Death as a multifactorial cumulative health event in older adults

描述（由申请人提供）： 在发达国家，大多数死亡发生在70岁以上的人身上，他们患有多种健康状况。目前的方法可能无法准确或完全捕获这些多种疾病对死亡的贡献。主要的算法、裁定方法可能会产生误导，高估或低估了共存疾病和病症的贡献。现在是时候通过确定导致死亡的累积慢性和急性疾病来补充现有的死因分配方法。该项目的两个子目标是：1）检验多种同时发生的慢性和急性疾病导致两组老年人死亡的假设; 2）确定这些疾病导致死亡的程度（数量）。参与者是2个老年人纵向队列的成员。心血管健康研究（CHS）有5，888名参与者，年龄65岁以上，来自美国4个县。医疗保险当前受益人研究（MCBS）包括全国65岁以上的代表性参与者。社区卫生服务和多学科能力调查都收集了大量的健康信息，包括慢性和急性疾病以及生命状况。比例风险模型，包括时间依赖性变量（对于研究疾病的发作、发生和/或复发很重要），将用于推导有和无特定疾病的个体的死亡风险比，同时控制其他疾病（Subaim 1）。第二个Subaim扩展了确定每种情况导致死亡的程度的方法。分析的结果将是最终模型中每种疾病对死亡的贡献量。个别条件可能会作出独立的贡献，但也将有助于死亡取决于其他条件的存在。使用创新的分析技术，我们将估计归因于条件的总贡献。一种反映导致死亡的多种疾病的药物衍生方法应该鼓励更好地了解临床决策，并使研究和报销资金与实际疾病负担更好地一致。随着婴儿潮一代进入晚年，准确估计导致死亡的条件对于健康和经济规划至关重要。

DESCRIPTION (provided by applicant): Description Most deaths in developed countries occur in persons over the age of 70 years who suffer from multiple health conditions. The contribution of these multiple conditions to death may not be accurately or completely captured with current methods. The predominant algorithmic, adjudication method approach may be misleading, both over- and under-estimating the contribution of co-existing diseases and conditions. It is time to complement existing methods for assigning cause of death by determining the cumulative chronic and acute conditions contributing to death. The two Subaims of this project are to: 1) test the hypothesis that multiple co-occurring chronic and acute conditions contributed to the deaths in two cohorts of older adults; and 2) determine the extent (amount) of the contribution of these conditions to the deaths. The participants are members of 2 longitudinal cohorts of older adults. The Cardiovascular Health Study (CHS) has 5,888 participants, age 65+ years from 4 U.S. counties. The Medicare Current Beneficiary Study (MCBS) includes representative participants age 65+ years sampled across the nation. Both CHS and MCBS collected a wealth of health information including chronic and acute conditions and vital status. Proportional hazards models, incorporating time-dependent variables (important for studying the onset, occurrence and/or reoccurrence of conditions), will be used to derive the ratio of the hazard of death for individuals with and without specific conditions, while controlling for the other conditions (Subaim 1). The second Subaim expands on methods for determining the extent to which each condition contributes to death. The product of the analyses will be the amount of contribution to death of each condition in the final model. Individual conditions likely will make an independent contribution but will also contribute to death dependent on the presence of other conditions. Using innovative analytical techniques we will estimate the total contribution attributed to the conditions. An empirically-derived method reflecting the multiple conditions contributing to death should encourage better informed clinical decision-making and better alignment of research and reimbursement dollars with actual disease burden. With baby boomers heading into their late years, accurate estimates of the conditions contributing to mortality are essential for health and economic planning.