MORTALITY DECLINE AMONG THE AGED--EXPLANATORY FACTORS

拟议研究的具体目的是阐明因素。 这解释了观察到的总死亡率的下降和原因- 明确定义的老年人的特定死亡率 1967年至1981年之间的人口数量，并确定是否有 是否与医疗服务利用率的增加或减少相关 随着死亡率的下降。 以下因素对下降的相对贡献 将评估：a)中风发病率的下降 肺炎，常见的潜在或促成死亡的原因 老年人；b)中风病死率下降； 因较少或严重的生命事件而引起的肺炎- 危险的并发症、合并症或危险因素。 这些研究问题对预测至关重要。 未来的健康状况和健康服务需求快速增长 人口中老年人口的数量不断增加。这项研究将 包括对特定年龄段的长期趋势的回顾分析 年死亡率、发病率和医疗服务利用率 1967-1981年期间的德皇长老成员 西北地区。研究数据将来自现有 计算机化的会员资格、出院和门诊档案， 并从病历提取和随访中获取信息。泊松 超泊松方差的回归和对数线性模型将 用于检验死亡率数据中的周期效应。 拟议的研究涉及两个已建立的 一名医学流行病学家和一名生物统计学家--世界卫生组织 已经成功完成了几项由联邦政府资助的研究 凯撒永久数据系统和医疗记录。

The specific aims of the proposed study are to elucidate factors which explain the observed decline in total mortality and cause- specific mortality among elderly persons in a well-defined population between 1967 and 1981 and to ascertain whether there has been an increase or decrease in medical care utilization associated with mortality decline. The relative contributions of the following factors to the decline in mortality will be assessed: a) decline in incidence of stroke and pneumonia, common underlying or contributing cause of death among the elderly; b) decline in case fatality rates for stroke and pneumonia due to less frequent or severe occurrence of life- threatening complications, co-morbidities or risk factors. These research questions are of critical importance for predicting the future health status and health services needs of the rapidly increasing numbers of elderly in the population. The study will consist of retrospective analyses of secular trends of age-specific rates of mortality, morbidity and medical care utilization among elderly Kaiser Permanente members during the period 1967-1981 in the Northwest Region. Study data will be from existing computerized membership, hospital discharge and outpatient files, and from medical record abstraction and follow-up. Poisson regression and log-linear models for extra-Poisson variation will be used to test for period effects in the mortality data. The proposed study involves the collaboration of two established investigators a medical epidemiologist and a biostatistian--who have successfully completed several federally funded studies using the Kaiser Permanente data systems and medical records.