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      Chronic Care for All? The Intersecting Roles of Race and Immigration in Shaping Multimorbidity, Primary Care Coordination, and Unmet Health Care Needs Among Older Canadians.

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          Abstract

          Despite the predominance of chronic disease clustering, primary care delivery for multimorbid patients tends to be less effective and often uncoordinated. This study aims to quantify racial-nativity inequalities in multimorbidity prevalence ≥3 chronic conditions), access to primary care, and relations to past-year subjective unmet health care needs (SUN) among older Canadians.

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          Most cited references78

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          Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.

          Karen Barnett, Stewart Mercer, Michael Norbury … (2012)
          Long-term disorders are the main challenge facing health-care systems worldwide, but health systems are largely configured for individual diseases rather than multimorbidity. We examined the distribution of multimorbidity, and of comorbidity of physical and mental health disorders, in relation to age and socioeconomic deprivation. In a cross-sectional study we extracted data on 40 morbidities from a database of 1,751,841 people registered with 314 medical practices in Scotland as of March, 2007. We analysed the data according to the number of morbidities, disorder type (physical or mental), sex, age, and socioeconomic status. We defined multimorbidity as the presence of two or more disorders. 42·2% (95% CI 42·1-42·3) of all patients had one or more morbidities, and 23·2% (23·08-23·21) were multimorbid. Although the prevalence of multimorbidity increased substantially with age and was present in most people aged 65 years and older, the absolute number of people with multimorbidity was higher in those younger than 65 years (210,500 vs 194,996). Onset of multimorbidity occurred 10-15 years earlier in people living in the most deprived areas compared with the most affluent, with socioeconomic deprivation particularly associated with multimorbidity that included mental health disorders (prevalence of both physical and mental health disorder 11·0%, 95% CI 10·9-11·2% in most deprived area vs 5·9%, 5·8%-6·0% in least deprived). The presence of a mental health disorder increased as the number of physical morbidities increased (adjusted odds ratio 6·74, 95% CI 6·59-6·90 for five or more disorders vs 1·95, 1·93-1·98 for one disorder), and was much greater in more deprived than in less deprived people (2·28, 2·21-2·32 vs 1·08, 1·05-1·11). Our findings challenge the single-disease framework by which most health care, medical research, and medical education is configured. A complementary strategy is needed, supporting generalist clinicians to provide personalised, comprehensive continuity of care, especially in socioeconomically deprived areas. Scottish Government Chief Scientist Office. Copyright © 2012 Elsevier Ltd. All rights reserved.
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            Structural racism and health inequities in the USA: evidence and interventions

            Zinzi D Bailey, Nancy Krieger, Madina Agénor … (2017)
            The Lancet, 389(10077), 1453-1463
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              Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?

              Ronald Andersen (1995)
              The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.
              Article 0 comments Cited 920 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (iso-abbrev): J Gerontol B Psychol Sci Soc Sci
                Title: The journals of gerontology. Series B, Psychological sciences and social sciences
                Publisher: Oxford University Press (OUP)
                ISSN (Electronic): 1758-5368
                ISSN (Print): 1079-5014
                Publication date (Electronic): Feb 19 2023
                Volume: 78
                Issue: 2
                Affiliations
                [1 ] Department of Social and Behavioural Sciences, City University of Hong Kong, China.
                [2 ] Factor-Inwentash Faculty of Social Work, University of Toronto, Canada.
                Article
                Publisher Item ID: 6679535
                DOI: 10.1093/geronb/gbac125
                PubMed ID: 36044754
                SO-VID: b056299f-6790-43e5-8370-82937191bf66
                History

                Keywords: Minority ageing,Social determinants of health,Health care equity,Complex health care needs
                Data availability:
                Keywords: Minority ageing, Social determinants of health, Health care equity, Complex health care needs

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