International Centre for Life Course Studies in Society and Health (ICLS), Research Department of Epidemiology and Public Health, University College London, London, United Kingdom.
PLoS One. 2013 Aug 14;8(8):e71893. doi: 10.1371/journal.pone.0071893. eCollection 2013.
To extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions.
We used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity).
Findings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA.
This paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability.
通过研究美国和四个欧洲地区（英格兰/北欧和西欧/南欧/东欧）从中年到老年残疾与年龄的关系，扩展关于美国相对于欧洲健康劣势的现有研究，包括其与财富相关的差异，使用灵活的统计方法来模拟年龄函数。
我们使用了三项关于衰老的研究的数据，这些研究涉及来自 15 个国家的 50 至 85 岁成年人的全国代表性样本（N=48225）：美国健康与退休研究（HRS）、英国纵向老龄化研究（ELSA）和欧洲健康、老龄化和退休调查（SHARE）。结果是行动不便和日常生活活动受限。我们应用年龄的分数多项式来确定每个地区残疾与年龄的最佳拟合功能形式，同时控制社会人口特征和重要风险因素（高血压、糖尿病、肥胖、吸烟、身体活动不足）。
研究结果显示，美国的残疾水平较高，50 至 85 岁之间的年龄相关性变化较小。东欧的残疾水平普遍较低，其次是英格兰和南欧，北欧和西欧的残疾水平最低。然而，在这些后两个国家，残疾与年龄相关的增加更为陡峭，尤其是在东欧和南欧。对于所有国家和所有年龄段，与高财富成年人相比，低财富成年人的残疾水平更高，在美国，这种财富相关的差异在早期老年时最大。
本文说明了残疾及其与年龄的关系存在相当大的差异。它支持了这样一种假设，即欠发达的社会政策和更明显的社会经济不平等与更高水平的残疾和更早的残疾发作有关。
