Abstract
BackgroundIt is unknown if the relationship between multimorbidity and disability differs by combinations of chronic conditions. The objective of our study was to elucidate how joint effect of different combinations of chronic conditions impact the five year risk of functional disability at the population level.MethodsParticipants ≥65 years from the Canadian Study of Health and Aging were assessed for functional disability measured using activities of daily living (ADL) and instrumental ADL (IADL), and the presence of conditions in five disease domains; cardiometabolic, neurological, sensory, musculoskeletal, and respiratory. Logistic regression was used to assess the relationship between each disease domain and incident ADL and IADL measured at five years of follow up and population attributable risk (PAR) was modeled for diseases domains that were significantly associated with disability. Results were stratified by sex and age (65–74 years, ≥75 years).ResultsThere were 6272 participants free of ADL disability and 4571 participants free from IADL disability at baseline. For incident ADL, the greatest PAR values were 21.3 (9.8–32.8) for the cardiometabolic domain in males 65–74 years, 22.7 (4.7–40.8) for the musculoskeletal domain for females aged 65–74 years, and 11.2 (2.8–19.7) for the musculoskeletal domain in males ≥75 years. The PAR for the musculoskeletal, sensory, and neurological domains were similar in females ≥75 years(9.3–9.9). PAR values were lower but followed similar patterns for IADL disability.ConclusionThe chronic disease domains which most strongly predicted incident ADLs and IADLs did not account for the greatest amount of disability at the population level.
Highlights
Increasing life expectancy and declining fertility rates have led to an ageing population worldwide [1]
Logistic regression was used to assess the relationship between each disease domain and incident activities of daily living (ADL) and instrumental ADL (IADL) measured at five years of follow up and population attributable risk (PAR) was modeled for diseases domains that were significantly associated with disability
In the ADL sample, 85 5% of participants had at least one chronic disease domain compared to 82 2% of participants in the IADL sample (Table 1)
Summary
Increasing life expectancy and declining fertility rates have led to an ageing population worldwide [1]. There is evidence that certain combinations of chronic conditions may increase the risk of disability beyond what would be expected based on the individual effect of each condition on disability alone [7,8,9] Many of these studies failed to find differences between specific combinations of conditions, in part due to the small number of participants with each combination of chronic disease conditions. These studies relied on regression modeling which provides information about the association between chronic conditions and health on an individual level, but did not provide insight about the relationship in the population It is unknown what impact the joint effect of different chronic disease conditions have on disability at the population level. The objective of our study was to elucidate how joint effect of different combinations of chronic conditions impact the five year risk of functional disability at the population level.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
