Evolution of the “fourth stage” of epidemiologic transition in people aged 80 years and over: population-based cohort study using electronic health records

Population Health Metrics

Research

Nisha C. Hazra¹  Martin Gulliford² 

[1] Department of Primary Care and Public Health Sciences, King’s College London, 3rd Floor Addison House, Guy’s Campus, SE1 1UL, London, UK;Department of Primary Care and Public Health Sciences, King’s College London, 3rd Floor Addison House, Guy’s Campus, SE1 1UL, London, UK;NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust, Great Maze Pond, SE1 9RT, London, UK;

关键词: Epidemiological transition;    Incidence;    Very old;    Senior elderly;    Chronic disease;    Morbidity;    Epidemiology;    Primary care;    UK;   

DOI  :  10.1186/s12963-017-0136-2

 received in 2016-11-16, accepted in 2017-05-04,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn the “fourth stage” of epidemiological transition, the distribution of non-communicable diseases is expected to shift to more advanced ages, but age-specific changes beyond 80 years of age have not been reported.MethodsThis study aimed to evaluate demographic and health transitions in a population aged 80 years and over in the United Kingdom from 1990 to 2014, using primary care electronic health records. Epidemiological analysis of chronic morbidities and age-related impairments included a cohort of 299,495 participants, with stratified sampling by five-year age group up to 100 years and over. Cause-specific proportional hazards models were used to estimate hazard ratios for incidence rates over time.ResultsBetween 1990 and 2014, nonagenarians and centenarians increased as a proportion of the over-80 population, as did the male-to-female ratio among individuals aged 80 to 95 years. A lower risk of coronary heart disease (HR 0.54, 95% confidence interval [CI]: 0.50–0.58), stroke (0.83, 0.76–0.90) and chronic obstructive pulmonary disease (0.59, 0.54–0.64) was observed among 80–84 year-olds in 2010–2014 compared to 1995–1999. By contrast, the risk of type II diabetes (2.18, 1.96–2.42), cancer (1.52, 1.43–1.61), dementia (2.94, 2.70–3.21), cognitive impairment (5.57, 5.01–6.20), and musculoskeletal pain (1.26, 1.21–1.32) was greater in 2010–2014 compared to 1995–1999.ConclusionsRedistribution of the over-80 population to older ages, and declining age-specific incidence of cardiovascular and respiratory diseases in over-80s, are consistent with the “fourth stage” of epidemiologic transition, but increases in diabetes, cancer, and age-related impairment show new emerging epidemiological patterns in the senior elderly.

【 授权许可】

CC BY   
© The Author(s). 2017