title: Increasing comorbidity and health services utilization in older adults with prior stroke.
abstract: OBJECTIVE
  To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke.
  
  
  METHODS
  This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke- and non-stroke-related reasons.
  
  
  RESULTS
  A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and dementia). Use of all health services doubled with increasing comorbidity and was largely attributed to non-stroke-related reasons. Total and per-patient costs increased with comorbidity. Main cost drivers shifted from physician and home care visits to hospital admissions with greater comorbidity.
  
  
  CONCLUSIONS
  Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada. gruneir@ualberta.ca.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Griffith
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Fisher
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
authors.forename: Dilzayn
authors.initials: D
authors.lastname: Panjwani
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
authors.forename: Sima
authors.initials: S
authors.lastname: Gandhi
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
authors.forename: Li
authors.initials: L
authors.lastname: Sheng
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Patterson
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
authors.forename: Amiram
authors.initials: A
authors.lastname: Gafni
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
authors.forename: Jenny
authors.initials: J
authors.lastname: Ploeg
authors.affiliation: From the Department of Family Medicine (A. Gruneir), University of Alberta, Edmonton; Centre for Health Economics and Policy Analysis (A. Gafni), Department of Clinical Epidemiology and Biostatistics (L.E.G.), School of Nursing (K.F., J.P., M.M.-R.), and Department of Medicine (C.P.), McMaster University, Hamilton; Women's College Research Institute (D.P.), Women's College Hospital; and Institute for Clinical Evaluative Sciences (ICES) (S.G., L.S.), Toronto, Canada.
authors.forename: Maureen
authors.initials: M
authors.lastname: Markle-Reid
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000191:economics / Q000453:epidemiology* / Q000628:therapy*