• Mitch Steffler, Yin Li, Sharada Weir, Shaun Shaikh, Farshad Murtada, James G Wright, and Jasmin Kantarevic.
• Economics, Policy & Research Department (Steffler, Li, Weir, Shaikh, Murtada, Wright, Kantarevic), Ontario Medical Association; Canadian Centre for Health Economics (Steffler, Weir, Kantarevic), University of Toronto, Toronto, Ont.; University of Western Ontario (Murtada), London, Ont.; Departments of Surgery and Public Health Sciences (Wright), and Institute of Health Policy, Management and Evaluation (Wright, Kantarevic), and Deparment of Economics (Kantarevic), University of Toronto, Toronto, Ont.; Institute of Labour Economics (Kantarevic), Deutsche Post Foundation, Bonn, Germany mitch.steffler@oma.org.
• CMAJ. 2021 Feb 22; 193 (8): E270-E277.

BackgroundNew case-mix tools from the Canadian Institute for Health Information offer a novel way of exploring the prevalence of chronic disease and multimorbidity using diagnostic data. We took a comprehensive approach to determine whether the prevalence of chronic disease and multimorbidity has been rising in Ontario, Canada.MethodsIn this observational study, we applied case-mix methodology to a population-based cohort. We used 10 years of patient-level data (fiscal years 2008/09 to 2017/18) from multiple care settings to compute the rolling 5-year prevalence of 85 chronic diseases and multimorbidity (i.e., the co-occurrence of 2 or more diagnoses). Diseases were further classified based on type and severity. We report both crude and age- and sex-standardized trends.ResultsThe number of patients with chronic disease increased by 11.0% over the 10-year study period to 9.8 million in 2017/18, and the number with multimorbidity increased 12.2% to 6.5 million. Overall increases from 2008/09 to 2017/18 in the crude prevalence of chronic conditions and multimorbidity were driven by population aging. After adjustments for age and sex, the prevalence of patients with ≥ 1 chronic conditions decreased from 70.2% to 69.1%, and the prevalence of multimorbidity decreased from 47.1% to 45.6%. This downward trend was concentrated in minor and moderate diseases, whereas the prevalence of many major chronic diseases rose, along with instances of extreme multimorbidity (≥ 8 conditions). Age- and sex-standardized resource intensity weights, which reflect relative expected costs associated with patient diagnostic profiles, increased 4.6%.InterpretationEvidence of an upward trend in the prevalence of chronic disease was mixed. However, the change in case mix toward more serious conditions, along with increasing patient resource intensity weights overall, may portend a future need for population health management and increased health system spending above that predicted by population aging.© 2021 Joule Inc. or its licensors.

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