Calypse Agborsangaya

Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey

BackgroundStudies on the prevalence of multimorbidity, defined as having two or more chronic conditions, have predominantly focused on the elderly. We estimated the prevalence and specific patterns of multimorbidity across different adult age groups. Furthermore, we examined the associations of multimorbidity with socio-demographic factors.MethodsUsing data from the Health Quality Council of Alberta (HQCA) 2010 Patient Experience Survey, the prevalence of self reported multimorbidity was assessed by telephone interview among a sample of 5010 adults (18 years and over) from the general population. Logistic regression analyses were performed to determine the association between a range of socio-demographic factors and multimorbidity.ResultsThe overall age- and sex-standardized prevalence of multimorbidity was 19.0% in the surveyed general population. Of those with multimorbidity, 70.2% were aged less than 65 years. The most common pairing of chronic conditions was chronic pain and arthritis. Age, sex, income and family structure were independently associated with multimorbidity.ConclusionsMultimorbidity is a common occurrence in the general adult population, and is not limited to the elderly. Future prevention programs and practice guidelines should take into account the common patterns of multimorbidity.

Weight loss required by the severely obese to achieve clinically important differences in health-related quality of life: two-year prospective cohort study

BackgroundGuidelines and experts describe 5% to 10% reductions in body weight as `clinically important’; however, it is not clear if 5% to 10% weight reductions correspond to clinically important improvements in health-related quality of life (HRQL). Our objective was to calculate the amount of weight loss required to attain established minimal clinically important differences (MCIDs) in HRQL, measured using three validated instruments.MethodsData from the Alberta Population-based Prospective Evaluation of Quality of Life Outcomes and Economic Impact of Bariatric Surgery (APPLES) study, a population-based, prospective Canadian cohort including 150 wait-listed, 200 medically managed and 150 surgically treated patients were examined. Two-year changes in weight and HRQL measures (Short-Form (SF)-12 physical (PCS; MCID = 5) and mental (MCS; MCID = 5) component summary score, EQ-5D Index (MCID = 0.03) and Visual Analog Scale (VAS; MCID = 10), Impact of Weight on Quality of Life (IWQOL)-Lite total score (MCID = 12)) were calculated. Separate multivariable linear regression models were constructed within medically and surgically treated patients to determine if weight changes achieved HRQL MCIDs. Pooled analysis in all 500 patients was performed to estimate the weight reductions required to achieve the pre-defined MCID for each HRQL instrument.ResultsMean age was 43.7 (SD 9.6) years, 88% were women, 92% were white, and mean initial body mass index was 47.9 (SD 8.1) kg/m2. In surgically treated patients (two-year weight loss = 16%), HRQL MCIDs were reached for all instruments except the SF-12 MCS. In medically managed patients (two-year weight loss = 3%), MCIDs were attained in the EQ-index but not the other instruments. In all patients, percent weight reductions to achieve MCIDs were: 23% (95% confidence interval (CI): 17.5, 32.5) for PCS, 25% (17.5, 40.2) for MCS, 9% (6.2, 15.0) for EQ-Index, 23% (17.3, 36.1) for EQ-VAS, and 17% (14.1, 20.4) for IWQOL-Lite total score.ConclusionsWeight reductions to achieve MCIDs for most HRQL instruments are markedly higher than the conventional threshold of 5% to 10%. Surgical, but not medical treatment, consistently led to clinically important improvements in HRQL over two years.Trial registrationClinicaltrials.gov NCT00850356.

Predictors of health‐related quality of life in 500 severely obese patients

To characterize health‐related quality of life (HRQL) impairment in severely obese subjects, using several validated instruments.

Multimorbidity in a prospective cohort: Prevalence and associations with weight loss and health status in severely obese patients

To examine the prevalence of multimorbidity (≥2 chronic conditions) in severely obese patients and its associations with weight loss and health status over 2 years.

Determinants of lifestyle behavior in type 2 diabetes: results of the 2011 cross-sectional survey on living with chronic diseases in Canada.

BackgroundLifestyle behavior modification is an essential component of self-management of type 2 diabetes. We evaluated the prevalence of engagement in lifestyle behaviors for management of the disease, as well as the impact of healthcare professional support on these behaviors.MethodsSelf-reported data were available from 2682 adult respondents, age 20 years or older, to the 2011 Survey on Living with Chronic Diseases in Canada’s diabetes component. Associations with never engaging in and not sustaining self-management behaviors (of dietary change, weight control, exercise, and smoking cessation) were evaluated using binomial regression models.ResultsThe prevalence of reported dietary change, weight control/loss, increased exercise and smoking cessation (among those who smoked since being diagnosed) were 89.7%, 72.1%, 69.5%, and 30.6%, respectively. Those who reported not receiving health professional advice in the previous 12 months were more likely to report never engaging in dietary change (RR = 2.7, 95% CI 1.8 – 4.2), exercise (RR = 1.7, 95% CI 1.3 – 2.1), or weight control/loss (RR = 2.2, 95% CI 1.3 – 3.6), but not smoking cessation (RR = 1.0; 95% CI: 0.7 – 1.5). Also, living with diabetes for more than six years was associated with not sustaining dietary change, weight loss and smoking cessation.ConclusionHealth professional advice for lifestyle behaviors for type 2 diabetes self-management may support individual actions. Patients living with the disease for more than 6 years may require additional support in sustaining recommended behaviors.

Population-level response shift: novel implications for research

ObjectivesResponse shift is a change in perceived HRQL that occurs as a result of recalibration, reprioritization, or reconceptualization of an individual respondent’s internal standards, values, or conceptualization of HRQL. In this commentary, we suggest that response shift may also occur at the population level, triggered by causes that affect the distribution of individual-level risk.MethodsWe illustrated the nature and consequences of potential population-level response shift with two examples: the September 11 terror attacks, and the recent denormalization of smoking.ResultsResponse shift may occur at the population-level, when a large proportion of the population experiences the shift simultaneously, as a unit, and when the cause of the response shift is a socially significant event or trend. Such catalysts are of a qualitatively different nature than the causes leading to health status changes among individuals, and speak to the determinants affecting the underlying distribution of risk in the population.ConclusionsWe do not know if population-level causes have actually resulted in response shifts. Nonetheless, response shifts at the population-level may be worthwhile to investigate further, both to assess the validity of research evidence based on the measurement of HRQL in large populations, and as a desirable intermediate outcome in evaluations of population health programs.

Health Behaviours and Awareness of Canada’s Food Guide: A Population-based Study

PURPOSE Lifestyle behaviours among adults reporting awareness of Canadas Food Guide (CFG) are described. METHODS Data from a cross-sectional survey of adults from Alberta were used to estimate the prevalence of reported health behaviours among respondents aware of the CFG. RESULTS Respondents (n = 1044) reported general awareness of CFG (mean age 50.3 years; 54.2% female) of whom 82.2% reported awareness of specific CFG recommendations. Respondents reported frequently reading food labels (>58.0%), reading the number of calories (45.5%), the amount of sodium (49.5%), the amount of fat (46.7%), and the type of fat (45.5%) on the food label. Most respondents (90.0%) reported frequently selecting foods to promote health. Approximately one-third of the respondents (35.8%) reported frequently consuming ≥5 portions of vegetables and fruit per day and regularly participating in physical activity (55.3%). Body weight was perceived as healthy by 63.4% of the respondents. Most engaged in 2 health behaviours frequently. Adjusting for important socio-demographic characteristics, those who reported frequently consuming ≥5 portions of vegetables and fruit per day were more likely to engage in a second health behaviour outlined in CGF (OR: 23.6, 95% CI (16.2-34.4)). CONCLUSION Awareness of CFG did not translate to positive health behaviours. More proactive population level strategies to support specific health behaviours as outlined in CFG might be warranted.

Clinical characteristics are not significant predictors of advanced Obstructive Sleep Apnea in the severely obese.

Introduction: Obstructive Sleep Apnea (OSA), present in 30-93% of bariatric patients, is an independent predictor of post-bariatric surgery complications. Universal screening with Polysomnography (PSG), the gold standard test for OSA, would be difficult to access and costly to perform. The purpose of this study was to identify clinically important, statistically significant predictors of moderate-to-severe OSA in a bariatric population that would enable providers to stratify or prioritize patients needing PSG. Methods: A cross-sectional study was performed in patients referred for clinical suspicion of OSA. All patients underwent PSG. From a list of potential covariates deemed clinically important, multivariable binary logistic regression was used to identify statistically significant predictors (p<0.05) of moderate-to-severe OSA. Subjects were recruited from a bariatric specialty program in Edmonton, Alberta, with a central, region-wide, single-point-ofaccess referral system. Results: Of 169 patients undergoing PSG, 161 (95.3%) had complete data. Mean age was 48.7 ± 9.1 years, 45(28%) were men, mean body mass index (BMI) was 49.5 ± 9.7 kg/m2. 96(60%) patients had moderate-to-severe OSA and the mean Apnea-Hypopnea Index (AHI) was 27.0 ± 27.3. The strongest predictors of OSA were neck circumference (OR 1.08; 95% CI 0.99-1.18) and hypertension (OR 1.95, 95% CI 0.93-4.09). However, no variable reached statistical significance. Conclusion: Despite a model adequately powered to identify 16-32 statistically significant predictors, none was found. Given the high prevalence of OSA in patients undergoing bariatric care, the lack of identifiable predictors mandates that objective sleep testing be performed in all patients clinically suspected to have OSA.