Developing a risk index for multimorbidity surveillance in British Columbia

This Health System Impact Fellowship is co-funded by CIHR, Michael Smith Health Research BC, and the BC Centre for Disease Control (health system partner), to help build BC’s health policy research capacity for the integration of policy research into decision-making.


Multimorbidity is when an individual has two or more chronic diseases. But, behind this simple definition lies a complex phenomenon. Chronic diseases interact, and their combined health impacts can be greater than predicted by their individual impacts. Multimorbidity accumulates with age and affects the majority of senior citizens in Canada. For these seniors, multimorbidity increases health complications; including dementia, severe complications from COVID-19, and susceptibility to heat and climate events.


The BC Centre for Disease Control’s mandate is to provide accurate, timely and actionable health intelligence about population well-being and its determinants to decision makers in BC. This project follows this mandate, to improve knowledge of multimorbidity across BC. Multimorbidity is a huge challenge for our health care system because of its complexity. There are countless possible disease combinations, each with unique interactive effects on health. For this reason, most previous research has indexed multimorbidity by a simple count of the number of co-occurring diseases. But this approach loses granularity in understanding the nature of disease combinations.


Our goal is to use data clustering analyses to identify patterns of co-occurring diseases across the BC population and create a multimorbidity disease cluster index. We will apply this cluster index to measure how common different clustered disease combinations are across BC, and how different disease clusters relate to negative health outcomes. Finally, we will measure how disease clusters vary by sociodemographic variables like age, sex and gender, and socioeconomic status.


This project will enhance the ability of BC health authorities to identify opportunities for public health planning around multimorbidity, with knowledge of specific disease combinations and their sociodemographic context. Our project output will lay the foundation for enhanced population health surveillance and monitoring in BC.


Source: CIHR Funding Decisions Database