Multiple Chronic Conditions and Life Expectancy A Life Table Analysis
Multiple Chronic Conditions and Life Expectancy A Life Table Analysis
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DOI：
10.1097/mlr.0000000000000166
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发表时间：
2014-08-01
期刊：
影响因子：
3
通讯作者：
Anderson, Gerard F.
中科院分区：
文献类型：
--
作者：
DuGoff, Eva H.;Canudas-Romo, Vladimir;Anderson, Gerard F.
背景：患有多种慢性疾病的人数正在增加，但我们对多种疾病对预期寿命的影响知之甚少。目的：我们通过慢性病的数量来分析医疗保险受益人的预期寿命。研究设计：采用单减量期生命表的回顾性队列研究。对象：截至2008年1月1日，年龄在67岁及以上的医疗保险服务收费受益人（N = 1,372,272）。衡量标准：我们的主要结果衡量标准是预期寿命。我们根据性别、种族、选定的慢性病（心脏病、癌症、慢性阻塞性肺病、中风和阿尔茨海默病）和合并症的数量对研究对象进行分类。共病是通过慢性病仓库和查尔森共病指数收集的疾病计数来测量的。结果：预期寿命随着慢性疾病的增加而减少。一个67岁没有慢性疾病的人平均能多活22.6年。如果一个67岁的人患有5种慢性病和bb0 = 10种慢性病，那么他的寿命将分别减少7.7年和17.6年。每增加一种慢性疾病，预期寿命的平均边际下降为1.8年——从第一种疾病减少0.4年到第六种疾病减少2.6年。这些结果在性别和种族上是一致的。我们观察到67岁时不同条件下预期寿命的差异，但这些差异随着年龄和合并症数量的增加而减少。结论：在确定人口预测和信托基金偿付能力时，社会保障和医疗保险精算师应考虑到越来越多的患有多种慢性病的受益人。
Background: The number of people living with multiple chronic conditions is increasing, but we know little about the impact of multimorbidity on life expectancy.Objective: We analyze life expectancy in Medicare beneficiaries by number of chronic conditions.Research Design: A retrospective cohort study using single-decrement period life tables.Subjects: Medicare fee-for-service beneficiaries (N = 1,372,272) aged 67 and older as of January 1, 2008.Measures: Our primary outcome measure is life expectancy. We categorize study subjects by sex, race, selected chronic conditions (heart disease, cancer, chronic obstructive pulmonary disease, stroke, and Alzheimer disease), and number of comorbid conditions. Comorbidity was measured as a count of conditions collected by Chronic Conditions Warehouse and the Charlson Comorbidity Index.Results: Life expectancy decreases with each additional chronic condition. A 67-year-old individual with no chronic conditions will live on average 22.6 additional years. A 67-year-old individual with 5 chronic conditions and >= 10 chronic conditions will live 7.7 fewer years and 17.6 fewer years, respectively. The average marginal decline in life expectancy is 1.8 years with each additional chronic condition-ranging from 0.4 fewer years with the first condition to 2.6 fewer years with the sixth condition. These results are consistent by sex and race. We observe differences in life expectancy by selected conditions at 67, but these differences diminish with age and increasing numbers of comorbid conditions.Conclusions: Social Security and Medicare actuaries should account for the growing number of beneficiaries with multiple chronic conditions when determining population projections and trust fund solvency.