In North America, the last two decades saw continued increases in population multimorbidity across all age groups. This trend, which is expected to endure in the coming years, has been attributed in large part to population aging and unhealthy lifestyle choices. While the societal consequences of multimorbidity have focused primarily on the burden it imposes on the sustainability of health systems and the need to implement innovative ways to deliver care, latent costs, such as possible increases in motor-vehicle accidents (MVAs) have received relatively little attention. The principal objective of this thesis was to investigate the relationship between multimorbidity and MVAs. To complement current knowledge on the topic, we conducted observational studies based on information recorded in electronic health records (EHR). The hypothesis that increasing levels of multimorbidity would translate into increasing risk of MVA was tested in both a general population of health care recipients and in persons with epilepsy, a subgroup of individuals predisposed to comorbidities and MVAs. To gain a better understanding of morbidity ascertainment in EHR data, preliminary validation studies were performed to evaluate the performance of Elixhauser comorbidity measures for predicting hospital mortality in our data source. A systematic review of risk factors contributing to the onset and progression of epilepsy was also performed in hopes of identifying elements that would help improve the methodological design of the principal thesis study limited to persons with epilepsy. Study results confirmed the excellent performance of the Elixhauser comorbidity measures for predicting hospital mortality in the Cerner Health Facts data repository. In the general health care recipient population, a positive exposure-outcome relationship was observed between multimorbidity and MVA risk. This relationship was consistent in adults across the lifespan and more pronounced in women than in men. In persons with epilepsy, the observed exposure-outcome relationship between multimorbidity and MVAs did not reach statistical significance. However, comorbid depression was identified as a risk factor for MVAs. Given increasing rates of multimorbidity in the general population, the findings of this thesis strongly support the need for replication and better characterization of the disease combinations that drive increases in MVA risk. Future work on this topic should also include estimates of MVA risk attributable to multimorbidity; this would inform and gauge the relevance of novel driving policies targeting individuals diagnosed with specific health conditions.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/36866 |
| Date | January 2017 |
| Creators | Fortin, Yannick |
| Contributors | Krewski, Daniel Richard |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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