Improvement and decline in health status from late middle age: Modeling age-related changes in deficit accumulation
Improvement and decline in health status from late middle age: Modeling age-related changes in deficit accumulation
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DOI：
10.1016/j.exger.2007.08.002
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发表时间：
2007-11-01
影响因子：
3.9
通讯作者：
Rockwood, Kenneth
中科院分区：
文献类型：
--
作者：
Mitnitski, Arnold;Song, Xiaowei;Rockwood, Kenneth
在一项前瞻性多组队列研究中，我们调查了从中年后期开始，个人的健康状况如何改善或下降。在加拿大全国人口健康调查中，估计了1994年至2000年期间基线时年龄在55岁以上的4 330人（58.8%为妇女）在不同健康状态之间的转换概率。健康状况由赤字计数定义，使用33个健康相关变量组合在一个脆弱指数中。对于每个时间间隔，积累赤字的机会与赤字的数量线性增加。老年幸存者（70-85岁）的稳定或改善机会（52%; 95%置信区间50-54%）略低于中年晚期（56%; 54-58%）。健康状态的变化可以通过修改后的泊松分布以高精度（R-2 = 0.92）来描述，使用四个参数：累积额外缺陷的背景几率，在现有数量下发生更多或更少缺陷的机会，以及相应的死亡概率。在22个赤字时观察到赤字积累的年龄不变的限制。从中年后期开始，健康状态的转变以一种很容易建模的规律发生。健康的改善可以发生在任何年龄。在所有年龄段，赤字积累都是有限的。(C)2007年爱思唯尔公司All rights reserved.
In a prospective multi-panel cohort study, we investigated how, from late middle age, individuals' health status improves or declines. In the Canadian National Population Health Survey, transition probabilities between different health states were estimated for 4330 people (58.8% women) aged 55+ at baseline over 2-year intervals from 1994 to 2000. Health status was defined by a deficit count, using 33 health-related variables combined in a frailty index. For each time interval, the chance of accumulating deficits increased linearly with the number of deficits. Older survivors (aged 70-85) showed a slightly lower chance of stability or improvement (52%; 95% confidence interval 50-54%) compared with those in late middle age (56%; 54-58%). Changes in health states can be described with high accuracy (R-2 = 0.92) by a modified Poisson distribution, using four parameters: the background odds of accumulating additional deficits, the chance of incurring more or fewer deficits, given the existing number, and the corresponding probabilities of dying. An age-invariant limit to deficit accumulation was observed at 22 deficits. From late middle age, transitions in health states occur with a regularity that is easily modeled. Improvements in health can occur at any age. At all ages, there is a limit to deficit accumulation. (C) 2007 Elsevier Inc. All rights reserved.