Rethinking morbidity compression and morbidity expansion: Differential developments of morbidity and social inequalities in terms of health impairments and chronic diseases.

拟议的项目建立在前一个项目的研究结果的基础上，该项目研究了心肌梗死、中风和功能损害的长期发展是否可以描述为发病率压缩、发病率扩大或动态平衡。第二个主要专题涉及卫生方面的相关社会不平等随着时间的推移而发展。出乎意料的是，在心肌梗死和其他与健康相关的终点中，高龄组出现了压缩，而年轻组则出现了扩张。基于这些发现，我们将研究慢性阻塞性肺疾病(COPD)作为人口健康的重要决定因素是如何随着时间的推移而发展的，以及相关的社会梯度是缩小还是扩大。此外，还将考虑疾病是否根据所考虑的年龄组而有不同的发展，即压缩和扩张是否发生在同一疾病中。与慢性阻塞性肺病有关的分析是使用索赔数据和调查进行的，因此可以复制从不同类型数据得出的结果。这也使得可以对其中一个数据集执行补充分析，而对另一个数据集则不能。根据目前的认识，高年龄组心肌梗死和中风的纵向发展可描述为发病率压缩，这在多大程度上可以归因于随着时间的推移预防性药物的增加。发病率压缩和扩大是描述人口发展的概念，即发病率或死亡率不一定来自相同的个人。该项目的第三部分通过考虑中风、心肌梗死和慢性阻塞性肺病患者合并疾病的纵向发展来离开这一视角。这意味着处于疾病和残疾状态的时间可能会增加，而发病率可能会在人口层面上降低。在该项目的最后部分，关于描述发病率发展的三个概念和疾病的调查结果将纳入人口发病率发展的统一概念。

The proposed project builds on the findings of a previous one where it was examined whether the long-term developments of myocardial infarction, stroke and functional impairments can be described as morbidity compression, morbidity expansion or as a dynamic equilibrium. The second main topic was related to the development of related social inequalities in health over time. Unexpectedly it turned out that in myocardial infarction and in other health-related endpoints compression occurred in the higher age groups, while we found expansion in the younger ones.Based in these findings it will be examined how chronic obstructive pulmonary disease (COPD) as an important determinant of population health develops over time and whether the related social gradients are narrowing or broadening. In addition, it will be considered whether the disease is developing differently according to the age groups considered, i.e., whether compression and expansion are occurring in the same disease. COPD-related analyses are performed both using claims data and surveys, thus making it possible to replicate findings derived from different types of data. This also makes it possible to perform supplementary analyses that may be possible with one of the datasets, but not with the other. According to present knowledge, the longitudinal developments of myocardial infarctions and stroke in higher age groups can be described as morbidity compression, and it has to be examined to what extent this can be attributed to increasing preventive medications over time. Morbidity compression and expansion are concepts describing developments at population level, i.e., numbers of morbidity or mortality may not necessarily be derived from the same individuals. The third part of the project leaves this perspective by considering the longitudinal development of comorbidities of individuals with stroke, myocardial infarction and COPD. This implies that time periods spent in states of disease and disability may increase, while morbidity compression may occur at population level. In the final part of the project the findings on the three concepts and diseases describing morbidity development will be integrated into a unified concept of morbidity development in the population.