The proportion of Ontarians who died with two or more chronic conditions increased from 79.6 per cent in 1994 to 95.3 per cent in 2013, according to a new study from the Dalla Lana School of Public Health and the Institute for Clinical Evaluative Sciences.
The study, published March 5 in the journal Health Affairs, examined more than 1.6 million deaths that were registered in Ontario from 1994 to 2013, and linked each to health administrative data from Ontario’s single-payer health-care system.
“By looking back in the linked data, we identified 18 chronic conditions that individuals accumulated up to the time of their death and examined how these trends differed over time and by socioeconomic status,” says Laura Rosella, assistant professor of epidemiology at the Dalla Lana School of Public Health.
The 18 chronic conditions the researchers identified were acute myocardial infarction, asthma, cancer, cardiac arrhythmia, chronic coronary syndrome, chronic obstructive pulmonary disorder, congestive heart failure, Crohn’s disease or colitis, dementia, diabetes, hypertension, mood disorder, osteo- and other arthritis, osteoporosis, other mental health disorder, renal failure, rheumatoid arthritis and stroke.
The study showed that almost all Ontarians accumulate multiple chronic conditions over their lifetime. The total number of chronic conditions that Ontarians died with increased over time. In 1994, about one-quarter (24.6 per cent) of Ontarians died with five or more chronic conditions – this increased to two-thirds of all Ontario deaths (65.7 per cent) in 2013.
The researchers found that the types of chronic conditions that Ontarians accumulated varied by socioeconomic groups. Individuals who lived in materially deprived neighbourhoods were more likely to die with chronic obstructive pulmonary disease (COPD), mental health disorders and diabetes, while cancer and dementia at time of death were more common among individuals who lived in high income neighbourhoods.
“The observed trends underscore the importance of integrated health-care planning and delivery that can meet the health-care needs of Ontarians with multiple and complex chronic conditions, as well as the need for chronic disease prevention and socioeconomic interventions that can address the inequities in the types of conditions Ontarians accumulate,” added Rosella, who is also adjunct scientist and site director at U of T's Institute for Clinical Evaluative Sciences.
But there were some health gains across the board, including the decline in the presence of chronic coronary syndrome, congestive heart failure and stroke at time of death, which decreased by almost two per cent each from 2004 to 2013.
The study was funded by the Canadian Institutes for Health Research.