EPIDEMIOLOGY OF CHRONIC DISEASE IN THE OLDEST OLD

在过去的几十年里死亡率的下降导致了 美国人口中超过的比例增加， 尤其是84岁以上的老人，更是“高龄老人”。因为衰老是 伴随着慢性病发病率和流行率的增加， 医疗需求很可能在#年稳步增长。 未来的岁月。然而，医疗保健的改善和减少 风险因素可能会使慢性病的发病推迟到更接近年龄的时候 到死亡；如果是这样的话，疾病发作到死亡之间的间隔 可能会压缩，导致对医疗保健的需求减少 服务。存活率的提高可能也会导致 多项诊断。共病影响治疗、生存和 疾病的发展。它与以下变化密切相关 功能状态和死亡率。合并症是一项核心事实 了解老年人慢性病的流行病学。 这项研究包括九年的死亡率、发病率和患病率 慢性病和卫生服务使用的两个队列，每个队列由 1971年和1980年，3000名65岁及以上的凯撒成员。仅限成员 在基线的5年内进行了多阶段健康体检(MHC) 日期可以包括在研究中。有关慢性病的信息 诊断、特定死因死亡率、生理和社会人口统计 风险因素，卫生服务利用率从 计算机化住院和多阶段健康体检记录和 从病历上看。最初的研究假设是， 从慢性病发病到死亡的发病率在20世纪80年代较短 一群人。发病时间较短，因为发病年龄 疾病发生的时间更晚，年龄更接近死亡。这一假设 将针对特定情况进行检查，特别是包括 心血管疾病和癌症。此外， 慢性病患者存活率共病的队列差异 检查过了。其他合并症风险的队列差异 在那些有心血管或肌肉骨骼诊断的人中， 检查过了。请求继续执行此操作是为了完成 最初的研究分析了因重大预算而被推迟的 削减和扩大工作范围。按照最初的提议，这 研究不包括评估共病对 队列差异。

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." Since aging is associated with an increased incidence and prevalence of chronic disease, it is likely that the demand for medical care will steadily increase in the years ahead. However, improvements in health care and reductions in risk factors may be delaying the onset of chronic disease to ages closer to death; if this is so, the interval between onset of disease and death may be compressed, resulting in a decreased demand for medical care services. Increased survival may also be leading to increases in multiple diagnoses. Comorbidity affects treatment, survival and progression of disease. It is strongly associated with changes in functional status and mortality. Comorbidity is a central fact in understanding the epidemiology of chronic diseases in the elderly. The research includes nine-year mortality, incidence and prevalence of chronic disease, and health services use in two cohorts each composed of 3,000 Kaiser members aged 65 and over in 1971 and 1980. Only members who took the Multiphasic Health Checkup (MHC) within 5 years of the baseline date can be included in the study. Information on chronic disease diagnoses, causespecific mortality, physiological and socio-demographic risk factors, and health services utilization is being obtained from computerized hospitalization and Multiphasic Health Checkup records and from medical charts. The original study hypothesis is that the period of morbidity from onset of chronic disease to death is shorter in the 1980 cohort. Duration of morbidity is shorter because the age at onset of disease is occurring later, at ages closer to death. This hypothesis will be examined for specific conditions, especially including cardiovascular diseases and cancers. In addition, the influence of cohort differences in comorbidity on survival with chronic disease win be examined. Cohort differences in the risk of additional comorbidities among those with cardiovascular or musculoskeletal diagnoses will be examined. This continuation is being requested to allow completion of the original study analyses which have been delayed by significant budget cuts and an increase in work scope. As originally proposed, this research did not include assessment of the influence of comorbidity on cohort differences.