The future of major geriatric disorders in the US elderly

描述(申请人提供)：拟议研究的长期目标是评估目前主要老年疾病的流行病学趋势，包括癌症、急性冠心病、哮喘、阿尔茨海默病？S(AD)。我们将评估发病率和患者的当前和未来趋势？考虑到与联邦医疗保险服务使用文件相关联的国家长期护理调查(NLTCS-M)和与联邦医疗保险服务使用文件相关联的监测流行病学和最终结果(SEER)以及5%的联邦医疗保险服务使用文件(SEER-M)作为对照，在来自国家长期护理调查(NLTCS-M)的老年个人样本中的疾病之间可能存在的协同/对抗作用。拟议研究的特别重点将是评估这些主要的流行病学特征，考虑到疾病之间的依赖性和某些疾病的可能康复对无病寿命的影响。将解决以下具体目标：1)使用NLTCS-M和SEER-M评估美国老年个体的发病率、患病率、恢复率和存活率(即疾病状态下的死亡率)的横断面年龄模式和时间趋势，包括上述四种主要老年疾病。2)开发具有风险率参数描述的多状态队列发病率/流行率/生存模型的版本。使用这些模型评估上面列出的各个健康特征的时间趋势。3)检查上述两种疾病发病风险之间的关系。扩展详细的多状态模型以描述共病的发展。将扩展模型应用于对关联度最高的疾病数据的联合分析。 公共卫生相关性：这项研究的结果将有助于更好地了解美国人口中老年人主要疾病之间的联系，并为预测2020年、2025年和2030年美国老年人的健康/福祉/生存特征创造合适的背景。

DESCRIPTION (provided by applicant): The long term objective of the proposed research is to evaluate current epidemiological trends in major geriatric disorders including cancer, acute coronary heart disease (ACHD), asthma, Alzheimer?s (AD) disease. We will evaluate current and prospective trends in the incidence rates and patients? survival, separately for each of the selected diseases as well as for their combinations, taking into account possible synergism/antagonism between the diseases in samples of aging individuals from the National Long Term Care Survey linked with Medicare Service Use Files (NLTCS-M) and the Surveillance Epidemiology and End Results (SEER) linked with Medicare Service Use Files along with 5% Medicare Service Use Files (SEER-M) as controls. Particular focus of the proposed research will be on evaluating these major epidemiological characteristics considering effects of dependence among diseases and possible recovery from certain diseases on disease free life span. The following specific aims will be addressed: 1) Evaluate cross-sectional age patterns and time trends in incidence, prevalence, recovery, and survival (i.e., mortality from the disease states) rates for elderly individuals of both sexes in the U.S. for four major geriatric conditions specified above using the NLTCS-M and SEER-M. 2) Develop versions of multistate cohort incidence/prevalence/survival models with parametric description of hazard rates. Using these models evaluate time trends for respective health characteristics listed above. 3) Examine the relationships between risks of disease onset in pairs of diseases listed above. Extend the elaborated multi-state models to describe development of co-morbidity. Apply extended models to the joint analyses of data on diseases showing highest connection. PUBLIC HEALTH RELEVANCE: The results of this study will contribute to better understanding connection among major diseases of the elderly in the U.S. population and create an appropriate background for predicting health/well-being/survival characteristics of the U.S. elderly in 2020, 2025 and 2030.