Estimating multimorbidity prevalence with the Canadian Chronic Disease Surveillance System

Abstract

Introduction The Public Health Agency of Canada’s Canadian Chronic Disease Surveillance System (CCDSS) uses a validated, standardized methodology to estimate prevalence of individual chronic diseases, such as diabetes. Expansion of the CCDSS for surveillance of multimorbidity, the co-occurrence of two or more chronic diseases, could better inform health promotion and disease prevention. The objective of this study was to assess the feasibility of using the CCDSS to estimate multimorbidity prevalence. Methods We used administrative health data from seven provinces and three territories and five validated chronic conditions (i.e. cardiovascular disease, respiratory disease, mental illness, hypertension and diabetes) to estimate multimorbidity prevalence. We produced age-standardized (using Canada’s 1991 population) and age-specific estimates for two multimorbidity definitions: (1) two or more conditions, and (2) three or more conditions from the five validated conditions, by sex, fiscal year and geography. Results Among Canadians aged 40 years and over in the fiscal year 2011/12, the prevalence of two or more and three or more chronic conditions was 26.5% and 10.2%, respectively, which is comparable to other estimates based on administrative health data. The increase in multimorbidity prevalence with increasing age was similar across provinces. The difference in prevalence for males and females varied by province and territory. We observed substantial variation in estimates over time. Results were consistent for the two definitions of multimorbidity. Conclusion The CCDSS methodology can produce comparative estimates of multimorbidity prevalence across provinces and territories, but there are challenges in using it to estimate temporal trends. Further expansion of the CCDSS in the number and breadth of validated case definitions will improve the accuracy of multimorbidity surveillance for the Canadian population.

Multimorbidity prevalence in Canada: a comparison of Northern Territories with Provinces, 2013/14

“…Previous analyses showing lower but increasing chronic disease prevalence in northern Canada were not adjusted for known risk factors beyond age and sex [18,21,24]. Our results contradict predictions of rising chronic disease among northern populations made in previous studies; however, we did not use a longitudinal design so could not test for trend.…”

“…Feely et al used the Canadian Chronic Disease Surveillance System (populated by administrative hospital discharge and physician claims data) to analyze multimorbidity across Canadian provinces and territories. They found slightly higher age-standardized rates of three or more chronic conditions in the Yukon and Nunavut compared to Canada overall with higher than average increases in all three territories between 2001/02 and 2011/12 [24]. However, their estimates are were also not adjusted for risk factors such as smoking, diet, physical activity, or socioeconomic status [24].…”

“…Estimates of the burden of multimorbidity and the factors associated with this burden can help inform needed primary care reform in northern Canada [23]. Two studies to date have included comparisons of multimorbidity between Canadian provinces and territories [18,24]. Deering et al found a higher prevalence of risk factors for chronic disease in northern compared to southern Canada, although at the time of their study (years 2000/01 and 2005) the higher prevalence of risk factors may not have translated to higher prevalence of chronic disease in northern Canada [18].…”

Effectiveness of interventions for managing multiple high-burden chronic diseases in older adults: a systematic review and meta-analysis

“…protocol registration: PROSPERO-CRD42014014489 needs, are at higher risk for adverse health outcomes and are admitted to hospital more frequently, 10 yet only 55% receive appropriate care. 7,8 In response, different interventions for managing chronic disease have been created (i.e., those that facilitate ongoing, proactive and preventive support for optimal management of disease). These strategies have potential to improve care for older adults, 11,12 but are not usually developed for older adults nor sustainable, and focus only on a single disease.…”

Global Burden of Disease Study trends for Canada from 1990 to 2016

“…The GBD Study does not model subnational (provincial/ territorial or regional) or other important subpopulation (e.g., Indigenous people, people living with low income) estimates for Canada, which may be important, given that previous research has identified variability in disease estimates across Canada. 24,25 These limitations may be addressed in future iterations of the GBD Study. The 2016 estimates provided here do not incorporate the most current vital statistics because of the time lag in releasing data, which means that our results may not reflect any recent and important changes such as the opioid epidemic.…”