EPIDEMIOLOGY OF CHRONIC DISEASE IN THE OLDEST OLD

在过去的几十年里，死亡率的下降起到了一定作用 到美国超过的人口比例上升 人口，特别是84岁以上的人，是“高龄老人”。这 在可预见的未来，老龄化趋势预计将持续下去。 由于老龄化与发病率的增加和 慢性病的流行，许多健康科学家预测 医疗保健的需求在未来几年将稳步增长 往前走。然而，另一些人认为，健康状况的改善 护理和风险因素的减少延缓了 慢性病更多的是延缓死亡；因此， 发病和死亡之间的间隔正在缩短， 导致对医疗保健服务的需求减少。 这项拟议的研究将比较九年的死亡率， 慢性病的发病率和流行率，以及保健服务 1971年的队列和1980年的队列。每个队列将包括 从北加州随机挑选的3000名成员 Kaiser Permanente医疗保健计划65岁及以上世卫组织 以前至少做过一次多相健康检查。 每个队列中大约三分之一的人将是80岁或以上。 关于慢性病诊断的信息，具体原因 死亡率、生理和社会人口风险因素，以及 卫生服务利用情况将通过计算机化获得 住院和多阶段健康体检记录以及 医疗表。 我们将检验在1980年的队列死亡率中的假设 更低，慢性病发病率更低，减少 发病率超过了死亡率的降低和健康的使用 服务业较低。 这项研究将由一组经验丰富的调查人员在 美国最大的医疗保健组织的成员样本， 具有高度的组织承诺。

Declining mortality over the past several decades has contributed to an increase in the proportion of persons over 64 in the US population, especially of persons over 84, the "oldest old." This aging trend is expected to continue for the foreseeable future. Since aging is associated with an increased incidence and prevalence of chronic disease, many health scientists predict that the demand for medical care will steadily increase in the years ahead. Others, however, believe that improvements in health care and reductions in risk factors are delaying the onset of chronic disease more than they are delaying death; thus, the interval between onset of disease and death is being compressed, resulting in a decreased demand for medical care services. The proposed research will compare the nine-year mortality, incidence and prevalence of chronic disease, and health services of a 1971 cohort that of a 1980 cohort. Each cohort will consist of 3000 randomly selected members of the Northern California Kaiser Permanente Medical Care Program aged 65 and over who have had at least one prior Multiphasic Health Checkup. Approximately one-third of each cohort will be 80 or older. Information on chronic disease diagnosis, cause-specific mortality, physiological and socio-demographic risk factors, and health services utilization will be obtained from computerized hospitalization and Multiphasic Health Checkup records and from medical charts. We will examine the hypotheses that in the 1980 cohort mortality is lower, chronic disease morbidity is lower, reductions in morbidity exceed reductions in mortality, and use of health services is lower. The study will be done by a team of experienced investigators on a sample of members of the largest HMO in the United States, with a high level of organizational commitment.