Table 3. Association between level of multimorbidity (number of diagnosed chronic conditions) and 1-y risk of acute hospitalization and emergency department visit among long-stay home care clients with dementia in Ontario in 2012.
| Outcome: hospitalization | Outcome: ED visit | |||||||
|---|---|---|---|---|---|---|---|---|
| Age- and sex-adjusted model | Multivariable model | Age- and sex-adjusted model | Multivariable model | |||||
| sHR (95% CI) | p-Value | sHR (95% CI) | p-Value | sHR (95% CI) | p-Value | sHR (95% CI) | p-Value | |
| Level of multimorbidity | ||||||||
| 0–1 CCs | 1.00 [Ref] | 1.00 [Ref] | 1.00 [Ref] | 1.00 [Ref] | ||||
| 2 CCs | 1.20 (1.09–1.33) | <0.001 | 1.17 (1.06–1.29) | 0.003 | 1.17 (1.07–1.27) | 0.001 | 1.15 (1.05–1.26) | 0.002 |
| 3 CCs | 1.37 (1.25–1.51) | <0.001 | 1.30 (1.18–1.43) | <0.001 | 1.34 (1.24–1.46) | <0.001 | 1.29 (1.18–1.40) | <0.001 |
| 4 CCs | 1.60 (1.46–1.75) | <0.001 | 1.48 (1.34–1.63) | <0.001 | 1.50 (1.39–1.63) | <0.001 | 1.43 (1.31–1.56) | <0.001 |
| 5+ CCs | 2.18 (2.00–2.37) | <0.001 | 1.88 (1.72–2.05) | <0.001 | 1.76 (1.63–1.90) | <0.001 | 1.63 (1.51–1.77) | <0.001 |
| Sex | ||||||||
| Women | 1.00 [Ref] | 1.00 [Ref] | 1.00 [Ref] | 1.00 [Ref] | ||||
| Men | 1.21 (1.16–1.27) | <0.001 | 1.18 (1.13–1.24) | <0.001 | 0.98 (0.95–1.03) | 0.452 | 0.94 (0.90–0.99) | 0.011 |
| Age (continuous) | 1.00 (1.00–1.01) | 0.003 | 1.01 (1.00–1.01) | <0.001 | 0.99 (0.00–1.00) | <0.001 | 1.00 (1.00–1.00) | 0.453 |
| Income quintile | ||||||||
| 1 (low) | 1.02 (0.96–1.09) | 0.466 | 1.07 (1.00–1.14) | 0.035 | ||||
| 2 | 1.01 (0.94–1.08) | 0.797 | 1.13 (1.06–1.20) | <0.001 | ||||
| 3 | 0.95 (0.89–1.02) | 0.128 | 1.05 (0.98–1.12) | 0.138 | ||||
| 4 | 0.91 (0.85–0.98) | 0.008 | 1.04 (0.97–1.11) | 0.246 | ||||
| 5 (high) | 1.00 [Ref] | 1.00 [Ref] | ||||||
| Marital status | ||||||||
| Married | 1.00 [Ref] | 1.00 [Ref] | ||||||
| Widowed | 0.98 (0.93–1.03) | 0.327 | 0.95 (0.90–0.99) | 0.021 | ||||
| Separated/divorced | 0.98 (0.90–1.08) | 0.754 | 0.93 (0.86–1.02) | 0.121 | ||||
| Never married/other | 0.86 (0.77–0.97) | 0.010 | 0.87 (0.78–0.96) | 0.005 | ||||
| Residence | ||||||||
| Urban | 1.00 [Ref] | 1.00 [Ref] | ||||||
| Rural | 1.03 (0.96–1.10) | 0.424 | 1.18 (1.12–1.25) | <0.001 | ||||
| Continuity of care | ||||||||
| Low (<median) | 1.02 (0.97–1.06) | 0.418 | 1.03 (0.99–1.07) | 0.159 | ||||
| High (≥median) | 1.00 [Ref] | 1.00 [Ref] | ||||||
| Prior hospitalizations | ||||||||
| None | 1.00 [Ref] | 1.00 [Ref] | ||||||
| 1 | 1.14 (1.09–1.20) | <0.001 | 0.94 (0.89–0.98) | 0.010 | ||||
| ≥2 | 1.40 (1.31–1.49) | <0.001 | 1.04 (0.98–1.11) | 0.203 | ||||
| Prior ED visits | ||||||||
| None | 1.00 [Ref] | 1.00 [Ref] | ||||||
| 1 | 1.22 (1.16–1.29) | <0.001 | 1.36 (1.30–1.43) | <0.001 | ||||
| ≥2 | 1.39 (1.32–1.47) | <0.001 | 1.94 (1.85–2.04) | <0.001 | ||||
| MDS-HSI (continuous) | 1.25 (1.12–1.39) | <0.001 | 2.36 (2.13–2.62) | <0.001 | ||||
| CHESS scale | ||||||||
| No instability | 1.00 [Ref] | 1.00 [Ref] | ||||||
| Minimal instability | 1.08 (1.02–1.14) | 0.012 | 1.01 (0.96–1.06) | 0.709 | ||||
| Low instability | 0.98 (0.93–1.05) | 0.595 | 0.93 (0.88–0.98) | 0.011 | ||||
| Moderate instability | 1.09 (1.01–1.18) | 0.029 | 0.89 (0.83–0.96) | 0.003 | ||||
| High to very high instability | 1.05 (0.93–1.18) | 0.442 | 0.82 (0.73–0.92) | 0.001 | ||||
CHESS values to range from 0 (no health instability) to 4 (high to very high instability), with higher values indicative of adverse outcomes.
CC, chronic condition; CHESS, Changes in Health, End-stage disease and Symptoms and Signs; ED, emergency department; MDS-HSI, Minimum Data Set Health Status Index; sHR, sub-hazard ratio.