Measuring the association between marginalization and multimorbidity in Ontario, Canada: A cross-sectional study

Moin, John S.; Moineddin, Rahim; Upshur, Ross

doi:10.1177/2235042x18814939

Cited by 41 publications

(47 citation statements)

References 19 publications

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“…This study found a linear relationship between increasing income and lower prevalence of multimorbidity after adjusting for other factors (Tables 2 and 4), which agrees with existing research [3,8,11,38]. How income affects multimorbidity is unclear, involving multiple potential pathways [2,9].…”

Section: Socioeconomic Status (Ses): Household Income and Household Esupporting

confidence: 89%

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

Basham

Karim

2019

International Journal of Circumpolar Health

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Rapid social, economic, and environmental changes in the northern territories of Canada have raised concerns about potentially increasing levels of chronic disease. This concern prompted us to compare multimorbidity prevalence in Canada between the territories and provinces. We analyzed Canadian Community Health Survey data for 2013/14. We defined multimorbidity, the outcome, as having 3 or more chronic conditions and used survey-weighted multivariable logistic regression for comparisons between territories and provinces. We found a prevalence of multimorbidity in Canada of 14.0% (95% CI: 13.6, 14.3). We could not find significant difference in multimorbidity prevalence between the territories and provinces of Canada overall; however, the territories tended to have lower prevalence estimates than provinces for multimorbidity (adj-OR = 0.88; 95% CI: 0.74-1.04). Sensitivity analyses from propensity score analyses had similar conclusions. Effect modification analyses identified lower multimorbidity in territories versus provinces among households without a post-secondary graduate (adj-OR = 0.46; 95% CI: 0.34-0.61 for northern residence), males (adj-OR = 0.71; 95% CI: 0.54-0.93), and ages 12-29 years (adj-OR = 0.63; 95% CI: 0.39-0.99). Caution is needed in interpreting the results in light of representativeness of CCHS in northern populations of Canada.

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Section: Socioeconomic Status (Ses): Household Income and Household Esupporting

confidence: 89%

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

Basham

Karim

2019

International Journal of Circumpolar Health

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“…Area-level socioeconomic deprivation (n=17): Studies that investigated how the socioeconomic situation of participants’ residential area was associated with multimorbidity prevalence or incidence showed fairly consistent findings. 4 22 34 35 39 42 44 46 49–51 54 55 57 63 64 67 In general, multimorbidity was higher for participants residing in areas of greater deprivation than those living in more affluent areas. Odds of multimorbidity prevalence were 42% higher for participants residing in the most vs the least deprived areas when available data were pooled (OR 1.42, 95% CI 1.41 to 1.42; figure 2).…”

Section: Resultsmentioning

confidence: 99%

“…Across the 41 studies, the number of conditions included on the pre-specified list ranged from five conditions to 146 diagnostic clusters defined using O’Halloran’s criteria for chronicity. 33 Thirty-six of 41 studies included a mix of chronic physical and mental health conditions, 4 22 34–67 while four included physical conditions only. 68–71 One study was unclear about the conditions included.…”

Section: Resultsmentioning

confidence: 99%

“…Older adult populations and older adult sub-group analyses (n=21): Nine studies included samples of adults solely aged 50 and over. 37 38 45–47 50 60 70 71 Five of these examined associations between household composition and multimorbidity (results described above). 37 45 47 60 70 There were no differences in results for studies with older adults only compared with studies that included younger adults.…”

Section: Resultsmentioning

confidence: 99%

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Household and area-level social determinants of multimorbidity: a systematic review

Ingram

Ledden

Beardon

et al. 2020

J Epidemiol Community Health

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BackgroundNo clear synthesis of evidence examining household and area-level social determinants of multimorbidity exists. This study aimed to systematically review the existing literature on associations between household and area-level social determinants of health (SDoH) and multimorbidity prevalence or incidence in the general population.MethodsSix databases (MedLine, EMBASE, PsychINFO, Web of Science, CINAHL Plus and Scopus) were searched. The search was limited to peer-reviewed studies conducted in high-income countries and published in English between 2010 and 2019. A second reviewer screened all titles with abstracts and a subset of full texts. Study quality was assessed and protocol pre-registered (CRD42019135281).Results41 studies spanning North America, Europe and Australasia were included. Household income and area-level deprivation were the most explored with fairly consistent findings. The odds of multimorbidity were up to 4.4 times higher for participants with the lowest level of income compared with the highest level. Those living in the most deprived areas had the highest prevalence or incidence of multimorbidity (pooled OR 1.42, 95% CI 1.41 to 1.42). Associations between deprivation and multimorbidity differed by age and multimorbidity type. Findings from the few studies investigating household tenure, household composition and area-level rurality were mixed and contradictory; homeownership and rurality were associated with increased and decreased multimorbidity, while living alone was found to be associated with a higher risk of multimorbidity and not associated.ConclusionImproving our understanding of broader social determinants of multimorbidity—particularly at the household level—could help inform strategies to tackle multimorbidity.

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“…Residential instability re ects home security, ownership and occupancy and is comprised of indicators of living alone, proportion of adults, number of people per dwelling, proportion who are single/divorced/widowed, and the proportion who have moved in the past 5 years. Marginalization and co-morbidity have previously been associated using ICES data [25].…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic, health and fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures in Ontario.

Jc¹,

McClure²,

Richard³

et al. 2020

Preprint

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Background The purpose of this study was to describe 1st incident fractures of the upper extremity in terms of fracture characteristics, demographics, social deprivation and comorbid health profiles. Methods:Cases with a 1st adult upper extremity fracture from the years 2013 to 2017 were extracted from administrative data in Ontario, (population 14.3M). Fracture locations (ICD-10 codes) and associated characteristics (open/closed, associated hospitalization within 1-day, associated nerve or tendon injury) were described by fracture type, age category and sex. Fracture comorbidity characteristics were described in terms of the prevalence of diabetes, rheumatoid arthritis; and the Charlson Comorbidity Index. Social marginalization was expressed using the Ontario Marginalization Index (ON-Marg) for material deprivation, dependency, residential instability, ethnic concentration. ResultsFrom 266,324 first incident UE fractures occurring over 4 years, 51.5% were in women and 48.5% were in men. This masked large differences in age-sex profiles. Most commonly affected were the hand (93K), wrist/forearm(80K), shoulder (48K) or elbow (35K). The highest number of fractures: distal radius (DRF, 47.4K), metacarpal (30.4K), phalangeal (29.9K), distal phalangeal (24.4K), proximal humerus (PHF, 21.7K), clavicle (15.1K), radial head (13.9K), and scaphoid fractures (13.2K). The most prevalent multiple fractures included: multiple radius and ulna fractures (11.8K), fractures occurring in multiple regions of the upper extremity (8.7K), or multiple regions in the forearm (8.4K). Fractures most common in 18 – 40-year-old men included metacarpal and finger fractures. A large increase in fractures in women over the age of 50 occurred for: DRF, PHF and radial head. Tendon (0.6% overall; 8.2% in multiple finger fractures) or nerve injuries (0.3% overall, 1.5% in distal humerus) were rarely reported. Fractures were open in 4.7%, highest for distal phalanx (23%). Diabetes occurred in 15.3%, highest in PHF (29.7%). Rheumatoid arthritis occurred more commonly in women (2.8% vs 0.8% men). The Charlson Index indicated low comorbidity (mean=0.2; median=0: 2.4% 3+), highest in PHF (median=0; 6.6% 3+). Higher fracture burden was related to instability (excess of fractures in lower 2 quartiles 4.8%), although social indices varied by fracture type. ConclusionsFracture specific prevention strategies should consider fracture-specific age-sex interactions, health, behavioural and social risks

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Measuring the association between marginalization and multimorbidity in Ontario, Canada: A cross-sectional study

Cited by 41 publications

References 19 publications

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

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

Household and area-level social determinants of multimorbidity: a systematic review

Sociodemographic, health and fracture profiles of a 4-year cohort of 266,324 first incident upper extremity fractures in Ontario.

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