MORTALITY DECLINE AMONG THE AGED--EXPLANATORY FACTORS

拟议研究的具体目标是阐明 这就解释了观察到的总死亡率下降和原因- 在一个明确界定的 1967年至1981年的人口，并确定是否有 医疗服务利用率的增加或减少 死亡率下降。 以下因素对下降的相对贡献 将评估死亡率：a）卒中发生率下降 和肺炎，常见的潜在或促成死亡的原因 B）中风病死率下降， 肺炎由于不太频繁或严重发生的生活- 威胁性并发症、合并症或风险因素。 这些研究问题对于预测 未来的健康状况和卫生服务需求的迅速 人口中的老年人越来越多。 这项研究将 包括对特定年龄组的长期趋势的回顾性分析， 死亡率、发病率和医疗利用率 1967年至1981年期间， 西北地区。 研究数据将来自现有的 计算机化的会员资格，出院和门诊档案， 以及从医疗记录提取和随访。 泊松 额外泊松变化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合作 一位医学流行病学家和一位生物统计学家， 成功完成了几项联邦资助的研究， 凯撒医疗机构的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.