Associations of multiple chronic health conditions with active life expectancy in the United States

摘要

Purpose: 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. Methods: Data from the Panel Study of Income Dynamics represented Americans ages 55+ (1999-2011, n=2118, mean baseline age 63.3, 19447 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. Results: 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. Conclusion: The increasing prevalence of multiple chronic conditions may substantially increase disability.