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Kone AP, Martin L, Scharf D, Gabriel H, Dean T, Costa I, Saskin R, Palma L, Wodchis WP. The impact of multimorbidity on severe COVID-19 outcomes in community and congregate settings. Dialogues Health 2023; 2:100128. [PMID: 37006909 PMCID: PMC10043958 DOI: 10.1016/j.dialog.2023.100128] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/11/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023]
Abstract
Purpose This study examined the impact of multimorbidity on severe COVID-19 outcomes in community and long-term care (LTC) settings, alone and in interaction with age and sex. Methods We conducted a retrospective cohort study of all Ontarians who tested positive for COVID-19 between January-2020 and May-2021 with follow-up until June 2021. We used cox regression to evaluate the adjusted impact of multimorbidity, individual characteristics, and interactions on time to hospitalization and death (any cause). Results 24.5% of the cohort had 2 or more pre-existing conditions. Multimorbidity was associated with 28% to 170% shorter time to hospitalization and death, respectively. However, predictors of hospitalization and death differed for people living in community and LTC. In community, increasing multimorbidity and age predicted shortened time to hospitalization and death. In LTC, we found none of the predictors examined were associated with time to hospitalization, except for increasing age that predicted reduced time to death up to 40.6 times. Sex was a predictor across all settings and outcomes: among male the risk of hospitalization or death was higher shortly after infection (e.g. HR for males at 14 days = 30.3) while among female risk was higher for both outcome in the longer term (e.g. HR for males at 150 days = 0.16). Age and sex modified the impact of multimorbidity in the community. Conclusion Community-focused public health measures should be targeted and consider sociodemographic and clinical characteristics such as multimorbidity. In LTC settings, further research is needed to identify factors that may contribute to improved outcomes.
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Affiliation(s)
- Anna Pefoyo Kone
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
- Health System Performance Network (HSPN), Toronto, ON, Canada
- Centre for Education and Research on Aging and Health (CERAH), Thunder Bay, Canada
- Centre for Rural and Northern Health Research (CraNHR), Thunder Bay, Canada
- ICES, Toronto, ON, Canada
| | - Lynn Martin
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
- Centre for Education and Research on Aging and Health (CERAH), Thunder Bay, Canada
| | - Deborah Scharf
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
- Department of Psychology, Lakehead University, Thunder Bay, Canada
| | - Helen Gabriel
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
| | - Tamara Dean
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Behavioural Research and Northern Community Health Evaluative Services (Branches) Lab, Lakehead University, Canada
| | - Idevania Costa
- Department of Health Sciences, Lakehead University, Thunder Bay, Canada
- Centre for Education and Research on Aging and Health (CERAH), Thunder Bay, Canada
- Centre for Rural and Northern Health Research (CraNHR), Thunder Bay, Canada
- School of Nursing, Lakehead University, Thunder Bay, Canada
| | | | | | - Walter P. Wodchis
- Health System Performance Network (HSPN), Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Department of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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Wilson J, Rinner C, Kone AP, Bosveld E. Vaccine hesitancy was not shown to be associated with traffic safety or driver behavior. Front Public Health 2023; 11:1204205. [PMID: 37869201 PMCID: PMC10585163 DOI: 10.3389/fpubh.2023.1204205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/20/2023] [Indexed: 10/24/2023] Open
Affiliation(s)
- Jeff Wilson
- Novometrix Research Inc., Moffat, ON, Canada
| | - Claus Rinner
- Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, ON, Canada
| | - Anna Pefoyo Kone
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Edward Bosveld
- Department of Politics and International Studies, Redeemer University, Hamilton, ON, Canada
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Alarilla A, Stafford M, Mondor L, Hughes J, Knight H, Kone AP, Woodchis W. Socioeconomic gradient in mortality of working age and older adults with multiple long-term conditions in England and Ontario, Canada. Int J Popul Data Sci 2022. [PMCID: PMC9644857 DOI: 10.23889/ijpds.v7i3.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kone AP, Mondor L, Maxwell C, Kabir US, Rosella LC, Wodchis WP. Correction to: Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians. Can J Public Health 2021; 112:786. [PMID: 33954925 DOI: 10.17269/s41997-021-00533-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Anna Pefoyo Kone
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Health System Performance Network (HSPN), Toronto, ON, Canada.
| | - Luke Mondor
- Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Colleen Maxwell
- Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.,School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Umme Saika Kabir
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Walter P Wodchis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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Kone AP, Mondor L, Maxwell C, Kabir US, Rosella LC, Wodchis WP. Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians. Can J Public Health 2021; 112:737-747. [PMID: 33847995 PMCID: PMC8043089 DOI: 10.17269/s41997-021-00474-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to provide population-level data regarding trends in multimorbidity over 13 years. METHODS We linked provincial health administrative data in Ontario, Canada, to create 3 cross-sectional panels of residents of any age in 2003, 2009, and 2016 to describe: (i) 13-year trends in multimorbidity prevalence and constellations among residents and across age, sex, and income; and (ii) chronic condition clusters. Multimorbidity was defined as having at least any 2 of 18 selected conditions, and further grouped into levels of 2, 3, 4, or 5 or more conditions. Age-sex standardized multimorbidity prevalence was estimated using the 2009 population as the standard. Clustering was defined using the observed combinations of conditions within levels of multimorbidity. RESULTS Standardized prevalence of multimorbidity increased over time (26.5%, 28.8%, and 30.0% across sequential panels), across sex, age, and area-based income. Females, older adults and those living in lower income areas exhibited higher rates in all years. However, multimorbidity increased relatively more among males, younger adults, and those with 4 or 5 or more conditions. We observed numerous and increasing diversity in disease clusters, namely at higher levels of multimorbidity. CONCLUSION Our study provides relevant and needed population-based information on the growing burden of multimorbidity, and related socio-demographic risk factors. Multimorbidity is markedly increasing among younger age cohorts. Also, there is an increasing complexity and lack of common clustering patterns at higher multimorbidity levels.
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Affiliation(s)
- Anna Pefoyo Kone
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Health System Performance Network (HSPN), Toronto, ON, Canada.
| | - Luke Mondor
- Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Colleen Maxwell
- Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.,School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Umme Saika Kabir
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Walter P Wodchis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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