{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T07:10:59Z","timestamp":1787728259810,"version":"build-2784847793"},"reference-count":67,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100012335","name":"Medical Research Fund","doi-asserted-by":"crossref","award":["215532"],"award-info":[{"award-number":["215532"]}],"id":[{"id":"10.13039\/100012335","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The number of persons living with multimorbidity\u2013defined as the co-occurrence of at least two chronic conditions in the same individual\u2013is growing globally, especially in developed countries. Traditionally, this increase has been attributed to a growing aging population, sedentary lifestyle, obesity, low socioeconomic status, and individual genetic susceptibility.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To investigate the prevalence and associated risk factors of the most common multimorbidity (MCM) among Canadian middle-aged and older adults.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Method<\/jats:title>\n<jats:p>Relevant data on all 30,097 middle-aged and older Canadian adults (aged 45 to 85 years) from the Canadian Longitudinal Study on Aging were used for this study. To identify the specific sociodemographic risk factors associated with the MCM, we used survey-specific logistic regression.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Findings<\/jats:title>\n<jats:p>Overall, co-occurrence of osteoarthritis and hypertension was identified as the MCM among Canadian adults aged 45+ with an estimated prevalence of 16.5%. The results from multivariate analysis showed that seven factors were significantly associated with increased odds of the MCM, which included increasing age, being retired from work (retired vs not retired), poorer rating of perceived health, (very good, good, poor vs excellent), increasing problems with sleep quality (satisfied, dissatisfied vs neutral), and abnormal body-mass index (underweight, overweight, obese vs normal). Also, residents in other urban centres had significantly lower odds than those in urban core. Persons living in Atlantic Canada, Ontario and Quebec were at increased odds of having the MCM compared to those in British Columbia. The odds of the MCM associated with increasing age was significantly higher among Females (OR = 1.12, 95% CI = 1.11\u20131.13) than Males (OR = 1.08, 95% CI = 1.07\u20131.10).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Multimorbidity is a common feature among Canadian adults. The identification of the most prevalent patterns and associated risk factors in this study provides fresh insights into the etiology, progression, and possible prevention of the MCM among Canadian adults.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317688","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T18:36:08Z","timestamp":1737570968000},"page":"e0317688","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prevalence and risk factors of the most common multimorbidity among Canadian adults"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7499-6328","authenticated-orcid":true,"given":"Obed","family":"Mortey","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Mugford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris","family":"Aubrey-Bassler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6007-4763","authenticated-orcid":true,"given":"Hensley H.","family":"Mariathas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugochukwu","family":"Odimba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5313-4884","authenticated-orcid":true,"given":"Zhiwei","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"issue":"9859","key":"pone.0317688.ref001","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","article-title":"Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990\u20132010: a systematic analysis for the Global Burden of Disease Study 2010.","volume":"380","author":"CJ Murray","year":"2012","journal-title":"Lancet"},{"issue":"9859","key":"pone.0317688.ref002","doi-asserted-by":"crossref","first-page":"2095","DOI":"10.1016\/S0140-6736(12)61728-0","article-title":"Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"R Lozano","year":"2012","journal-title":"Lancet"},{"issue":"4","key":"pone.0317688.ref003","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1370\/afm.983","article-title":"Defining comorbidity: implications for understanding health and health services.","volume":"7","author":"JM Valderas","year":"2009","journal-title":"Ann Fam Med"},{"issue":"10","key":"pone.0317688.ref004","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1093\/gerona\/glz185","article-title":"Prevalence and Patterns of Multimorbidity in a Nationally Representative Sample of Older Chinese: Results From the China Health and Retirement Longitudinal Study","volume":"75","author":"SS Yao","year":"2020","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"10131","key":"pone.0317688.ref005","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1016\/S0140-6736(18)30941-3","article-title":"Making more of multimorbidity: an emerging priority.","volume":"391","author":"The Lancet Editorial","year":"2018","journal-title":"Lancet"},{"issue":"12","key":"pone.0317688.ref006","doi-asserted-by":"crossref","first-page":"e597","DOI":"10.1016\/S2468-2667(19)30206-3","article-title":"Health and the effect of universal health coverage in Italy.","volume":"4","author":"A Odone","year":"2019","journal-title":"Lancet Public Health"},{"key":"pone.0317688.ref007","doi-asserted-by":"crossref","first-page":"101860","DOI":"10.1016\/j.eclinm.2023.101860","article-title":"Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis.","volume":"57","author":"SR Chowdhury","year":"2023","journal-title":"EClinicalMedicine."},{"issue":"452","key":"pone.0317688.ref008","first-page":"1","article-title":"The impact of multiple chronic diseases on ambulatory care use; a population based study in Ontario, Canada.","volume":"12","author":"E Muggah","year":"2012","journal-title":"BMC Health Serv Res"},{"issue":"5\u20136","key":"pone.0317688.ref009","doi-asserted-by":"crossref","first-page":"845","DOI":"10.17269\/s41997-018-0103-0","article-title":"Beyond the grey tsunami: a cross-sectional population-based study of multimorbidity","volume":"109","author":"BL Ryan","year":"2018","journal-title":"Ontario. Can J Public Health"},{"issue":"7","key":"pone.0317688.ref010","doi-asserted-by":"crossref","first-page":"215","DOI":"10.24095\/hpcdp.37.7.02","article-title":"Estimating multimorbidity prevalence with the Canadian Chronic Disease Surveillance System.","volume":"37","author":"A Feely","year":"2017","journal-title":"Health Promot Chronic Dis Prev Can"},{"key":"pone.0317688.ref011","doi-asserted-by":"crossref","first-page":"87","DOI":"10.24095\/hpcdp.35.6.01","article-title":"Prevalence and patterns of chronic disease multimorbidity and associated determinants in Canada.","volume":"35","author":"KC Roberts","year":"2015","journal-title":"Health Promot Chronic Dis Prev Can"},{"issue":"8","key":"pone.0317688.ref012","doi-asserted-by":"crossref","first-page":"E270","DOI":"10.1503\/cmaj.201473","article-title":"Trends in prevalence of chronic disease and multimorbidity in Ontario, Canada.","volume":"193","author":"M Steffler","year":"2021","journal-title":"CMAJ"},{"issue":"3","key":"pone.0317688.ref013","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.jclinepi.2013.09.021","article-title":"Multimorbidity patterns: a systematic review.","volume":"67","author":"A Prados-Torres","year":"2014","journal-title":"J Clin Epidemiol"},{"issue":"75","key":"pone.0317688.ref014","first-page":"1","article-title":"Age and gender differences in the prevalence and patterns of multimorbidity in the older population.","volume":"14","author":"JM Abad-D\u00edez","year":"2014","journal-title":"BMC Geriatr"},{"issue":"10159","key":"pone.0317688.ref015","doi-asserted-by":"crossref","first-page":"1789","DOI":"10.1016\/S0140-6736(18)32279-7","article-title":"Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017.","volume":"392","author":"The Global Burden of Diseases 2017 Collaborators","year":"2018","journal-title":"Lancet"},{"issue":"3","key":"pone.0317688.ref016","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1017\/S0714980809990055","article-title":"The Canadian longitudinal study on aging (CLSA).","volume":"28","author":"PS Raina","year":"2009","journal-title":"Can J Aging"},{"issue":"6","key":"pone.0317688.ref017","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1093\/ije\/dyz173","article-title":"Cohort Profile: The Canadian Longitudinal Study on Aging (CLSA).","volume":"48","author":"P Raina","year":"2019","journal-title":"Int J Epidemiol."},{"issue":"3","key":"pone.0317688.ref018","doi-asserted-by":"crossref","first-page":"e059021","DOI":"10.1136\/bmjopen-2021-059021","article-title":"Cohort profile: genomic data for 26 622 individuals from the Canadian Longitudinal Study on Aging (CLSA).","volume":"12","author":"V Forgetta","year":"2022","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0317688.ref019","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1080\/15412555.2023.2229906","article-title":"Sex-Specific Genetic Determinants of Asthma-COPD Phenotype and COPD in Middle-Aged and Older Canadian Adults: An Analysis of CLSA Data.","volume":"20","author":"U Odimba","year":"2023","journal-title":"COPD."},{"key":"pone.0317688.ref020","first-page":"19","article-title":"The prevalence of multimorbidity and associations with lifestyle factors among middle-aged Canadians: an analysis of Canadian Longitudinal Study on Aging data.","author":"MN Sakib","year":"2019","journal-title":"BMC Public Health"},{"issue":"8","key":"pone.0317688.ref021","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1111\/jgs.15921","article-title":"Multimorbidity Frameworks Impact Prevalence and Relationships with Patient\u2010Important Outcomes.","volume":"67","author":"LE Griffith","year":"2019","journal-title":"J Am Geriatr Soc."},{"issue":"2","key":"pone.0317688.ref022","doi-asserted-by":"crossref","first-page":"112","DOI":"10.3109\/02813432.2016.1153242","article-title":"The role of diseases, risk factors and symptoms in the definition of multimorbidity\u2013a systematic review.","volume":"34","author":"TG Willadsen","year":"2016","journal-title":"Scand J Prim Health Care"},{"key":"pone.0317688.ref023","first-page":"v1","article-title":"Sampling and Computation of Response Rates and Sample Weights for the Tracking (Telephone Interview) Participants and Comprehensive Participants.","author":"Canadian Longitudinal Study on Aging methodology working group","year":"2017"},{"issue":"5","key":"pone.0317688.ref024","doi-asserted-by":"crossref","first-page":"4063","DOI":"10.3390\/cimb46050251","article-title":"Osteoarthritis: Insights into Diagnosis, Pathophysiology, Therapeutic Avenues, and the Potential of Natural Extracts","volume":"46","author":"C Coppola","year":"2024","journal-title":"Curr Issues Mol Biol"},{"issue":"4","key":"pone.0317688.ref025","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.pop.2013.08.003","article-title":"Diagnosis and treatment of osteoarthritis.","volume":"40","author":"RL Taruc-Uy","year":"2013","journal-title":"Prim Care."},{"key":"pone.0317688.ref026","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jot.2021.05.003","article-title":"Association between hypertension and osteoarthritis: A systematic review and meta-analysis of observational studies","volume":"32","author":"K Lo","year":"2021","journal-title":"J Orthop Translat"},{"issue":"1","key":"pone.0317688.ref027","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1503\/cmaj.101863","article-title":"Diagnosed hypertension in Canada: incidence, prevalence and associated mortality.","volume":"184","author":"C Robitaille","year":"2012","journal-title":"CMAJ."},{"issue":"5","key":"pone.0317688.ref028","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1161\/01.HYP.0000242335.32890.c6","article-title":"Large increases in hypertension diagnosis and treatment in Canada after a healthcare professional education program","volume":"48","author":"J Onysko","year":"2006","journal-title":"Hypertension"},{"issue":"1","key":"pone.0317688.ref029","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s10020-021-00270-x","article-title":"Estrogen-related receptors: novel potential regulators of osteoarthritis pathogenesis","volume":"27","author":"J Tang","year":"2021","journal-title":"Mol Med"},{"issue":"4","key":"pone.0317688.ref030","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.jbspin.2012.11.008","article-title":"Estrogens, osteoarthritis and inflammation","volume":"80","author":"M Martin-Millan","year":"2013","journal-title":"Joint Bone Spine"},{"key":"pone.0317688.ref031","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1589\/jpts.29.12","article-title":"Gender-related differences in lower limb alignment, range of joint motion, and the incidence of sports injuries in Japanese university athletes","volume":"29","author":"Y. Mitani","year":"2017","journal-title":"J Phys Ther Sci"},{"issue":"5","key":"pone.0317688.ref032","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1002\/art.39565","article-title":"Association of Pre-Pregnancy Body Mass Index, Pregnancy-Related Weight Changes, and Parity With the Risk of Developing Degenerative Musculoskeletal Conditions.","volume":"68","author":"M Bliddal","year":"2016","journal-title":"Arthritis Rheumatol."},{"issue":"1","key":"pone.0317688.ref033","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1093\/pubmed\/fdy017","article-title":"Multimorbidity in South Asian adults: prevalence, risk factors and mortality.","volume":"41","author":"K Singh","year":"2019","journal-title":"J Public Health (Oxf)."},{"issue":"Suppl 2","key":"pone.0317688.ref034","doi-asserted-by":"crossref","first-page":"10s","DOI":"10.11606\/s1518-8787.2018052000637","article-title":"Multimorbidity: The Brazilian Longitudinal Study of Aging (ELSI-Brazil).","volume":"52","author":"BP Nunes","year":"2018","journal-title":"Rev Saude Publica."},{"issue":"1","key":"pone.0317688.ref035","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","volume":"8","author":"ST Skou","year":"2022","journal-title":"Multimorbidity. Nat Rev Dis Primers"},{"issue":"4","key":"pone.0317688.ref036","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.arr.2011.03.003","article-title":"Aging with multimorbidity: a systematic review of the literature.","volume":"10","author":"A Marengoni","year":"2011","journal-title":"Ageing Res Rev"},{"issue":"3","key":"pone.0317688.ref037","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1183\/09031936.00229714","article-title":"Mechanisms of development of multimorbidity in the elderly","volume":"45","author":"PJ Barnes","year":"2015","journal-title":"Eur Respir J"},{"key":"pone.0317688.ref038","first-page":"1","article-title":"Epidemiology of Aging, Disability, Frailty and Overall Role of Physiatry.","author":"KR Poduri","year":"2018","journal-title":"Geriatric Rehabilitation."},{"issue":"1","key":"pone.0317688.ref039","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.1186\/s12889-021-11291-w","article-title":"Prevalence and early-life determinants of mid-life multimorbidity: evidence from the 1970 British birth cohort.","volume":"21","author":"D Gondek","year":"2021","journal-title":"BMC Public Health"},{"issue":"6","key":"pone.0317688.ref040","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s11906-022-01183-8","article-title":"Sex Differences in the Prevalence, Outcomes and Management of Hypertension.","volume":"24","author":"PJ Connelly","year":"2022","journal-title":"Curr Hypertens Rep"},{"issue":"5","key":"pone.0317688.ref041","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1097\/BOR.0b013e3283494005","article-title":"Aging and osteoarthritis.","volume":"23","author":"RF Loeser","year":"2011","journal-title":"Curr Opin Rheumatol"},{"issue":"1\u20132","key":"pone.0317688.ref042","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1007\/s11010-012-1276-0","article-title":"Accelerated aging as evidenced by increased telomere shortening and mitochondrial DNA depletion in patients with type 2 diabetes.","volume":"365","author":"F Monickaraj","year":"2012","journal-title":"Mol Cell Biochem"},{"issue":"5","key":"pone.0317688.ref043","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1038\/nrcardio.2013.30","article-title":"The roles of senescence and telomere shortening in cardiovascular disease.","volume":"10","author":"F Fyhrquist","year":"2013","journal-title":"Nat Rev Cardiol"},{"issue":"8","key":"pone.0317688.ref044","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1038\/nm.3651","article-title":"Stem cell aging: mechanisms, regulators and therapeutic opportunities","volume":"20","author":"J Oh","year":"2014","journal-title":"Nat Med"},{"issue":"80","key":"pone.0317688.ref045","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1126\/science.aax0860","article-title":"T cells with dysfunctional mitochondria induce multimorbidity and premature senescence","volume":"368","author":"G Desd\u00edn-Mic\u00f3","year":"2020","journal-title":"Science"},{"issue":"e009287","key":"pone.0317688.ref046","first-page":"1","article-title":"Prevalence of multimorbidity in the adult population attending primary care in Portugal: a cross-sectional study","volume":"5","author":"F Prazeres","year":"2015","journal-title":"BMJ Open"},{"issue":"185","key":"pone.0317688.ref047","first-page":"1","article-title":"Association of self-rated health with multimorbidity, chronic disease and psychosocial factors in a large middle-aged and older cohort from general practice: a cross-sectional study.","volume":"15","author":"N Mavaddat","year":"2014","journal-title":"BMC Fam Pract."},{"issue":"2","key":"pone.0317688.ref048","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1177\/089826430001200202","article-title":"Factors That Contribute to Positive Perceived Health in an Older Population.","volume":"12","author":"LL Bryant","year":"2000","journal-title":"J Aging Health."},{"issue":"1","key":"pone.0317688.ref049","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.jclinepi.2011.04.013","article-title":"Health burden in chronic disease: Multimorbidity is associated with self-rated health more than medical comorbidity alone.","volume":"65","author":"AV Perruccio","year":"2012","journal-title":"J Clin Epidemiol"},{"key":"pone.0317688.ref050","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.sleep.2020.07.002","article-title":"Sleep behaviours and multimorbidity occurrence in middle-aged and older adults: findings from the Canadian Longitudinal Study on Aging (CLSA).","volume":"75","author":"K Nicholson","year":"2020","journal-title":"Sleep Med"},{"issue":"6","key":"pone.0317688.ref051","first-page":"341","article-title":"endocrine effects of sleep deprivation","volume":"6","author":"Copinschi G. Metabolic","year":"2005","journal-title":"Essent Psycho pharmacol"},{"key":"pone.0317688.ref052","doi-asserted-by":"crossref","first-page":"1605469","DOI":"10.3389\/phrs.2023.1605469","article-title":"Sleep Problems Associate With Multimorbidity: A Systematic Review and Meta-analysis.","volume":"44","author":"Y Zhou","year":"2023","journal-title":"Public Health Rev."},{"issue":"4","key":"pone.0317688.ref053","doi-asserted-by":"crossref","first-page":"217","DOI":"10.5935\/1984-0063.20180036","article-title":"Sleep duration, lifestyles and chronic diseases: a cross-sectional population-based study.","volume":"11","author":"C Reis","year":"2018","journal-title":"Sleep Sci"},{"issue":"8","key":"pone.0317688.ref054","doi-asserted-by":"crossref","first-page":"e026942","DOI":"10.1136\/bmjopen-2018-026942","article-title":"Sleep duration and multimorbidity in Luxembourg: results from the European Health Examination Survey in Luxembourg, 2013\u20132015","volume":"9","author":"M Ruiz-Castell","year":"2019","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0317688.ref055","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1186\/s12889-023-15965-5","article-title":"Association between sleep problems and multimorbidity patterns in older adults.","volume":"23","author":"SCC Idalino","year":"2023","journal-title":"BMC Public Health"},{"issue":"1","key":"pone.0317688.ref056","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1111\/jch.12049","article-title":"Obesity-related hypertension: pathogenesis, cardiovascular risk, and treatment: a position paper of The Obesity Society and the American Society of Hypertension.","volume":"15","author":"L Landsberg","year":"2013","journal-title":"J Clin Hypertens (Greenwich)."},{"issue":"2","key":"pone.0317688.ref057","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jbspin.2010.04.011","article-title":"The relationship between body mass index and hip osteoarthritis: a systematic review and meta-analysis","volume":"78","author":"L Jiang","year":"2011","journal-title":"Joint Bone Spine"},{"issue":"3","key":"pone.0317688.ref058","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1016\/j.jbspin.2011.05.015","article-title":"Body mass index and susceptibility to knee osteoarthritis: a systematic review and meta-analysis","volume":"79","author":"L Jiang","year":"2012","journal-title":"Joint Bone Spine"},{"issue":"2","key":"pone.0317688.ref059","first-page":"3","article-title":"Risk factors for hypertension","volume":"30","author":"AA Leung","year":"2019","journal-title":"Canada. Health Rep"},{"issue":"4","key":"pone.0317688.ref060","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1002\/art.33467","article-title":"The excess burden of osteoarthritis in the province of Ontario","volume":"64","author":"J-E Tarride","year":"2012","journal-title":"Canada. Arthritis Rheum"},{"issue":"11","key":"pone.0317688.ref061","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1503\/cmaj.071283","article-title":"Prevalence and incidence of hypertension from 1995 to 2005: a population-based study.","volume":"178","author":"K Tu","year":"2008","journal-title":"CMAJ."},{"issue":"55","key":"pone.0317688.ref062","first-page":"1","article-title":"Impact of multimorbidity: acute morbidity, area of residency and use of health services across the life span in a region of south Europe.","volume":"15","author":"Q Foguet-Boreu","year":"2014","journal-title":"BMC Fam Pract"},{"key":"pone.0317688.ref063","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/2235042X19893470","article-title":"Urban\u2013rural and socioeconomic status: Impact on multimorbidity prevalence in hospitalized patients.","volume":"10","author":"L Robertson","year":"2020","journal-title":"J. Comorbidity."},{"issue":"14","key":"pone.0317688.ref064","first-page":"1265","article-title":"for the Canadian Cardiovascular Outcomes Research Team. Regional variation in self-reported heart disease prevalence in Canada","volume":"21","author":"C-M Chow","year":"2005","journal-title":"Can J Cardiol"},{"key":"pone.0317688.ref065","article-title":"High Blood Pressure","author":"Statistics Canada"},{"key":"pone.0317688.ref066","article-title":"Arthritis","author":"Statistics Canada"},{"issue":"3","key":"pone.0317688.ref067","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1093\/oxfordjournals.aje.a010208","article-title":"Do Health Interview Surveys Yield Reliable Data on Chronic Illness among Older Respondents?","volume":"151","author":"M Beckett","year":"2000","journal-title":"Am. J. Epidemiol"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0321700","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,4,8]],"date-time":"2025-04-08T00:00:00Z","timestamp":1744070400000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317688","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T18:36:24Z","timestamp":1737570984000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0317688"}},"subtitle":[],"editor":[{"given":"Bruno Pereira","family":"Nunes","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,22]]},"references-count":67,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0317688","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,22]]}}}