Compression of morbidity and its alternatives with the context of health inequalities

Fries的发病压缩假说是指发病、残疾和死亡之间的时间间隔缩短。据推测，预防和生活条件的改善有助于发病率的变化。作为一种悲观的替代方案，格伦伯格提出了一种假设，即发病率的增加是医学进步的意外后果。根据曼顿的说法，作为最后一种选择，动态平衡描述了在疾病和残疾状态下度过的寿命的延长，但管理日常生活的能力得到了提高。对于德国和心肌梗死、中风、多病和功能障碍的病例，将检查发病率的发展是否可以描述为发病率压缩。作为第二步，将考虑发病率的变化是否沿着社会不平等的方向发展。作为第三步，将解释发病率的发展是否以及在多大程度上可以用与健康有关的行为和/或预防和治疗措施的改变来解释。分析的主要依据是2005年至2015年下萨克森州（AOK Niedersachsen）法定健康保险的数据。在项目进行过程中，将对2016年和2017年的数据进行补充。年度数据集中的个体数量约为。2绪。每年。健康保险数据将用于心肌梗死、中风和多病的分析。KORA/ KORA- age研究的数据b应使用用于复制心肌梗死的研究结果，以及基于行为的解释将得到发展。最后，欧洲健康、老龄化和退休调查（SHARE） b应使用的数据，用于检查功能障碍的发展和解释。发病率压缩的发展影响着福利和卫生保健系统未来发展的主要领域。例如，这指的是工作寿命的发展、卫生保健的优先事项设定、老年人的照顾，或如何为老年人自行决定的住房开发住宅。

Fries' hypothesis of morbidity compression refers to the shortening of time periods between the onset of disease, disability, and death. It is assumed that prevention and improved living conditions are contributing to changes of morbidity. As a pessimistic alternative Gruenberg put up the hypothesis of morbidity expansion as an unplanned consequence of medical progress. As a last alternative the dynamic equilibrium according to Manton describes an expansion of lifetimes spent in states of illness and disability, but with improved abilities for managing everyday life. For Germany and for the cases of myocardial infarction, stroke, multimorbidity and functional impairments it will be examined whether the development of morbidity can be described as morbidity compression. As a second step it will be considered whether morbidity changes are developing along the lines of social inequalities. As the third step it will be explained whether and to what extent the development of morbidity can be explained by health-related behaviours and/ or by changes of preventive and curative measures. The main basis of the analyses are data of the Statutory Health Insurance of Lower Saxony (AOK Niedersachsen) of the years 2005 to 2015. During the course of the project the data of 2016 and 2017 will be supplemented. The number of individuals in the annual datasets are approx. 2 Mio. per year. The health insurance data will be used for performing analyses on myocardial infarction, stroke, and multimorbidity. The data of the KORA/ KORA-Age study shall be used for replicating the findings on myocardial infarction, and also behaviour-based explanations shall be developed. Finally, the data of the Survey of Health, Ageing and Retirement in Europe (SHARE) shall be used for examining the development and the explanation of functional impairments. The development of morbidity compression affects major areas of the future development of welfare and the health care system. This refers e.g. to the development of working lifetime, priority setting in health care, the care of the elderly, or on how to develop residences for self-determined housing at old age.