Manton K G, Stallard E
Health Care Financ Rev. 1982 Mar;3(3):89-106.
The incidence and prevalence of chronic degenerative disease in America's elderly population are important determinants of the need for long-term care health services. Though a wide range of data on disease incidence and prevalence is available from a variety of different health studies, a Congressional Budget Office study (1977) concluded that data limitations are a major factor in the lack of precise national long-term care cost estimates. In this paper, we present a modeling strategy to make better use of existing data by using biomedically motivated actuarial models to integrate multiple data sources into a comprehensive model of population health dynamics. The development of a specific model for application to a disease of interest involves three distinct phases. First, biomedical evidence and data are used to specify a cohort model of chronic disease morbidity and mortality. Second, the model is fitted to cohort mortality data with estimates of its parameters being derived by maximum likelihood procedures. Third, the morbidity distribution in the national population is generated from the parameter estimates. The model is used to examine lung cancer morbidity and mortality patterns for U. S. white and non-white males in 1977. A review of these patterns suggests that, based on current concepts of lung cancer incidence and natural history, over 2 percent of white males in the United States have lung cancer at some stage of development, though most of this prevalence is pre-clinical.
美国老年人口中慢性退行性疾病的发病率和患病率是长期护理健康服务需求的重要决定因素。尽管从各种不同的健康研究中可以获得大量关于疾病发病率和患病率的数据，但国会预算办公室的一项研究（1977年）得出结论，数据限制是缺乏精确的全国长期护理成本估计的一个主要因素。在本文中，我们提出了一种建模策略，通过使用具有生物医学动机的精算模型，将多个数据源整合到一个全面的人口健康动态模型中，从而更好地利用现有数据。开发一个适用于感兴趣疾病的特定模型涉及三个不同阶段。首先，利用生物医学证据和数据来指定一个慢性病发病和死亡的队列模型。其次，将该模型与队列死亡率数据进行拟合，其参数估计通过最大似然程序得出。第三，根据参数估计生成全国人口中的发病分布。该模型用于研究1977年美国白人男性和非白人男性的肺癌发病和死亡模式。对这些模式的回顾表明，根据目前关于肺癌发病率和自然史的概念，美国超过2%的白人男性在某个发展阶段患有肺癌，尽管这种患病率大多处于临床前阶段。
