• Lauren E Griffith, Anne Gilsing, Dee Mangin, Christopher Patterson, Edwin van den Heuvel, Nazmul Sohel, St JohnPhilipPSection of Geriatric Medicine, Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada., Marjan van den Akker, and Parminder Raina.
• Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
• J Am Geriatr Soc. 2019 Aug 1; 67 (8): 1632-1640.

ObjectivesTo explore how different frameworks and categories of chronic conditions impact multimorbidity (defined as two or more chronic conditions) prevalence estimates and associations with patient-important functional outcomes.DesignBaseline data from a population-based cohort study.SettingNational sample of Canadians.ParticipantsA total of 51 338 community-living adults, aged 45 to 85 years.Main Outcome MeasuresChronic conditions from three commonly recognized frameworks were categorized as: (1) diseases, (2) risk factors, or (3) symptoms. Estimates of multimorbidity prevalence were compared among frameworks by age and sex. Separate weighted logistic regression models were used to explore the impact of the different frameworks and categories of chronic conditions on odds ratios (ORs) for multimorbidity for four patient-important functional outcomes: disability, social participation restriction, and self-rated physical and mental health.ResultsOne framework included diseases and risk factors, and two frameworks included diseases, risk factors, and symptoms. The prevalence of multimorbidity differed among the frameworks, ranging from 33.5% to 60.6% having two or more chronic conditions. Including risk factors in frameworks increased prevalence estimates, while including symptoms increased prevalence estimates and associations with most patient-important outcomes. The two frameworks that included symptoms had the largest ORs for associations with disability, social participation restriction, and self-rated physical health but not self-rated mental health. Similar results were found when we compared ORs for patient-important outcome for multimorbidity based on three subframeworks: one including diseases only, one including diseases and risk factors, and one including diseases, risk factors, and symptoms.ConclusionsIncluding risk factors appeared to increase only the prevalence of multimorbidity without significantly altering relationships to outcomes. The inclusion of symptoms increased prevalence and associations with patient-important outcomes. These findings underscore the importance of considering not only the number, but also the category, of conditions included in multimorbidity frameworks, as simply counting the number of diagnoses may reduce sensitivity to outcomes that are important to individuals. J Am Geriatr Soc 67:1632-1640, 2019.© 2019 The American Geriatrics Society.

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