Go to content

Almost all Ontarians accumulate multiple chronic conditions over their lifetime


The number of Ontarians who died with two or more chronic conditions increased from 79.6 per cent in 1994 to 95.3 per cent in 2013, according to a new study from the Institute for Clinical Evaluative Sciences (ICES).

The study published today in the journal Health Affairs, examined more than 1.6 million deaths that were registered in Ontario from 1994 to 2013, and linked each to health administrative data from Ontario’s single payer healthcare system.

“By looking back in the linked data we identified 18 chronic conditions that individuals accumulated up to the time of their death and examined how these trends differed over time and by socioeconomic status,” says Dr. Laura Rosella, adjunct scientist and site director at ICES UofT and assistant professor at the Dalla Lana School of Public Health at the University of Toronto.

The 18 chronic conditions the researchers identified were acute myocardial infarction, asthma, cancer, cardiac arrhythmia, chronic coronary syndrome, chronic obstructive pulmonary disorder, congestive heart failure, Crohn’s disease or colitis, dementia, diabetes, hypertension, mood disorder, osteo- and other arthritis, osteoporosis, other mental health disorder, renal failure, rheumatoid arthritis and stroke.

The study showed that almost all Ontarians accumulate multiple chronic conditions over their lifetime.  The total number of chronic conditions that Ontarians died with increased over time. In 1994, about one quarter (24.6 per cent) of Ontarians died with five or more chronic conditions, this increased to two thirds of all Ontario deaths (65.7 per cent) in 2013.

The researchers found that the types of chronic conditions that Ontarians accumulated varied by socioeconomic groups. Individuals that lived in materially deprived neighbourhoods were more likely to die with chronic obstructive pulmonary disease (COPD), mental health disorders and diabetes. While cancer and dementia at time of death were more common among individuals that lived in high income neighbourhoods.

“The observed trends underscore the importance of integrated healthcare planning and delivery that can meet the healthcare needs of Ontarians with multiple and complex chronic conditions, as well as the need for chronic disease prevention and socioeconomic interventions that can address the inequities in the types of conditions Ontarians accumulate,” added Rosella.

But there were some health gains across the board including the decline in the presence of chronic coronary syndrome, congestive heart failure and stroke at time of death, which decreased by almost two per cent each from 2004 to 2013.

The journal will hold a press conference profiling their March issue at the National Press Club, in Washington, DC on Tuesday, March 6, 2018 (9:00 a.m. – 12:30 p.m.)

Advancing Health Equity Twitter: Follow Live Tweets from the briefing @Health_Affairs, and join in the conversation with #healthequity

“Accumulation of chronic conditions at the time of death increased in Ontario from 1994 to 2013” was published in the March issue of Health Affairs.

Author block: Laura Rosella, Kathy Kornas, Anjie Huang, Catherine Bornbaum, David Henry, and Walter P. Wodchis.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario


Deborah Creatura
Media Advisor, ICES
[email protected]
(o) 416-480-4780 or (c) 647-406-5996


Contributing ICES Scientists

Associated Sites

Read the Journal Article