Laditka James N, Laditka Sarah B
a Department of Public Health Sciences , University of North Carolina at Charlotte , Charlotte , NC , USA.
Disabil Rehabil. 2016;38(4):354-61. doi: 10.3109/09638288.2015.1041614. Epub 2015 May 4.
To estimate associations of eight common health conditions with life expectancy (LE) and disabled life expectancy (DLE), the percentage of life disabled in an activity of daily living.
Data from the Panel Study of Income Dynamics represented Americans ages 55+ (1999-2011, n = 2118, mean baseline age 63.3, 19 447 person-years). We estimated probabilities of death and disability with multinomial logistic Markov models adjusted for age, sex, race/ethnicity and education. We used the probabilities to create large populations with microsimulations, each individual having a known monthly disability status, age 55 through death. We calculated LE and DLE for the populations, repeating each microsimulation 100 times for confidence intervals.
Nearly half (48.8%) of the participants had two or more conditions, 24.7% had three or more, 11.5% had four or more. Having any one condition significantly reduced LE. For example, white women lived to age 87.3 (95% confidence interval 86.5-88.1) with no conditions, 75.8 (70.9-80.7) with heart disease. Multiple conditions did not further reduce LE but often increased DLE, which for white women was 12.2% (11.1-13.2) with no conditions, 39.1% (28.3-49.8) with heart disease and 47.0% (46.9-47.1) with heart disease, diabetes and hypertension.
The increasing prevalence of multiple chronic conditions may substantially increase disability. Implications for Rehabilitation The growing number of individuals with multiple chronic conditions will greatly increase the prevalence of disability in later life. It is important for rehabilitation science, practice and policy to address this emerging epidemiological transition. Rehabilitation is especially important for people with pre-diabetes, developing heart disease or early stages of other cardiovascular-related diseases as avoiding the development of multiple chronic diseases through increased activity may greatly reduce disability and mortality.
评估八种常见健康状况与预期寿命（LE）和失能预期寿命（DLE，即日常生活活动中失能的生命百分比）之间的关联。
收入动态跟踪调查的数据代表了55岁及以上的美国人（1999 - 2011年，n = 2118，平均基线年龄63.3岁，19447人年）。我们使用多项逻辑马尔可夫模型估计死亡和失能概率，并对年龄、性别、种族/族裔和教育程度进行了调整。我们利用这些概率通过微观模拟创建了大量人群，每个人从55岁到死亡都有已知的每月失能状态。我们计算了这些人群的预期寿命和失能预期寿命，对每个微观模拟重复100次以获得置信区间。
近一半（48.8%）的参与者患有两种或更多种疾病，24.7%患有三种或更多种，11.5%患有四种或更多种。患有任何一种疾病都会显著降低预期寿命。例如，没有疾病的白人女性预期寿命为87.3岁（95%置信区间86.5 - 88.1），患有心脏病的为75.8岁（70.9 - 80.7）。多种疾病并不会进一步降低预期寿命，但通常会增加失能预期寿命，对于白人女性来说，没有疾病时失能预期寿命为12.2%（11.1 - 13.2），患有心脏病时为39.1%（28.3 - 49.8），患有心脏病、糖尿病和高血压时为47.0%（46.9 - 47.1）。
多种慢性病患病率的上升可能会大幅增加失能情况。对康复的启示 患有多种慢性病的个体数量不断增加，将极大地提高晚年失能的患病率。康复科学、实践和政策应对这一新兴的流行病学转变非常重要。对于患有糖尿病前期、正在发展心脏病或处于其他心血管相关疾病早期阶段的人来说，康复尤为重要，因为通过增加活动量避免发展为多种慢性病可能会大大降低失能和死亡率。
