 75-85 0 45-54 55-64 65-74 75-85 Male 2+ Women 2+ Male 3+ Women 3+ Male 2+ Dx Male 3+ Dx Women 2+ Dx Women 3+ Dx 11

Results Multimorbidity Prevalence (2+ and 3+ CCs) by Age Group and Sex Fortin-20 any chronic conditions Fortin-20 any diseases 100 100 90 80 70 60 50 40 30 20 10 0 45-54 55-64 65-74 75-85 90 80 70 60 50 40 30 20 10 0 45-54 55-64 65-74 75-85 Male 2+ Dx Women 2+ Dx Male 2+ Women 2+ Male 3+ Women 3+ Male 3+ Dx Women 3+ Dx 12

Results Multimorbidity Prevalence (2+ and 3+ CCs) by Age Group and Sex Fortin-Prev any chron conditions Fortin-Prev any diseases 100 100 90 90 80 80 70 70 60 60 50 50 40 40 30 30 20 20 10 10 0 45-54 55-64 65-74 75-85 0 45-54 55-64 65-74 75-85 Male 2+ Women 2+ Male 3+ Women 3+ Male 2+ Dx Male 3+ Dx Women 2+ Dx Women 3+ Dx 13

Results ORs for Disability for People with MM (2+ CCs) Compared to those without MM Using Different Disease Lists Disease List OR [95% CI] Diederichs List 3.73 [3.31, 4.21] Fortin List 5.03 [4.25, 5.96] Fortin (12-Prev) 4.44 [3.84, 5.13] Willadsen (DX) 3.65 [3.25, 4.11] Willadsen (Dx+RF) Willadsen (Dx+RF+Sym) 3.89 [3.33, 4.54] 5.54 [4.42, 6.94] 0 1 2 3 4 5 6 7 8 OR (95% CI) 14

Results ORs for Participation Restriction for People with MM (2+ CCs) Compared to those without MM Using Different Disease Lists Disease List OR [95% CI] Diederichs List 3.42 [2.89, 3.64] Fortin List 4.46 [3.80, 5.23] Fortin (12-Prev) 3.31 [2.88, 3.80] Willadsen (DX) 3.38 [3.01, 3.78] Willadsen (Dx+RF) Willadsen (Dx+RF+Sym) 3.33 [2.85, 3.87] 4.62 [3.71, 5.75] 0 1 2 3 4 5 6 7 8 OR (95% CI) 15

Results ORs for Self-Reported Physical Health (poor or fair vs. good-excellent) for People with MM (2+ CCs) Compared to those without MM Using Different Disease Lists Disease List OR [95% CI] Diederichs Fortin-20 Fortin- Prevalence Willadsen-D Willadsen-DR Willadsen-DRS 5.4 [5.0, 5.8] 6.5 [5.8, 7.2] 5.0 [4.6, 5.5] 5.0 [4.7, 5.4] 4.8 [4.4, 5.3] 7.6 [6.6, 8.7] 0.5 1 2 4 8 OR (95% CI) 16

Results ORs for Self-Reported Mental Health (poor or fair vs. good-excellent) for People with MM (2+ CCs) Compared to those without MM Using Different Disease Lists Disease List OR [95% CI] Diederichs Fortin-20 Fortin-Prevalence Willadsen-D Willadsen-DR Willadsen-DRS 4.0 [3.6, 4.4] 4.2 [3.7, 4.7] 4.3 [3.8, 4.8] 4.4 [4.0, 4.8] 4.0 [3.5, 4.5] 5.3 [4.5, 6.2] 0 1 2 3 4 5 6 7 8 9 OR (95% CI) 17

Results ORs for Self-Reported Healthy Aging (poor or fair vs. good-excellent) for People with MM (2+ CCs) Compared to those without MM Using Different Disease Lists Disease List OR [95% CI] Diederichs Fortin-20 Fortin-Prevalence Willadsen-D Willadsen-DR Willadsen-DRS 4.8 [4.5, 5.2] 5.3 [4.8, 5.9] 4.3 [4.0, 4.8] 4.6 [4.3, 5.0] 4.3 [3.9, 4.7] 6.0 [5.3, 6.9] 0 1 2 3 4 5 6 7 8 9 OR (95% CI) 18

Key Messages Definition of Multimorbidity and/list of included conditions drives the prevalence rate of Multimorbidity across all age and sex groups regardless of choosing the 2 or 3 cut point Some indication that the list chosen can also impact gender differences seen in Multimorbidity research Choice of Multimorbidity list impacts the magnitude of the association with disability, social participation, and self-rated health prevalence based list not necessary include most disabling conditions symptoms more likely to impact person-important outcomes than risk factors 19

Implications, Next Steps Potential clinical and public health importance Clinical trials addition of symptoms may increase the power to detect changes in patient-important outcomes Intervention targeting Additional risk factors may dilute the denominator Public health Risk factors may be included to help identify preventative, interventions on modifiable risk factors for future conditions Most research focussed on cross-sectional associations Need to look at longitudinal trajectories of person-important outcomes related to multimorbidity Examine how the accumulation of new conditions impacts outcomes 20

Acknowledgements Co-Authors: Anne Gilsing, Edwin van den Heuvel, Sohel Nazmul, Christopher Patterson, Phil St. John, Marjan van den Akker, Parminder Raina, Funding: Canadian Institutes of Health Research New Investigator, McLaughlin Foundation Professorship in Population and Public Health 21

References 1. Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H: A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Annals of Family Medicine 2012, 10: 142-151. 2. Harrison C, Britt H, Miller G, Henderson J: Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open 2014, 4: e004694. 3. Diederichs C, Berger K, Bartels DB: The measurement of multiple chronic diseases--a systematic review on existing multimorbidity indices. Journals of Gerontology Series A-Biological Sciences & Medical Sciences 2011, 66: 301-311. 4. Fortin M, Almirall J, Nicholson K: Development of a research tool to document self-reported chronic conditions in primary care. Jounal of Comorbidity 2017, 7: 117-123. 5. Willadsen TG, Bebe A, Koster-Rasmussen R, Jarbol DE, Guassora AD, Waldorff FB et al.: The role of diseases, risk factors and symptoms in the definition of multimorbidity - a systematic review. Scandinavian Journal of Primary Health Care 2016, 34: 112-121. 22

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