Policy analysis in an information-rich environment

Population-based insurance systems using longitudinal administrative data and record linkage techniques have helped create "information-rich" environments in several sites around the world. The output of five research groups using administrative data (Oxford, Western Australia, and three Canadian centres: Manitoba, Ontario and British Columbia) was analysed from contacts with the research groups and through use of the National Library of Medicine's PubMed and Medical Subject Headings (MeSH) categories. MeSH words "utilization", "economics", "physicians", and "physician practice patterns" more frequently characterized the research by the three Canadian centres than that of the other sites. With core funding for deliverables negotiated with the provincial health ministries, Canadian researchers have been more likely to use linked databases for policy analyses. Manitoba examples highlight the capabilities associated with these information-rich environments. They include the ability to analyse interventions longitudinally; to compare regions, areas and hospitals in defined populations; to combine information on patients and physicians; to add up expenditures for different services within the Canadian health-care system; and to examine population health issues in areas such as education and family services. Well-organized data and the capability for rapid response have been critical for timely policy analysis in Manitoba. A number of successes are mentioned; less successful efforts to influence practice patterns and to modify the internal workings of hospitals are noted. Investments in filling gaps in data collection and in enriching existing data would facilitate additional research. Planning and managing health care for an entire population has benefited greatly from the development of an information-rich environment.Health services research Policy analysis Longitudinal Population based Health information systems Canada

The prevalence of multimorbidity and associations with lifestyle factors among middle-aged Canadians: an analysis of Canadian Longitudinal Study on Aging data

Abstract Background Multimorbidity can be defined as the presence of more than one chronic condition in an individual. Research on multimorbidity has predominantly focused on older adults and few studies have examined multimorbidity in middle-aged people. The objectives of this study were to: 1) examine the prevalence of multimorbidity among middle-aged Canadians; and 2) examine the association between lifestyle factors (smoking, alcohol intake, physical activity) and multimorbidity in this age group. Methods In this analysis of the Canadian Longitudinal Study on Aging (CLSA) baseline data, we extracted data from 29,841 participants aged 45–64 years from a database of 51,338 people aged 45–85 years. Self-reported data on 27 chronic physical health conditions were used to derive different multimorbidity definitions. We estimated the prevalence of 3+ to 5+ chronic physical health conditions in different subgroups for descriptive purposes. Multivariable logistic regression analyses were performed to determine the association between socio-demographic and lifestyle factors, and multimorbidity using a 3+ multimorbidity case definition. Result We found that 39.6% (99% CI 38.4–40.7) of participants had three or more chronic conditions with a mean number of chronic condition of 2.41 (99% CI 2.37–2.46). The prevalence of multimorbidity increased with age from 29.7% in the 45–49-year-old age group to 52% in individuals aged 60–64 years. The prevalence of 4+ and 5+ chronic conditions was 24.5 and 14.2% respectively. Analyses indicated that female sex and low income were associated with higher odds of multimorbidity, whereas daily or weekly alcohol intake were associated with lower odds of multimorbidity. Exercise was not associated with multimorbidity. Results were similar when analyses were conducted separately for women and men. Conclusions Multimorbidity is not limited to older adults, but is a common phenomenon among middle-aged people. Longitudinal research is needed to better understand the temporal relationship between lifestyle factors and multimorbidity