Healthy Ageing: tackling the burden of disease and disability in an ageing population

Healthy ageing of individuals is crucial to prevent strong increases in the burden of disease and disability due to population ageing. We aimed to quantify the current burden of disease and disability and assessed which determinants explain the burden of disability. The occurrence of disability increased towards older ages, but there was a particularly strong increase during the last few years of life. Mild disability was strongly related with age (time since birth), whereas severe disability was related most with time to death. This suggests that, when the life expectancy further increases, the years lived with mild disability will increase, whereas the years with severe disability will remain more unchanged. The analysis of determinants showed that diseases such as back pain, peripheral vascular disease and stroke had a high disabling impact and, therefore, contributed much to the burden of disability. Arthritis and heart disease were less disabling but contributed much because of their high prevalence. There was a substantial educational inequality in the burden of disability, which was to a large extent (50%) explained by differences in diseases’ disabling impact. Obese persons could e

Disability occurrence and proximity to death

Purpose: This paper aims to assess whether disability occurrence is related more strongly to proximity to death than to age. Method: Self reported disability and vital status were available from six annual waves and a subsequent 12-year mortality follow-up of the Dutch GLOBE longitudinal study. Logit and Poisson regression methods were used to study associations of disability occurrence with age and with proximity to death. Results: For disability in activities of daily living (ADL), regression models with proximity to death had better goodness of fit than models with age. With approaching death, the odds for ADL disability prevalence and incidence rates increased 20.0% and 18.9% per year, whereas severity increased 4.1% per year. For the ages younger than 60, 60-69 and older than 70 years, the odds for ADL disability prevalence increased 6.4%, 16.0% and 23.0% per year. Among subjects with asthma/COPD, heart disease and diabetes increases were 25.1%, 19.5% and 22.72% per year. Functional impairments were more strongly related to age. Conclusions: The strong association of (ADL) disability occurrence with proximity to death implies that a substantial part of the disability burden may shift to older ages with further increases in life expectancy

Compressie van morbiditeit: een veelbelovende benadering om de maatschappelijke consequenties van vergrijzing te verlichten?

There is an urgent need for strategies that alleviate the societal consequences of population ageing. A possible strategy is aiming for compression of morbidity. Some of the initial conditions for a compression of morbidity have been invalidated. The life expectancy has shown a much stronger increase than was expected and the modal age at death has exceeded the age of 85. Trend studies have found no consistent evidence for a compression of morbidity. At the department of Public Health, we aim at identifying entry-points for a compression. For example, an analysis was performed on potential contributions of changes in exposure to life style factors (smoking, hypertension, physical inactivity and overweight/obesity) to compression of cardiovascular disease, using multi-state life tables with data from the Framingham Heart Study. It was shown that smoking and physical inactivity increased the incidence of cardiovascular disease, as well as mortality with and without cardiovascular disease. Hypertension and overweight mainly increased the incidence of cardiovascular disease. Interventions on the latter risk factors will therefore increase the life expectancy, but will also result in a compression of morbidity. For policymakers and researchers it is important to find a mix of interventions that lead to a comparable overall effect

Future disability projections could be improved by connecting to the theory of a dynamic equilibrium

Objective Projections of future trends in the burden of disability could be guided by models linking disability to life expectancy, such as the dynamic equilibrium theory. This paper tests the key assumption of this theory that severe disability is associated to proximity to death whereas mild disability is not. Study Design and Setting Using data from the GLOBE study, the association of three levels of self-reported ADL disability with age and proximity to death was studied using logistic regression models. These regression estimates were used to estimate the number of life years with disability for life spans of 75 and 85 years. Results The prevalence of disability incrementally increased with approaching death with 12 percent per year for moderate disability to 19 percent for severe disability. However, no association was observed for mild disability. A ten year increase of lifespan was estimated to result in a substantial expansion of mild disability (4.6 years) compared to a small expansion of moderate (0.7 years) and severe (0.9 years) disability. Conclusion These findings support the theory of a dynamic equilibrium. Projections of the future burden of disability could be substantially improved by connecting to this theory and incorporating information on proximity to death

Do social relations buffer the effect of neighborhood deprivation on health-related quality of life? Results from the LifeLines Cohort Study

We investigated whether social relations buffer the effect of neighborhood deprivation on mental and physical health-related quality of life. Baseline data from the LifeLines Cohort Study (N=68,111) and a neighborhood deprivation index were used to perform mixed effect linear regression analyses. Results showed that fewer personal contacts (b, 95%CI: 0.88(-1.08;-0.67)) and lower social need fulfillment (-4.52(-4.67;-4.36)) are associated with lower mental health-related quality of life. Higher neighborhood deprivation was also associated with lower mental health related quality of life (-0.18(-0.24;-0.11)), but only for those with few personal contacts or low social need fulfillment. Our results suggest that social relations buffer the effect of neighborhood deprivation on mental health-related quality of life

Screening for type 2 diabetes in a high-risk population: Study design and feasibility of a population-based randomized controlled trial

Background: We describe the design and present the results of the first year of a population-based study of screening for type 2 diabetes in individuals at high risk of developing the disease. High risk is defined as having abdominal obesity. Methods. Between 2006 and 2007, 79,142 inhabitants of two Dutch municipalities aged 40-74 years were approached to participate in screening. Eligible participants had a self-reported waist circumference of 80 cm for women and 94 cm for men, and no known pre-existing diabetes. Of the respondents (n=20,578; response rate 26%), 16,135 were abdominally obese. In total, 10,609 individuals gave written informed consent for participation and were randomized into either the screening (n=5305) or the control arm (n=5304). Participants in the screening arm were invited to have their fasting plasma glucose (FPG) measured and were referred to their general practitioner (GP) if it was 6.1 mmol/L. In addition, blood lipids were determined in the screening arm, because abdominal obesity is often associated with cardiovascular risk factors. Participants in both arms received written healthy lifestyle information. Between-group differences were analyzed with Chi-square tests and logistic regression (categorical variables) and unpaired t-tests (continuous variables). Results: The screening attendance rate was 84.1%. Attending screening was associated with age at randomization (OR=1.03, 95% CI 1.02-1.04), being married (OR=1.57, 95% CI 1.33-1.83) and not-smoking currently (OR=0.52, 95% CI 0.44-0.62). Of the individuals screened, 5.6% had hyperglycemia, and a further 11.6% had an estimated absolute cardiovascular disease risk of 5% or higher, according to the Systematic Coronary Risk Evaluation risk model. These participants were referred to their GP. Conclusions: Self-reported home-assessed waist circumference could feasibly detect persons at high risk of hyperglycemia or cardiovascular disease. Continuation of the large-scale RCT is warranted to test the hypothesis that targeted population-based screening for type 2 diabetes leads to a significant reduction in cardiovascular morbidity and mortality

Obesity, smoking, alcohol consumption and years lived with disability: A Sullivan life table approach

Background: To avoid strong declines in the quality of life due to population ageing, and to ensure sustainability of the health care system, reductions in the burden of disability among elderly populations are urgently needed. Life style interventions may help to reduce the years lived with one or more disabilities, but it is not fully understood which life style factor has the largest potential for such reductions. Therefore, the primary aim of this paper is to compare the effect of BMI, smoking and alcohol consumption on life expectancy with disability, using the Sullivan life table method. A secondary aim is to assess potential improvement of the Sullivan method by using information on the association of disability with time to death. Methods. Data from the Dutch Permanent Survey of the Living Situation (POLS) 1997-1999 with mortality follow-up until 2006 (n = 6,446) were used. Using estimated relative mortality risks by risk factor exposure, separate life tables were constructed for groups defined in terms of BMI, smoking status and alcohol consumption. Logistic regression models were fitted to predict the prevalence of ADL and mobility disabilities in relationship to age and risk factor exposure. Using the Sullivan method, predicted age-specific prevalence rates were included in the life table to calculate years lived with disability at age 55. In further analysis we assessed whether adding information on time to death in both the regression models and the life table estimates would lead to substantive changes in the results. Results: Life expectancy at age 55 differed by 1.4 years among groups defined in terms of BMI, 4.0 years by smoking status, and 3.0 years by alcohol consumption. Years lived with disability differed by 2.8 years according to BMI, 0.2 years by smoking and 1.6 by alcohol consumption. Obese persons could expect to live more years with disability (5.9 years) than smokers (3.8 years) and drinkers (3.1 years). Employing information on time to death led to lower estimates of years lived with disability, and to smaller differences in these years according to BMI (2.1 years), alcohol (1.2 years), and smoking (0.1 years). Conclusions: Compared with smoking and drinking alcohol, obesity is most strongly associated with an increased risk of spending many years of life with disability. Although employing information on the relation of disability with time to death improves the precision of Sullivan life table estimates, the relative importance of risk factors remained unchanged

Contribution of Chronic Disease to the Burden of Disability

Background: Population ageing is expected to lead to strong increases in the number of persons with one or more disabilities, which may result in substantial declines in the quality of life. To reduce the burden of disability and to prevent concomitant declines in the quality of life, one of the first steps is to establish which diseases contribute most to

Mortality risk associated with disability: A population-based record linkage study

Objectives: We assessed the association between mortality and disability and quantified the effect of disability-associated risk factors. Methods: We linked data from cross-sectional health surveys in the Netherlands to the population registry to create a large data set comprising baseline covariates and an indicator of death. We used Cox regression models to estimate the hazard ratio of disability on mortality. Results: Among men, the unadjusted hazard ratio for activities of daily living, mobility, or mild disability defined by the Organization for Economic Cooperation and Development at age 55 years was 7.85 (95% confidence interval [CI]=4.36, 14.13), 5.21 (95% CI=3.19, 8.51), and 1.87 (95% CI=1.58, 2.22), respectively. People with disability in activities of daily living and mobility had a 10-year shorter life expectancy than nondisabled people had, of which 6 years could be explained by differences in lifestyle, sociodemographics, and major chronic diseases. Conclusions: Disabled people face a higher mortality risk than nondisabled people do. Although the difference can be explained by diseases and other risk factors for those with mild disability, we cannot rule out that more severe disabilities have an independent effect on mortality