Stephan Anna-Janina, Strobl Ralf, Schwettmann Lars, Meisinger Christa, Ladwig Karl-Heinz, Linkohr Birgit, Thorand Barbara, Peters Annette, Grill Eva
Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany; German Center for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany.
Prev Med. 2020 Feb 13;133:106025. doi: 10.1016/j.ypmed.2020.106025.
Health projections often extrapolate from observations in current ageing cohorts, but health in older age may depend not only on individual characteristics but also on a person's historical context. Our objective was to investigate how health deficit accumulation trajectories after age 65 differed in five adjacent birth cohorts and according to individual life course characteristics. Data originate from the 2008/09 KORA (Cooperative Health Research in the Region of Augsburg)-Age cohort study from Southern Germany and their 2012 and 2016 follow-ups. Deficit accumulation was assessed using a Frailty Index. The effects of birth cohort membership and individual life course characteristics on deficit accumulation trajectories were analyzed using generalized linear mixed models. Out of 2701 participants (49% male) from five birth cohorts (1919-23, 1924-28, 1929-33, 1934-38, 1939-43), we included 2512 individuals with 5560 observations. Frailty Index levels were higher for women, smokers, alcohol abstainers, obese participants and persons with a sedentary lifestyle or living below the poverty threshold. We found higher age-specific Frailty Index levels for the two most recent birth cohorts (e.g. 61%, CI: [13%; 130%] for the 1934-38 as compared to the 1919-23 cohort), but the rate of deficit accumulation with age (7% per life year, (CI: [5%, 9%]) was cohort-independent. Results indicate that the historical context (birth cohort membership) may influence the number of accumulated health deficits after age 65 in addition to poverty and other individual life course characteristics, but BMI, physical activity and smoking remain the modifiable risk factors offering the highest prevention potential.
健康预测通常是根据当前老年人群体的观察结果进行外推，但老年时期的健康状况可能不仅取决于个体特征，还取决于一个人的历史背景。我们的目标是研究65岁之后健康赤字积累轨迹在五个相邻出生队列中以及根据个体生命历程特征是如何不同的。数据来源于德国南部2008/09年的KORA（奥格斯堡地区合作健康研究）-年龄队列研究及其2012年和2016年的随访。使用衰弱指数评估赤字积累情况。使用广义线性混合模型分析出生队列成员身份和个体生命历程特征对赤字积累轨迹的影响。在来自五个出生队列（1919 - 23年、1924 - 28年、1929 - 33年、1934 - 38年、1939 - 43年）的2701名参与者（49%为男性）中，我们纳入了2512名个体的5560条观察数据。女性、吸烟者、戒酒者、肥胖参与者以及久坐不动或生活在贫困线以下的人的衰弱指数水平更高。我们发现最近的两个出生队列的特定年龄衰弱指数水平更高（例如，与1919 - 23年队列相比，1934 - 38年队列的为61%，置信区间：[13%；130%]），但随着年龄增长的赤字积累率（每年7%，置信区间：[5%，9%]）与队列无关。结果表明，除了贫困和其他个体生命历程特征外，历史背景（出生队列成员身份）可能会影响65岁之后积累的健康赤字数量，但体重指数、身体活动和吸烟仍然是具有最高预防潜力的可改变风险因素。
