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Determinants and trajectories of healthy life expectancy and deficit accumulation in older adults in Germany - follow-up of the KORA-Age cohort study

德国老年人健康预期寿命和赤字积累的决定因素和轨迹 - KORA-Age 队列研究的后续行动

基本信息

批准号：
316904889
负责人：
Professorin Dr. Eva Grill
金额：
--
依托单位：
Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie
依托单位国家：
德国
项目类别：
Research Grants
财政年份：
2016
资助国家：
德国
起止时间：
2015-12-31 至 2019-12-31
项目状态：
已结题

来源：
https://gepris.dfg.de/gepris/projekt/316904889?language=en
关键词：
Determinants trajectories healthy life expectancy

项目摘要

Increasing life expectancy combined with slowing birth rates will be an organizational and financial challenge if this increases the share of persons in the population living longer periods of time with chronic disease. Empirical evidence regarding the compression or extension of morbidity is still ambivalent. Healthy life expectancy (HLE) varies largely across countries, with Germany being below the European average. Here, estimates are ambiguous across gender and age strata and birth cohorts. Heterogeneity in healthy life expectancy can be due to the influence of critical (pre-, peri-post-war) life periods or to the gradual deterioration of functional status over the life span, i.e. deficit accumulation (DA). We therefore propose to study determinants of HLE in a representative sample of the aged German population, taking early life experience as a consequence of birth cohort and DA into account. We plan to use the well-established KORA (Cooperative Health Research in the Region of Augsburg) platform for a new data collection, and to use our already existing data from the KORA-Age cohort. We plan to examine HLE and DA as a function of birth cohort and sex in the KORA Age cohort, and to examine the association of DA with mortality. Since 1984 four cross-sectional population based studies, the KORA surveys S1 to S4, were conducted in Augsburg, Germany, and two surrounding counties. The KORA-Age cohort includes all participants from those KORA surveys aged 65 years or older at the end of 2008, i.e. born in or before 1943. The baseline study of KORA-Age took place in 2009. The proposed cohort study will be carried out as a 7-year re-assessment of estimated 2500 participants of the KORA-Age baseline study. Participants will be aged 73 to 96 years in 2015/2016 (older subgroup, stratum I). Additionally, the younger participants from the KORA surveys who were not yet 65 at the end of 2008 and thus not eligible for KORA-Age baseline but will be 65 to 72 at the end of 2015 will be included as an age- and sex-stratified sample of all KORA S1-S4 participants (i.e. born from 1944 to 1950, younger subgroup, stratum II). All information will be obtained by means of a postal health follow-up with a short health questionnaire and a telephone interview. Health expectancy will be defined as the time spent in different health states until death. As summary measure for DA, a Deficit Accumulation Index (DAI) will be constructed according to a well-defined procedure. The DAI will contain signs and symptoms, diseases, functional impairments and activity restrictions. Multivariable log-linear, mixed-effects and Cox regression models will be fitted to the data. Including a wide span of birth cohorts with longitudinal follow-ups should make it possible to disentangle the mechanisms that lead to a compression or extension of morbidity, separating age, period, and cohort effects.

预期寿命的增加加上出生率的下降，如果这会增加慢性病患者在人口中的比例，那么这将是一个组织和财政挑战。关于发病率的压缩或扩大的经验证据仍然是矛盾的。健康预期寿命（HLE）在各国之间差异很大，德国低于欧洲平均水平。在这方面，性别、年龄层和出生组群的估计数不明确。健康预期寿命的异质性可能是由于关键（战前、战后前后）生命期的影响，或由于生命期内功能状态的逐渐恶化，即赤字积累（DA）。因此，我们建议在德国老年人口的代表性样本中研究HLE的决定因素，同时考虑到出生队列和DA的结果，早期生活经验。我们计划使用完善的KORA（奥格斯堡地区合作健康研究）平台进行新的数据收集，并使用我们现有的KORA年龄组数据。我们计划在KORA年龄队列中检查HLE和DA作为出生队列和性别的函数，并检查DA与死亡率的关系。自1984年以来，在德国奥格斯堡和两个周边县进行了四项基于横断面人群的研究，KORA调查S1至S4。KORA-Age队列包括KORA调查中截至2008年底年龄在65岁或以上的所有参与者，即1943年或之前出生的人。KORA-Age的基线研究于2009年进行。拟定的队列研究将对KORA-年龄基线研究的约2500例受试者进行为期7年的重新评估。2015/2016年参与者的年龄为73至96岁（老年亚组，第I层）。此外，KORA调查中的年轻参与者，在2008年底时尚未达到65岁，因此不符合KORA年龄基线，但在2015年底时将达到65至72岁，将作为所有KORA S1-S4参与者的年龄和性别分层样本（即1944年至1950年出生，年轻亚组，分层II）。所有信息都将通过邮寄健康随访和简短的健康问卷和电话访谈获得。健康预期将被定义为在不同健康状态下直到死亡所花费的时间。作为DA的汇总指标，将根据明确定义的程序构建赤字累积指数（DAI）。DAI将包含体征和症状、疾病、功能障碍和活动限制。将多变量对数线性、混合效应和考克斯回归模型拟合至数据。包括一个广泛的出生队列的纵向随访应该有可能解开的机制，导致发病率的压缩或扩展，分离年龄，时期和队列效应。