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Assessing morbidity compression in two cohorts from the Health and Retirement Study.

ABSTRACT: Increases in life expectancy are hypothesised to be associated with shorter proportional time spent with morbidity (compression of morbidity). We assessed whether this has occurred among older adults in the USA during the 1990s and 2000s.We used data from the Health and Retirement Study to estimate a morbidity score based on eight chronic conditions and compare it (1) prospectively between two age-matched cohorts in 1992 and 2004 over a 6-year follow-up, and (2) retrospectively in the three waves prior to death among respondents who die in (1998-2004) and (2004-2010).Prospective assessment shows significantly higher prevalence in 6 of eight chronic conditions in the 2000s, with 37% higher diabetes prevalence. A retrospective evaluation shows significantly higher prevalence in 7 of eight chronic conditions in the three waves prior to death for (2004-2010) versus (1998-2004), with 41% higher prevalence of arthritis. Importantly, the farther away from time of death, the higher the average number of chronic conditions in (2004-2010).Using the largest longitudinal ageing study in the USA, we found no clear evidence of compression of morbidity as measured by self-reported chronic disease. Older adults in the USA may be experiencing greater disease burden in recent times.

SUBMITTER: Beltran-Sanchez H

PROVIDER: S-EPMC5486403 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Assessing morbidity compression in two cohorts from the Health and Retirement Study.

Beltrán-Sánchez Hiram H Jiménez Marcia P MP Subramanian S V SV

Journal of epidemiology and community health 20160421 10

<h4>Background</h4>Increases in life expectancy are hypothesised to be associated with shorter proportional time spent with morbidity (compression of morbidity). We assessed whether this has occurred among older adults in the USA during the 1990s and 2000s.<h4>Methods</h4>We used data from the Health and Retirement Study to estimate a morbidity score based on eight chronic conditions and compare it (1) prospectively between two age-matched cohorts in 1992 and 2004 over a 6-year follow-up, and (2 ...[more]

PMID: 27103663

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Project description:Description: The University of Michigan Health and Retirement Study (HRS) is a longitudinal survey of a representative sample of Americans over the age of 50. Supported by the National Institute on Aging (NIA U01AG009740) and the Social Security Administration, the HRS is designed to provide reliable data on the decisions, choices, and behaviors of people as they age and respond to changes in public policy, the economy, and health. The study obtains information every two years about income and wealth, health and use of health services, work and retirement, and family connections. Through its unique and in-depth interviews, the HRS provides an invaluable and growing body of multidisciplinary data that researchers can use to address important questions about the challenges and opportunities of aging. Because of its innovation and importance, the HRS has become the model and hub for a growing network of harmonized longitudinal aging studies around the world. Origins of the HRS. As the population ages it is increasingly important to obtain reliable data about aging and topics that are relevant to a range of policy issues in aging. To address this need, the National Institutes on Aging (NIA) established a cooperative agreement with the University of Michigan Institute for Social Research to collect such data. The HRS launched data collection in 1992 and has re-interviewed the original sample of respondents every two years since then. By adding new cohorts and refreshing the sample, the HRS has grown to become the largest, most representative longitudinal panel study of Americans 50 years and older. HRS Study Design. The target population for the original HRS cohort includes all adults in the contiguous United States born during the years 1931-1941 who reside in households, with a 2:1 oversample of African-American and Hispanic populations. The original sample is refreshed with new birth cohorts (51-56 years of age) every six years. The sample has been expanded over the years to include a broader range of birth cohorts as well. The target population for the AHEAD survey consists of United States household residents who were born in 1923 or earlier. Children of the Depression (CODA) recruits households born 1924-1930, Warbabies 1942-47, Early Boomers 1948-53, and Mid-Boomers 1954-59. The current sample is over 26,000 persons in 17,000 households. Data collection includes a mixed mode design combining in-person, telephone, mail, and Internet. For consenting respondents, HRS data is linked at the individual level to administrative records from Social Security and Medicare claims. Genetic Research in the HRS. The HRS is now genotyping 2.5 million single nucleotide polymorphisms (SNPs) on respondents using Illumina's Human Omni2.5-Quad (Omni2.5) BeadChip methodology. The genotyping is being performed by the NIH Center for Inherited Disease Research (CIDR). Saliva was collected on half of the HRS sample each wave starting in 2006. In 2006, saliva was collected using a mouthwash collection method. In 2008, the data collection method switched to the Oragene kit. Saliva completion rates were 83% in 2006 and 84% in 2008. Based on prior rates of consent and completion, we expect an additional 6,000 Oragene samples to be added by 2012, including a substantial expansion of the minority sample. HRS Phenotypic data. Phenotypic data are available on a variety of dimensions. Health measures include physical/psychological self-report, various health conditions, disabilities; cognitive performance; health behaviors (smoking, drinking, exercise), physical performance and anthropomorphic measures, and biomarkers (HbA1c, Total Cholesterol, HDL, CRP, Cystatin-C). Data are also available on health services including utilization, insurance and out-of-pocket spending with linkage to Medicare records. Economic measures include employment status/history, earnings, disability, retirement, type of work, income by source, wealth by asset type, capital gains/debt, consumption, linkage to pensions, Social Security earnings/benefit histories. There is also extensive information on family structure, proximity, transfers to/from of money, time, social and psychological characteristics, as well as a wide range of demographics. Performance on a cognitive test combining immediate and delayed word recall was selected as an example trait for the dbGaP data release. In the immediate word recall task the interviewer reads a list of 10 nouns to the respondent and asks the respondent to recall as many words as possible from the list in any order. After approximately five minutes of asking other survey questions, the respondent is asked to recall the nouns previously presented as part of the immediate recall task. The total recall score is the sum of the correct answers to these two tasks, with a range of 0 to 20. Researchers who wish to link to other HRS measures not in dbGaP will be able to apply for access from HRS. A separate Data Use Agreement (DUA) will be required for linkage to the HRS data. See the HRS website (<a href="http://hrsonline.isr.umich.edu/gwas" target="_blank">http://hrsonline.isr.umich.edu/gwas</a>) for details.

Project description:ObjectiveDespite the popular belief that baby boomers are ageing in better health than previous generations, limited scientific evidence is available since baby boomers have turned retirement age only recently. This study aimed to compare self-reported health status at ages 65-70 years among three cohorts of older people born before, during and at the end (baby boomers) of the Second World War.DesignRepeated cross-sectional population-based study.SettingCommunity in a region of French-speaking Switzerland.ParticipantsCommunity-dwelling older adults who enrolled in the Lausanne cohort 65+ study at ages 65-70 years in 2004 (n=1561), 2009 (n=1489) or 2014 (n=1678).OutcomesNumber of self-reported chronic conditions (from a list of 11) and chronic symptoms (from a list of 11); depressive symptoms; self-rated health (very good, good, average, poor or very poor); fear of disease (not afraid at all, barely afraid, a bit afraid, quite afraid or very afraid); self-perception of ageing; disability in basic and instrumental activities of daily living.ResultsThere was no significant difference between cohorts in the number of self-reported chronic conditions and chronic symptoms as well as the presence of difficulty in basic activities of daily living, depressive symptoms, fear of disease and negative self-perception of ageing. In women only, significant differences between cohorts were observed in self-rated health (p=0.005) and disability in instrumental activities of daily living (p=0.003), but these associations did not remain significant in logistic regression models adjusted for sociodemographic characteristics and unhealthy behaviours.ConclusionsDespite important sociodemographic differences between older baby boomers and earlier cohorts, most health indicators did not suggest any trend towards a compression of morbidity. Future studies comparing these three cohorts at more advanced age are required to further investigate whether differences emerge later in life.

Project description:BACKGROUND:The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years. METHODS:In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11?414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years. FINDINGS:In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0·8-2·3 year delay in disability across the three metrics (mobility, 63·0 [95% CI 62·3-63·6] to 64·8 [63·6-65·7], p=0·01; instrumental activities of daily living, 63·5 [63·0-64·0] to 64·3 [63·0-65·3], p=0·24; activities of daily living, 62·7 [62·1-63·3] to 65·0 [63·5-65·9], p<0·0001) and 1·3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2·8 [2·5-3·2] to 1·5 [1·3-1·9]; p<0·0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1·1-2·3 year delay in disability across the three metrics (mobility, 61·3 [95% CI 60·5-62·1] to 63·2 [61·5-64·5], p=0·0416; instrumental activities of daily living, 63·0 [62·4-63·7] to 64·1 [62·7-65·2], p=0·16; activities of daily living, 62·3 [61·6-63·0] to 64·6 [63·1-65·6], p<0·0001) and 0·8 fewer life-years lost by age 70 years (1·9 [1·7-2·2] to 1·1 [0·9-1·5]; p<0·0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0·0001 for all comparisons). INTERPRETATION:Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years. FUNDING:US Department of Health & Human Services and the US Centers for Disease Control and Prevention.

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Assessing morbidity compression in two cohorts from the Health and Retirement Study.

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Assessing morbidity compression in two cohorts from the Health and Retirement Study.

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