Section for Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark.
BMC Geriatr. 2022 Apr 8;22(1):301. doi: 10.1186/s12877-022-02992-x.
The process of aging renders older people susceptible for adverse outcomes upon stress. Various indicators derived from complex systems theory have been proposed for quantifying resilience in living organisms, including humans. We investigated the ability of system-based indicators in capturing the dynamics of resilience in humans who suffer the adversity of spousal bereavement and tested their predictive power in mortality as a finite health transition.
Using longitudinal register data on weekly healthcare consumption of all Danish citizens over the age of 65 from January 1st, 2011, throughout December 31st, 2016, we performed statistical comparisons of the indicators 'average', 'slope', 'mean squared error', and 'lag-1 autocorrelation' one year before and after spousal bereavement, stratified for age and sex. The relation between levels of these indicators before bereavement and mortality hazards thereafter was determined by time to event analysis. We assessed the added value for mortality prediction via the time dependent area (AUC) under the receiver operating characteristic curve.
The study included 934,003 citizens of whom 51,890 experienced spousal bereavement and 2862 died in the first year thereafter. Healthcare consumption is increased, more volatile and accelerating with aging and in men compared to women (all p-values < 0.001). All dynamic indicators before bereavement were positively related with mortality hazards thereafter (all p-values < 0.001). The average discriminative performance for the 1-year mortality risk of the model with only age as a predictor (AUC: 68.9% and 70.2%) was significantly increased with the addition of dynamical indicators (78.5% and 82.4%) for males and females, respectively.
Dynamic indicators in time series of health care expenditures are strong predictors of mortality risk and could be part of predictive models for prognosis after life stressors, such as bereavement.
衰老过程使老年人在面临压力时容易出现不良后果。各种源自复杂系统理论的指标已被提出，用于量化生物体（包括人类）的恢复力。我们研究了基于系统的指标在捕捉经历配偶丧亡逆境的人类恢复力动态方面的能力，并测试了它们在作为有限健康转变的死亡率方面的预测能力。
使用 2011 年 1 月 1 日至 2016 年 12 月 31 日期间丹麦所有 65 岁以上公民每周医疗保健消费的纵向登记数据，我们对配偶丧亡前一年和后一年的指标“平均值”、“斜率”、“均方误差”和“滞后 1 自相关”进行了统计比较，按年龄和性别进行分层。通过生存时间分析确定这些指标在丧亡前的水平与随后的死亡率风险之间的关系。我们通过接收者操作特征曲线下的时间依赖面积（AUC）评估了对死亡率预测的增值。
该研究包括 934003 名公民，其中 51890 人经历了配偶丧亡，2862 人在其后的第一年死亡。医疗保健消费随着年龄的增长而增加，且在男性中比女性更为波动和加速（所有 p 值均<0.001）。所有丧亡前的动态指标均与随后的死亡率风险呈正相关（所有 p 值均<0.001）。仅以年龄为预测因子的模型对 1 年死亡率风险的平均判别性能（AUC：68.9%和 70.2%），随着动态指标的加入（男性和女性分别为 78.5%和 82.4%），显著提高。
健康支出时间序列中的动态指标是死亡率风险的有力预测因子，可能成为丧亡等生活应激后预后预测模型的一部分。
