Chronic Disease Prevalence

An Exploration of the Data

Chronic disease(s), or non-communicable disease (NCD), progress slowly over time, tend to have a long duration impacting a person’s quality of life and often require ongoing medical supervision and care (CCO, 2019). The Centers for Disease Control and Prevention (2020) defines chronic disease, or NCD, as:

• Lasting one (1) year or longer and,

• require ongoing medical attention, or

• limit activities of daily living, or both.

According to the World Health Organization (WHO) (2020), globally, NCD contributes to almost 70% of all deaths and a 60% burden of disease. Burden of disease is used to “describe death and loss of health due to diseases, injuries and risk factors for all regions of the world” (WHO, n.d., p. 1).

National Data

In Canada, 67% of deaths are attributed to one of the four most commons NCD’s:

• Cancer

• Diabetes

• Cardiovascular disease

• Chronic respiratory disease (Public Health Agency of Canada, 2013).

The Public Health Agency of Canada (2013) reports that there are more Canadians (age 34-64) living with chronic disease than ever before. Modifiable risk factors are the driving factor for this increase (Appendix A).

Appendix A: Common Risk Factors for Chronic Disease (Public Health Agency of Canada, 2013).

Provincial Data

In a recently published report by CCO and Public Health Ontario (2019), it is estimated that NCD caused approximately ¾ of all deaths in Ontario (Appendix B). The top four NCD’s (as listed above) contributed to 63.7% of all deaths. The report also highlighted that people living in a lower socioeconomic class were more likely to require hospitalization and experience death as a result of NCD. The direct healthcare costs are estimated to be $10.5 billion annually in Ontario.

Appendix B: Causes of death, all causes and chronic disease causes, Ontario, 2015 (CCO, 2019).

Local Data

The Hamilton Niagara Haldimand Brant (HNHB) Local Health Integration Network (LHIN) was established by the Government of Ontario to “plan, coordinate, integrate and fund health services at the local level” (Central West LHIN, 2014). Please note that the Government of Ontario is transitioning to a new model of coordinated care in the province; Ontario Health Teams (OHT) are currently being developed in a staggered approach. No data from OHT’s is currently available.

The HNHB LHIN is comprised of the following communities or sub-regions:

• Brant

• Burlington

• Haldimand-Norfolk

• Hamilton

• Niagara

• Niagara North West

Data of this region suggests that approximately 18.9% of the population has been diagnosed with 1 or more chronic condition. The most commonly reported NCD’s are congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM). Unfortunately, this number is set to increase as the LHIN’s population continues to age. Approximately 200 000 seniors reside within the HNHB LHIN, which is the largest number of seniors in all of the Ontario LHIN regions. This region is projected to continue growing over the next ten plus years, with an increase in the following demographics:

a) 43.5% increase of people aged 65-74

b) 28.5% increase pf people aged 84 and higher (HNHB LHIN, 2014).

COPD is a NCD that requires an integrated health care framework in order to improve health outcomes. The prevalence of COPD in the HNHB LHIN is 1.5% higher than the provincial average (5.3% to 3.8%) (HNHB LHIN, 2014). The Brant County Health Unit’s Health Atlas reports that in 2018 there were 673 cases of lower respiratory disease, including COPD and asthma, hospitalizations for city and county residents that lead to 719.7 hospitalizations. This number was slightly increased from 2017 data (Brant County Health Unit, 2019).

Synthesis of Data – Next Steps

Chronic disease and chronic disease management is clearly a national problem that requires strategies, policies and delivery models in order to improve patient outcomes. The Government of Ontario has implemented a model of healthcare delivery to address some of the more common chronic diseases. Quality Based Procedures (QBP’s) “ are specific groups of patient services that offer opportunities for health care providers to share best practices that will allow the system to achieve even better quality and system efficiencies” (Ministry of Health and Long Term Care, 2020).

As a nurse working in an acute care hospital, I have encountered many patients with chronic diseases requiring both short term and long term management. The most common NCD’s that I encounter on a daily basis is:

1. Chronic Obstructive Pulmonary Disease (COPD)

2. Congestive Heart Failure (CHF)

3. Diabetes Mellitus (DM)

COPD and CHF are both considered QBP’s; they follow policies and procedures in order to support care across the continuum. Standardization and evidence based best practice guidelines are foundational in allowing the healthcare system achieve better quality and system efficiencies (Ontario Hospital Association, n.d.).

Have other provinces or territories adopted a similar framework in order to achieve optimal and standard care for their patients? Do other organizations in the province of Ontario follow QBP recommendations, which as stated are used to guide evidence based practice, policy and procedures?

References

Brant County Health Unit. (2019). Brant health atlas. https://www.bchu.org/stats-reports/bchu-reports

CCO. (2019). The burden of chronic diseases in Ontario: Key estimates to support efforts in prevention. https://www.publichealthontario.ca/-/media/documents/c/2019/cdburden-report.pdf?la=en

Center's for Disease Control and Prevention. (2020). About chronic diseases. https://www.cdc.gov/chronicdisease/about/index.htm

Central West LHIN. (2014). FAQ: Ontario’s local health integration networks (LHIN). http://www.centralwestlhin.on.ca/About%20Us/Frequently%20Asked%20Questions/About%20Ontario%20LHINs.aspx

Hamilton Niagara Haldimand Brant LHIN. (2014). Complex and chronic conditions. http://www.hnhblhin.on.ca/goalsandachievements/integrationpopulationbased/complexandchronicconditions.aspx

Hamilton Niagara Haldimand Brant LHIN. (2014). Key findings from the HNHB LHIN health atlas. http://www.hnhblhin.on.ca/aboutus/geographyanddemographics/HealthAtlas.aspx

Ministry of Health and Long Term Care. (2020). Health system funding reform. http://www.health.gov.on.ca/en/pro/programs/ecfa/funding/hs_funding_qbp.aspx

Ontario Hospital Association. (n.d.). Toolkit to support the implementation of quality based procedures. https://www.oha.com/Documents/QBP%20Toolkit.pdf

Public Health Agency of Canada. (2013). Preventing chronic disease strategic plan 2013-2016. https://epe.lac-bac.gc.ca/100/201/301/weekly_checklist/2014/internet/w14-10-U-

E.html/collections/collection_2014/aspc-phac/HP35-39-2013-eng.pdf

World Health Organization. (2020). Noncommunicable diseases. https://www.who.int/health-topics/noncommunicable-diseases#tab=tab_1