Fries James F
Stanford University School of Medicine, CA, USA.
Ann Intern Med. 2003 Sep 2;139(5 Pt 2):455-9. doi: 10.7326/0003-4819-139-5_part_2-200309021-00015.
The Compression of Morbidity paradigm, introduced in 1980, maintains that if the average age at first infirmity, disability, or other morbidity is postponed and if this postponement is greater than increases in life expectancy, then cumulative lifetime morbidity will decrease-compressed between a later onset and the time of death. The National Long-Term Care Survey, the National Health Interview Survey, and other data now document declining disability trends beginning in 1982 and accelerating more recently. The decline is about 2% per year, contrasted with a decline in mortality rates of about 1% per year, thereby documenting compression of morbidity in the United States at the population level. Longitudinal studies now link good health risk status with long-term reductions in cumulative lifetime disability; persons with few behavioral health risks have only one-fourth the disability of those who have more risk factors, and the onset of disability is postponed from 7 to 12 years, far more than any increases in longevity in the groups. Randomized, controlled trials of health enhancement programs in elderly populations show reduction in health risks, improved health status, and decreased medical care utilization. Health policy initiatives now being undertaken have promise of increasing and consolidating health gains for the elderly.
1980年提出的发病压缩模式认为，如果首次出现体弱、残疾或其他疾病的平均年龄被推迟，并且这种推迟超过了预期寿命的增加，那么累积终生发病率将会降低——在发病延迟和死亡时间之间被压缩。全国长期护理调查、国民健康访谈调查以及其他数据现在都记录了自1982年开始且近期加速的残疾下降趋势。下降幅度约为每年2%，而死亡率的下降幅度约为每年1%，从而证明了美国在人口层面上的发病压缩情况。纵向研究现在将良好的健康风险状况与累积终生残疾的长期减少联系起来；行为健康风险较少的人的残疾程度仅为风险因素较多者的四分之一，残疾的发病时间从7年推迟到12年，远远超过了这些人群中预期寿命的任何增加。针对老年人群的健康促进项目的随机对照试验表明，健康风险降低、健康状况改善以及医疗保健利用率下降。目前正在开展的健康政策举措有望为老年人增加并巩固健康收益。
