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Chronic Conditions, Co-Morbidity, and Healthcare Utilization


8 July 2014

Chronic health conditions affect nearly one half of Canadians aged thirty-five and over, and the proportion of Canadians diagnosed with such conditions is only expected to grow in the coming years. In the past decade, the prevalence of several common chronic health conditions has been increasing steadily, and this trend is expected to continue as the population ages.

In order to better understand the impact of chronic conditions on both Canadians and the Canadian healthcare system, we’ve examined data from the Canadian Community Health Survey between the years 2000 and 2012, and have focused specifically on those living with one of seven common or high-impact chronic conditions – arthritis, cancer, chronic obstructive pulmonary disease (COPD), diabetes, heart disease, high blood pressure, and mood disorders.1 We highlight changes in prevalence over time, co-morbidity among these conditions, and healthcare utilization by those diagnosed with these conditions.

Prevalence of Chronic Conditions

In 2011-12, 48.7% of CCHS respondents reported having been diagnosed with at least one of seven select chronic conditions – an increase of 5.3% above the 46.1% that reported having a chronic condition only one decade earlier in 2002-03. Over this same period, prevalence of arthritis, COPD and heart disease decreased slightly, while the proportion of those living with cancer, diabetes, high blood pressure and mood disorders has increased. Particularly noteworthy is the magnitude by which prevalence of these conditions has grown: between 2002-03 and 2011-12, diabetes prevalence increased by 26.5% (from 6.9% to 9.3%), cancer increased by 24.7% (from 2.5% to 3.3%), mood disorders increased by 24.6% (from 5.9% to 7.8%), and high blood pressure increased by 16.4% (from 21.6% to 25.8%).

Unsurprisingly, the prevalence of chronic conditions increases alongside age, greatly impacting older Canadians. Among those aged 35 to 44, only 22.2% report having at least one chronic conditions, compared to 42.7% among those aged 45 to 59, 69.9% among those aged 60 to 74, and 82.1% among those aged 75 and over. With the exception of mood disorders, the prevalence of each of the seven conditions examined increase with age, but the prevalence of high blood pressure and arthritis are particularly high among older Canadians, with 52.2% of those aged 75 and over reporting having high blood pressure and 47.9% reporting having been diagnosed with arthritis.

Prevalence of Co-Morbidity

As the proportion of Canadians affected by chronic conditions has risen, so too has the prevalence of co-morbidity – the presence of multiple diagnosed conditions. Among those with at least one chronic condition, the proportion reporting one or more additional diagnoses increased from 40.5% in 2002-03 to 44.0% in 2011-12, reflecting an increase of 8.6%, while the proportion of Canadians experiencing three or more conditions grew by 12.5% (from 13.6% to 15.3%).

Given the high prevalence of both conditions, it is not surprising that arthritis and high blood pressure are the two conditions most likely to be experienced in combination with other conditions. Specifically, 48.5% of those diagnosed with COPD and 42.9% with heart disease also experience arthritis, while 59.2% of those with diabetes and 56.5% of those with heart disease have also been diagnosed with high blood pressure.

COPD and heart disease are the two conditions most commonly co-occurring with cancer. Although only 3.3% of all those aged 35 and over have been diagnosed with some form of cancer, 7.8% of those with heart disease and 6.1% of those with COPD are living with the disease.

Those with diabetes are more than twice as likely as others to experience heart disease and high blood pressure, as 18.0% of those with diabetes also have heart disease, and 59.2% of individuals with diabetes also have high blood pressure, compared to only 7.2% and 25.8%, respectively, among the total population aged 35 and over.

Co-Morbidity of seven select chronic conditions (2011-12)
Also Has ArthritisAlso Has CancerAlso Has COPDAlso Has DiabetesAlso Has Heart DiseaseAlso Has High BPAlso Has Mood Disorder
Has Arthritis- - -5.40%8.80%15.20%13.50%41.80%12.70%
Has Cancer37.30%- - -7.70%14.40%16.90%39.40%9.90%
Has COPD48.50%6.10%- - -17.30%19.90%41.10%18.10%
Has Diabetes37.20%5.10%7.70%- - -18.00%59.20%11.40%
Has Heart Disease42.90%7.80%11.50%23.30%- - -56.50%10.20%
Has High BP36.90%5.00%6.60%21.30%15.70%- - -9.00%
Has Mood Disorder37.10%4.20%9.60%13.60%9.30%29.70%- - -

As with chronic conditions generally, the prevalence of co-morbidity increases with age. While only 20.4% of those aged 35 to 44 have been diagnosed with more than one chronic condition, the same is true of 34.4% of those aged 45 to 59, 51.2% of those aged 60 to 74, and 62.7% of those 75 and over.

Healthcare Utilization

Those living with chronic conditions are more likely than others to have a regular medical doctor. Among those with chronic conditions 94.2% report having a regular medical doctor, while the same is true of only 84.5% of those without a chronic condition. Also, across all age groups, those with chronic conditions are more likely than those without to report having a regular doctor. While the likelihood of having a doctor increases with age, even among those aged 30 to 44, only 10.9% of those with chronic conditions do not have a regular doctor, compared to 18.9% of those in this same age group and without a chronic condition.

Further, among those with a chronic condition and without a regular doctor, 84.1% report having a usual place where they seek medical care – leaving less than one percent of those living with chronic conditions in Canada without either a regular doctor or a usual place to seek care. For the majority (52.8%) of those with a chronic condition and without a doctor, care is usually sought at walk-in clinics, followed by emergency rooms (15.5%) and community health centres (10.4%).

In addition to being more likely to have a regular doctor, people diagnosed with chronic conditions also consult with doctors twice as often as those without, were more than twice as likely to have been hospitalized, and spent twice as long in the hospital as patients without a chronic condition. Among those with at least one chronic condition, the mean number of doctor consultations – including both family physicians and specialists – reported in the previous twelve-month period was 5.2, compared to 2.6 among those without a chronic condition. The proportion of those diagnosed with a chronic condition to have spent at least one night in the hospital in the past year was 12.0%, compared to 4.6% among those without a condition. And, the average duration of a hospital stay among those with a chronic condition was 7.5 nights, compared to 3.8 nights among those without a condition.

The past decade has seen steady increases in the prevalence of several chronic health conditions, and as the population ages, it is expected that the number of Canadians affected by these conditions will continue to rise. However, the negative consequences of the rising prevalence of chronic conditions will not only manifest in the detrimental impact these conditions have on the well-being of those affected, but as a growing economic burden on the Canadian healthcare system. As our findings demonstrate, people with chronic conditions make more frequent use of the healthcare system, which speaks both to the impact of these conditions on the health of those affected, and to the burden such conditions place on the healthcare system. While not all chronic conditions are preventable, many high-prevalence diseases such as diabetes, heart disease, COPD, and some cancers, are known to have common risk factors and, in many cases, can be avoided through clinical, behavioral, and social interventions.

1 Broemeling, Anne-Marie, Diane Watson and Farrah Prebatani. 2008. “Population Patterns of Chronic Health Conditions, Co-morbidity and Healthcare Use in Canada: Implications for Policy and Practice.” Healthcare Quarterly 11(3): 70-76.

Unless otherwise noted, all data contained herein is drawn from the Canadian Community Health Survey (CCHS) 2000/01-2011/12. The CCHS is a joint effort of Health Canada, the Public Health Agency of Canada, Statistics Canada, and the Canadian Institute for Health Information (CIHI).