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Is a Compression of Morbidity in Late Life Occurring?: Examination of Death Certificate Evidence

Published online by Cambridge University Press:  29 November 2010

Arthur S. Kraus
Arthur S. Kraus
Affiliation:
Department of Community Health and Epidemiology, Queen's University
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Abstract

Fries predicted in 1980 a continuing rectangularization of the survival curve, and trends toward delayed age of onset of chronic disease and toward compression of morbidity in late life. Others have presented evidence that challenges the first two predictions. However, direct evidence regarding the last one has been lacking.

The study reported here analyzed death certificate data on the longest interval between the onset of any condition listed as causing or contributing to the death and the occurrence of the death, from a representative sample of 500 Ontario death certificates in 1975 versus 1985, to deceased individuals aged 65 +. There was a statistically significant decrease between 1975 and 1985 in the frequency of the shortest intervals (under a month) and a not statistically significant increase in the frequency of the longest intervals (5+ years or “years”). Adjustments regarding not-stated intervals and attempts to control for a confounding factor did not change the picture. This study did not yield any statistically significant evidence of a compression of morbidity in late life, and did yield statistically significant findings that were inconsistent with that hypothesis.

Résumé

Fries a prédit en 1980 une rectangularisation continuelle de la courbe de survie, une tendance vers le retardement de l'avènement de maladies chroniques et vers la compression de la morbidité durant la vieillesse. Plusieurs ont présenté des preuves contestant les deux premières prédictions. Cependant, des preuves directes touchant la troisième n'ont pas été avancées. Dans l'étude actuelle, 500 actes de décès de défunts âgés de 65 ans et plus, tirés d'un échantillon représentatif en Ontario, ont été analysés et les données contenues ont été comparées pour les années 1975 et 1985. En particulier, les chercheurs se sont concentrés sur l'intervalle le plus long depuis l'avènement de la condition inscrite causant ou contribuant à la mort jusqu'à la mort actuelle. Statistiquement, une diminution significative a été notée entre 1975 et 1985 au niveau de la fréquence des intervalles les plus courts (moins qu'un mois) mais les résultats n'indiquent aucune augmentation significative dans les intervalles les plus longs (cinq ans ou plus ou “années”). Malgré les ajustements faits pour les étapes non mentionnées et les efforts déployés dans le but de contrôler le facteur confusionnel, les résultats sont demeurés les mêmes. Cette étude n'a pas prouvée d'une façon statistiquement significative la compression de la moribidité durant la vieillesse mais elle nous a fourni des données statistiquement significatives qui contredisent cette hypothèse.

Keywords

Morbiditythe ElderlyDeath Certificates
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 7 , Issue 1 , Spring/printemps 1988 , pp. 58 - 70
Copyright
Copyright © Canadian Association on Gerontology 1988

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References

REFERENCES

1Fries, JF, 1980. Aging, natural death, and the compression of morbidity. N Eng J Med 303: 130–5.CrossRefGoogle ScholarPubMed
2Hertzman, C and Hayes, M, 1985. Will the elderly really bankrupt us with increased health care costs? Canad J Pub Health 76: 373–7.Google ScholarPubMed
3Schneider, EL and Brody, JA, 1983. Aging, natural death, and the compression of morbidity: another view. N Eng J Med 309: 854–6.CrossRefGoogle ScholarPubMed
4Manton, KG, 1982. Changing concepts of morbidity and mortality in the elderly population. Milbank Mem Fund Q 60: 183–244.CrossRefGoogle ScholarPubMed
5Grandy, E, 1984. Mortality and morbidity among the old. Brit Med J 288: 663–664.CrossRefGoogle Scholar
6Kraus, AS, 1987. The increase in the usual life span in North America. Canad J Aging 6: 19–32.CrossRefGoogle Scholar
7Colvez, A and Blanchet, M, 1981. Disability trends in the United States population 1966–1976: analysis of reported causes. Amer J Pub Health 71: 464–471.CrossRefGoogle Scholar
8Palmore, EB, 1986. Trends in the health of the aged. Gerontologist 26: 298–302.CrossRefGoogle ScholarPubMed
9Kraus, AS and McGeer, CP, 1982. The effect of dementia on mortality in the elderly institutionalized population. Canad J Aging 1: 40–7.CrossRefGoogle Scholar
10Christie, Ab, 1982. Changing patterns in mental illness in the elderly. Brit J Psychiatry 140: 154–9.CrossRefGoogle ScholarPubMed
11Blessed, G and Wilson, ID, 1982. The contemporary natural history of mental disorder in old age. Brit J Psychiatry 141: 59–67.CrossRefGoogle ScholarPubMed
12Gittelsohn, AM, 1982. On the distribution of underlying causes of death. Amer J Pub Health 72: 133–39.CrossRefGoogle ScholarPubMed
13Gittelsohn, AM and Senning, J, 1979. Studies on the reliability of vital and health records: I. Comparison of cause of death and hospital record diagnoses. Amer J Pub Health 69: 680–689.CrossRefGoogle ScholarPubMed
14Kircher, T, Nelson, J and Bordo, H, 1985. The autopsv as a measure of accuracy of the death certificate. New Eng J Med 313: 1263–1269.CrossRefGoogle Scholar
15Government of Canada, Statistics Canada, 1976. Vital Statistics, Volume III, deaths, 1974. Ottawa.Google Scholar
16Government of Canada, Statistics Canada, 1986. Mortalitv, summary list of causes, vital statistics, 1984. Ottawa.Google Scholar
17Casgrande, J, Pike, M and Smith, P, 1978. The power function of the “exact” test for comparing two binomial distributions. Applied Statistics 27: 179.Google Scholar