Cardiometabolic multimorbidity and activity limitation: a cross-sectional study of adults using the Canadian Longitudinal Study on Aging data

Fam Pract. 2021 Oct 13;cmab129. doi: 10.1093/fampra/cmab129. Online ahead of print.

Abstract

Background: Cardiometabolic multimorbidity (CM) is the diagnosis of 2 or more cardiometabolic conditions. Multimorbidity and individual cardiometabolic conditions have been associated with activity limitation, a common form of disability, but few studies have investigated the association between CM and activity limitation.

Objectives: To estimate the prevalence of activity limitation among Canadians with CM and to quantify the association between CM and activity limitation.

Methods: Using data from the Canadian Longitudinal Study on Aging, we conducted a cross-sectional analysis of activity limitation among Canadians aged 45-85 (n = 50,777; weighted n = 13,118,474). CM was defined as the diagnosis of 2 or more of diabetes/prediabetes, myocardial infarction, and stroke, and activity limitation was evaluated using the Older Americans Resources and Services scale. Descriptive statistics and logistic and multinomial logistic regression analyses were conducted to determine the association between CM and activity limitation.

Results: The estimated prevalence of activity limitation among participants living with CM was 27.4% compared with 7.5% with no cardiometabolic conditions. Activity limitation increased in prevalence and severity with the number of cardiometabolic conditions. People with CM had increased odds of activity limitation compared with those without any cardiometabolic conditions (adjusted relative risk ratio = 3.99, 95% confidence interval [3.35-4.75]), and the odds increased with each additional condition. Stroke survivors had greater odds of activity limitation than those without a history of stroke and the same number of cardiometabolic conditions.

Conclusion: Activity limitation is common among Canadians living with CM. Odds of activity limitation increase with each additional cardiometabolic condition, especially for stroke survivors.

Keywords: activities of daily living; chronic disease; diabetes mellitus; multimorbidity; myocardial infarction; stroke.

Plain Language Summary

Cardiometabolic multimorbidity (CM) is a common pattern of multimorbidity characterized by the diagnosis of 2 or more cardiometabolic conditions, such as stroke, diabetes, and myocardial infarction. Previous research has found that individuals with stroke, diabetes, or myocardial infarction are at an increased risk of activity limitation, defined by the World Health Organization as the “difficulties an individual may have in executing activities.” This study investigated the prevalence, risk, and severity of activity limitation among Canadians with CM and combinations of stroke, diabetes/prediabetes, and myocardial infarction. Using data from the Canadian Longitudinal Study on Aging, the estimated prevalence of activity limitation among those living with CM was 27.4% compared with 7.5% among individuals without any cardiometabolic conditions. Individuals living with CM also had increased odds of activity limitation compared with those with no cardiometabolic conditions. Importantly, the prevalence, severity, and risk of activity limitation increased with each additional condition, especially when the cluster of conditions included stroke, suggesting an additive effect of CM on activity limitation. Based on these findings, special efforts should be made to manage chronic disease risk in individuals with a history of stroke given the increased risk of activity limitation when combined with diabetes/prediabetes and myocardial infarction.