Gimeno Laura, Goisis Alice, Dowd Jennifer B, Ploubidis George B
Centre for Longitudinal Studies, Social Research Institute, Institute of Education, University College London.
Leverhulme Centre for Demographic Science, Nuffield Department of Population Health, Nuffield College, University of Oxford.
medRxiv. 2024 Jan 17:2024.01.16.24301347. doi: 10.1101/2024.01.16.24301347.
Declines in mortality have typically been associated with improvements in physical health across generations. While life expectancy in most high-income countries continues to increase, there is evidence that younger generations, particularly in the United States (US), are less healthy than previous generations at the same age. We compared generational trends in physical health in the US, England, and continental Europe to explore whether other regions have experienced a similar pattern of worsening health across cohorts.
Using data from nationally representative studies of adults aged ≥50 years from the US (Health and Retirement Study, 26,939), England (English Longitudinal Study of Ageing, 14,992) and 11 continental European countries (Survey of Health, Ageing and Retirement in Europe, 72,595), we estimated differences in the age-adjusted prevalence of self-reported chronic disease and disability and observer-measured health indicators across pseudo-birth cohorts (born <1925, 1925-1935, 1936-1945, 1946-1954, 1955-1959).
Age-adjusted prevalence of doctor-diagnosed chronic disease increased across cohorts in all regions. Trends in disability prevalence were more regionally varied. Still, in both the US and Europe, we observed a structural break in disability trends, with declines observed in pre-war cohorts slowing, stalling, or reversing for cohorts born since 1945.
In all regions, we found evidence for worsening health across cohorts, particularly for those born since 1945. While more chronic disease in younger cohorts need not necessarily translate to worse quality of life or higher rates of functional limitation, there is some suggestion that worsening chronic disease morbidity may be spilling over into worsening disability.
死亡率的下降通常与各代人身体健康状况的改善相关。虽然大多数高收入国家的预期寿命持续上升，但有证据表明，年轻一代，尤其是美国的年轻一代，在相同年龄时不如前几代人健康。我们比较了美国、英国和欧洲大陆的代际身体健康趋势，以探讨其他地区是否也经历了类似的各年龄组健康状况恶化模式。
利用来自美国（健康与退休研究，26939人）、英国（英国老龄化纵向研究，14992人）以及11个欧洲大陆国家（欧洲健康、老龄化和退休调查，72595人）具有全国代表性的50岁及以上成年人研究数据，我们估计了自我报告的慢性病和残疾的年龄调整患病率以及观察测量的健康指标在虚拟出生队列（出生于<1925年、1925 - 1935年、1936 - 1945年、1946 - 1954年、1955 - 1959年）之间的差异。
所有地区各年龄组中医生诊断的慢性病年龄调整患病率均有所上升。残疾患病率的趋势在地区上差异更大。不过，在美国和欧洲，我们都观察到残疾趋势出现了结构性变化，自1945年以来出生的队列中，战前队列中观察到的残疾率下降放缓、停滞或逆转。
在所有地区，我们都发现了各年龄组健康状况恶化的证据，尤其是对于1945年以后出生的人群。虽然年轻队列中更多的慢性病不一定意味着生活质量更差或功能受限率更高，但有迹象表明，慢性病发病率的恶化可能正在蔓延到残疾状况的恶化。
