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Gimeno L, Goisis A, Dowd JB, Ploubidis GB. Cohort Differences in Physical Health and Disability in the United States and Europe. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae113. [PMID: 38898719 PMCID: PMC11272052 DOI: 10.1093/geronb/gbae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVES Declines in mortality have historically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States, are less healthy than previous generations at the same age. We compared generational trends in physical health in the United States, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts. METHODS Using data from nationally representative studies of adults aged ≥50 years from the United States (Health and Retirement Study, n = 26,939), England (English Longitudinal Study of Ageing, n = 14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, n = 72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959). RESULTS Age-adjusted prevalence of doctor-diagnosed chronic disease increased across successive cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the United States and Europe, we observed a structural break in disability trends, with declines observed in prewar cohorts slowing, stalling, or reversing for cohorts born since 1945. DISCUSSION In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.
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Affiliation(s)
- Laura Gimeno
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London, London, UK
| | - Alice Goisis
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London, London, UK
| | - Jennifer B Dowd
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford, Oxford, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London, London, UK
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Lloyd SJ, Striessnig E, Achebak H, Hajat S, Muttarak R, Quijal-Zamorano M, Rizzi S, Vielma C, Ballester J. Remeasuring the influence of ageing on heat-related mortality in Spain, 1980 to 2018. ENVIRONMENTAL RESEARCH 2024; 248:118408. [PMID: 38311205 DOI: 10.1016/j.envres.2024.118408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/19/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
Climate change and population ageing are converging challenges that are expected to significantly worsen the health impacts of high temperatures. We aimed to remeasure the implications of ageing for heat-related mortality by comparing time trends based on chronological age (number of years already lived) with those derived from the application of state-of-the-art demographic methodology which better captures the dynamics of evolving longevity: prospective age (number of years still to be lived). We conducted a nationwide time-series analysis of 13 regions in Spain over 1980-2018 using all-cause mortality microdata for people aged 65+ and annual life tables from the Spanish National Institute of Statistics, and daily mean temperatures from E-OBS. Based on confounder-adjusted quasi-Poisson regression with distributed lag non-linear models and multivariate meta-analysis in moving 15-year timeslices, we assessed sex-specific changes in absolute risk and impacts for heat-related mortality at extreme and moderate temperatures, for chronological and prospective age groups. In the conventional chronological age analysis, absolute risk fell over the study period (e.g. females, extreme heat: -54%; moderate heat: -23%); after accounting for rising longevity, the prospective age analysis, however, found a smaller decline in risk for extreme heat (-15%) and a rise for moderate heat (+46%). Additionally, while the chronological age analysis suggested a shift in mortality towards higher ages, the prospective age analysis showed that over the study period, people of largely the same (prospective) age were impacted. Further, the prospective age analysis revealed excess risk in females (compared to males) rose from 20% to 27% for extreme heat, and from 40% to 70% for moderate heat. Assessing the implications of ageing using a prospective age perspective showed the urgency of re-doubling risk reduction efforts, including accelerating healthy ageing programs that incorporate climate considerations. The age patterns of impacts suggested that such actions have the potential to mitigate ageing-related heat-health threats to generate climate change-ready, healthy societies.
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Affiliation(s)
| | - Erich Striessnig
- Department of Demography, University of Vienna, Vienna, 1010, Austria.
| | - Hicham Achebak
- ISGlobal, Barcelona, 08003, Spain; National Institute of Health and Medical Research (Inserm), Paris, 75013, UK
| | - Shakoor Hajat
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Raya Muttarak
- Department of Statistical Sciences "Paolo Fortunati", University of Bologna, Bologna, Italy, 40126
| | | | - Silvia Rizzi
- The Interdisciplinary Centre on Population Dynamics, University of Southern Denmark, Odense, DK-5320, Denmark
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Gimeno L, Goisis A, Dowd JB, Ploubidis GB. Generational differences in physical health and disability in the United States and Europe. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.16.24301347. [PMID: 38293226 PMCID: PMC10827238 DOI: 10.1101/2024.01.16.24301347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Objectives Declines in mortality have typically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States (US), are less healthy than previous generations at the same age. We compared generational trends in physical health in the US, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts. Methods Using data from nationally representative studies of adults aged ≥50 years from the US (Health and Retirement Study, n=26,939), England (English Longitudinal Study of Ageing, n=14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, n=72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959). Results Age-adjusted prevalence of doctor-diagnosed chronic disease increased across cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the US and Europe, we observed a structural break in disability trends, with declines observed in pre-war cohorts slowing, stalling, or reversing for cohorts born since 1945. Discussion In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.
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Affiliation(s)
- Laura Gimeno
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London
| | - Alice Goisis
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London
| | - Jennifer B. Dowd
- Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford
| | - George B. Ploubidis
- Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London
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Spijker JJA, Rentería E. Shifts in Chronic Disease Patterns Among Spanish Older Adults With Multimorbidity Between 2006 and 2017. Int J Public Health 2023; 68:1606259. [PMID: 37920847 PMCID: PMC10618995 DOI: 10.3389/ijph.2023.1606259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
Objectives: To investigate changes in multimorbidity patterns among Spanish older adults. Methods: Data come from the Spanish National Health Survey (ENSE) for individuals aged 60-89 years (2006: n = 9,758; 2017: n = 8,535). Prevalence rates and relative risks of 20 chronic conditions are estimated for the multimorbidity (3+ chronic conditions) sample, along with observed-to-expected prevalence of three-way disease combinations. Principal component and cluster analyses identify multimorbidity patterns and track temporal changes. Results: Overall, multimorbidity remained stable [2006: 59.6% (95% CI: 58.7%-60.6%); 2017: 60.3% (CI: 59.3%-61.3%)], except at older ages. Women exhibited higher multimorbidity prevalence, but sex differences declined by five percentage points. Low-high education differences widened by three percentage points. In 2017 most individuals living with multimorbidity experienced hypertension (63.4%), osteoarthrosis (62.4%) and chronic back pain (55.9%). These chronic conditions also dominate the most common triadic combinations. Multimorbid men also saw increases in cholesterol and diabetes. Conclusion: Multimorbidity trends and the most common combination of diseases can help plan healthcare for an ageing population. Sex and socioeconomic differences pose additional public health challenges as women and deprived populations tend to have more health complexities.
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Stable Gender Gap and Similar Gender Trend in Chronic Morbidities between 1997-2015 in Adult Canary Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159404. [PMID: 35954761 PMCID: PMC9368162 DOI: 10.3390/ijerph19159404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/24/2022] [Accepted: 07/29/2022] [Indexed: 01/25/2023]
Abstract
There is little information about the trend of the gender gap in chronic morbidities and whether the trend of expansion occurs equally in the age and gender groups. The objectives were to examine the consistency and stability of the gender gap in the main self-reported chronic morbidities in the general population, and, likewise, to analyze the trend of major chronic morbidities between 1997 and 2015 in men and women across age groups. The data were extracted from the Canary Health Survey, which uses a probabilistic sampling in the population >16 years of age, for the years 1997 (n = 2167), 2004 (n = 4304), 2009 (n = 4542), and 2015 (n = 4560). The data for the twelve most frequent chronic morbidities were analyzed using logistic regression, estimating the annual change ratio between 1997 and 2015, adjusting for age and educational level. The interaction of age with the period (1997−2015) was examined to analyze the rate of change for each morbidity in the age groups. Musculoskeletal diseases, headaches, anxiety and depression, and peripheral vascular diseases showed a stable gender gap across observed years. High cholesterol and high blood pressure tended to a gap reduction, while heart disease, diabetes, and respiratory disease did not show a significant gender gap along the period. The trend of the main chronic morbidities increased similarly in men and women in all age groups, but significantly in women older than 60 years and in men older than 45 years. Aging explained a substantial part of the trend of increasing prevalence of the main chronic morbidities, but not totally. Factors other than age and education are driving the increase in chronic morbidity in older age groups.
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Meinow B, Li P, Jasilionis D, Oksuzyan A, Sundberg L, Kelfve S, Wastesson JW. Trends over two decades in life expectancy with complex health problems among older Swedes: implications for the provision of integrated health care and social care. BMC Public Health 2022; 22:759. [PMID: 35421981 PMCID: PMC9012017 DOI: 10.1186/s12889-022-13099-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Due to population aging, it is essential to examine to what extent rises in life expectancy (LE) consist of healthy or unhealthy years. Most health expectancy studies have been based on single health measures and have shown divergent trends. We used a multi-domain indicator, complex health problems (CHP), indicative of the need for integrated medical and social care, to investigate how LE with and without CHP developed in Sweden between 1992 and 2011. We also addressed whether individuals with CHP more commonly lived in the community in 2011 compared to earlier years. METHODS CHP were defined as having severe problems in at least two of three health domains related to the need for medical and/or social care: symptoms/diseases, cognition/communication, and mobility. The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), a nationally representative survey of the Swedish population aged ≥ 77 years with waves in 1992, 2002 and 2011 (n≈2000), was used to estimate the prevalence of CHP. Age- and gender-specific death rates were obtained from the Human Mortality Database. The Sullivan method was deployed to calculate the remaining life expectancy with and without CHP. The estimates were decomposed to calculate the contribution of changes from morbidity and mortality to the overall trends in LE without CHP. RESULTS Between 1992 and 2011, both total LE (+ 1.69 years [95% CI 1.56;1.83] and LE without CHP (+ 0.84 years [-0,87;2.55]) at age 77 increased for men, whereas LE at age 77 increased for women (+ 1.33 [1.21;1.47]) but not LE without CHP (-0.06 years [-1.39;1.26]). When decomposing the trend, we found that the increase in LE with CHP was mainly driven by an increase in the prevalence of CHP. Among individuals with CHP the proportion residing in care homes was lower in 2011 (37%) compared to 2002 (58%) and 1992 (53%). CONCLUSIONS The findings, that an increasing number of older people are expected to live more years with CHP, and increasingly live in the community, point towards a challenge for individuals and families, as well as for society in financing and organizing coordinated and coherent medical and social services.
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Affiliation(s)
- Bettina Meinow
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden. .,Stockholm Gerontology Research Center, Stockholm, Sweden.
| | - Peng Li
- Max Planck Institute for Demographic Research, Rostock, Germany
| | | | - Anna Oksuzyan
- Max Planck Institute for Demographic Research, Rostock, Germany.,Chair of Demography and Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Louise Sundberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Susanne Kelfve
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,Division of Ageing and Social Change, Department of Culture and Society, Linköping University, Linköping, Sweden
| | - Jonas W Wastesson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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Barak Y, Leitch S, Glue P. The Great Escape. Centenarians' exceptional health. Aging Clin Exp Res 2021; 33:513-520. [PMID: 32488471 DOI: 10.1007/s40520-020-01552-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Centenarians escapers are those who reached 100 years of age without the diagnosis of any of the common age-related diseases and exploring their characteristics will inform about successful ageing. No previous study has examined centenarians free of common chronic diseases amongst New Zealand centenarians. METHODS Retrospective observational cross-sectional review of a national dataset determining the prevalence of depression, dementia, diabetes and hypertension, smoking, physical activity and social relationships among older adults (aged 60-99 years) and centenarians. Participants were all older New Zealanders living independently in the community who completed the international Residential Assessment Instrument-Home Care (interRAI-HC) assessment during the study's 5-year period (July 2013-June 2018). RESULTS The assessments of 292 centenarians (mean age 101.03, SD 1.27 years) and 103,377 elderly (mean age 81.7, SD 5.7 years) were analysed. Compared to the elderly, centenarians were more likely to be female (74.7%, compared with 59.3% elderly, p < 0.001). Centenarians free of common chronic diseases did not differ from other centenarians on any of the analysed variables. Reduction in smoking rates and steady high rates of social engagement were associated with reaching a centenarian status free of common chronic diseases compared with older adults. CONCLUSIONS Not smoking and being socially engaged throughout older age were associated with being a centenarian free of common chronic diseases. This study adds to our understanding the complexities of attaining exceptional longevity.
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Zueras P, Rentería E. Trends in disease-free life expectancy at age 65 in Spain: Diverging patterns by sex, region and disease. PLoS One 2020; 15:e0240923. [PMID: 33175856 PMCID: PMC7657566 DOI: 10.1371/journal.pone.0240923] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022] Open
Abstract
Life expectancy in Spain is among the highest in the world. Nevertheless, we do not know if improvements in health conditions at older ages have followed postponements of death. Previous studies in Spain show a stable trend in years lived in ill health in the past. In this paper we investigate changes between 2006, 2012 and 2017 in life expectancy with and without disease at age 65 in Spain and, for the first time, in Spanish regions, which have autonomous powers of health planning, public health and healthcare. Results show that, at the country level, disease-free life expectancy reduced between 2006 and 2017 in Spain. This was explained by an expansion of most diseases except for some cardiovascular and respiratory chronic conditions. However, at the regional level the evolution was different, especially regarding each disease and sex. First, regional differences reduced between 2006 and 2012 but largely widened in 2017, suggesting that not all regions had the same ability to recover after the 2008 financial crisis that caused government cuts to health services. Second, regional analysis also highlighted diverging trends by sex. While men experienced expansion of morbidity in most regions, women experienced a compression in about half of them, ending up with women showing higher disease-free life expectancies than men in 9 out of the 17 regions considered. This study, then, calls attention to the importance of focusing the analysis of health surveillance to more disaggregated levels, more in accordance with the level of health management, as regional trends showed heterogeneity in the prevalence of diseases and different progresses in the relationship between sexes.
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Affiliation(s)
- Pilar Zueras
- Centre d'Estudis Demogràfics, Bellaterra, Barcelona, Spain
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The impact of demographic change in the balance between formal and informal old-age care in Spain. Results from a mixed microsimulation–agent-based model. AGEING & SOCIETY 2020. [DOI: 10.1017/s0144686x20001026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Abstract
Changes in population and family structures are altering the provision of care for dependent older people. In Southern European countries like Spain, such care is still largely provided by family, typically spouses and adult daughters. However, an increasing proportion of women have entered the labour force, thereby affecting their availability. To study the demand and supply balance of informal care and to quantify the need for formal care when there is a deficit, we have developed a mixed microsimulation–agent-based model (ABM). Based on nuptiality, fertility and mortality levels of cohorts born at ten-year intervals between 1908 and 1968, the model starts with a microsimulation of the lifecycle of individuals and their close relatives until death. The ABM then determines the amount of time available or needed to care for family members, starting from age 50. Estimates are derived from Spanish survey data on employment, disability and time of care received. Surprisingly, results show that the family care deficit was greater in the older cohorts due to higher mortality and thus a greater impact of widowhood. However, for future elderly persons, we foresee that persistent below-replacement fertility and, paradoxically, the prolongation of the lifespan of couples will increase the demand for formal care as there will be more couples with both members incapacitated but without children to take care of them.
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Tetzlaff J, Muschik D, Epping J, Eberhard S, Geyer S. Expansion or compression of multimorbidity? 10-year development of life years spent in multimorbidity based on health insurance claims data of Lower Saxony, Germany. Int J Public Health 2017. [PMID: 28283685 DOI: 10.1007/s00038‐017‐0962‐9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Our study examined how life years spent in multimorbidity changed over a period of 10 years (2005-2014) and whether morbidity expansion or compression has taken place. There is a little evidence on whether life years gained due to increasing life expectancy are spent in good health, or if they are accompanied by morbidity expansion. METHODS The analyses are based on German administrative claims data. Multimorbidity was defined as a combination of at least six chronic conditions and polypharmacy. After having estimated age-standardized prevalence, time trends for life years with and without multimorbidity, and the proportion of life years spent in multimorbidity (morbidity ratio) were estimated. RESULTS Prevalence proportions of multimorbidity rose continuously. Increasing life expectancies were accompanied by increasing life years with multimorbidity, decreasing multimorbidity-free life years, and by an increasing morbidity ratio. CONCLUSIONS The lifespan spent in multimorbidity was increasing over time. Our findings indicate a growing burden of multimorbidity and an increasing proportion of life years with multiple chronic conditions. It can be concluded that an expansion of morbidity in absolute and in relative terms has occurred. The findings stress the importance of prevention, healthy lifestyles, and improved medical care strategies meeting the specific requirements of patients with multimorbidity.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
| | - Denise Muschik
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Sveja Eberhard
- AOK Niedersachsen-Statutory Health Insurance of Lower Saxony, Hanover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Expansion or compression of multimorbidity? 10-year development of life years spent in multimorbidity based on health insurance claims data of Lower Saxony, Germany. Int J Public Health 2017; 62:679-686. [DOI: 10.1007/s00038-017-0962-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 02/08/2017] [Accepted: 02/20/2017] [Indexed: 11/26/2022] Open
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von dem Knesebeck O, Vonneilich N, Lüdecke D. Income and functional limitations among the aged in Europe: a trend analysis in 16 countries. J Epidemiol Community Health 2017; 71:584-591. [DOI: 10.1136/jech-2016-208369] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/11/2016] [Accepted: 12/14/2016] [Indexed: 11/03/2022]
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Morbidity compression: a promising and well-established concept? Int J Public Health 2016; 61:727-8. [DOI: 10.1007/s00038-016-0853-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022] Open
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