Many adults are living longer with health conditions in the United States. Understanding the disability-adjusted life years (DALYs) for such health conditions may help to inform healthcare providers and their patients, guide health interventions, reduce healthcare costs, improve quality of life, and increase longevity for aging Americans. The purpose of this study was to determine the burden of 10 health conditions for a nationally-representative sample of adults aged 50 years and older in the United States.
Methods
Data from the 1998–2014 waves of the Health and Retirement Study were analyzed. At each wave, participants indicated if they were diagnosed with the following 10 conditions: cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes, back pain, hypertension, a fractured hip, myocardial infarction, rheumatism or arthritis, and a stroke. Years lived with a disability and years of life lost to premature mortality were summed for calculating DALYs. Sample weights were utilized in the analyses to make the DALY estimates nationally-representative. Results for the DALYs were presented in thousands.
Results
There were 30,101 participants included. Sex stratified DALY estimates ranged from 4092 (fractured hip)-to-178,055 (hypertension) for men and 13,621 (fractured hip)-to-200,794 (hypertension) for women. The weighted overall DALYs were: 17,660 for hip fractures, 62,630 for congestive heart failure, 64,710 for myocardial infarction, 90,337 for COPD, 93,996 for stroke, 142,012 for cancer, 117,534 for diabetes, 186,586 for back pain, 333,420 for arthritis, and 378,849 for hypertension. In total, there were an estimated 1,487,734 years of healthy life lost from the 10 health conditions examined over the study period.
Conclusions
The burden of these health conditions accounted for over a million years of healthy life lost for middle-aged and older Americans over the 16 year study period. Our results should be used to inform healthcare providers and guide health interventions aiming to improve the health of middle-aged and older adults. Moreover, shifting health policy and resources to match DALY trends may help to improve quality of life during aging and longevity.
Increased age is a hallmark risk factor for several health conditions [1]. Although approximately 86% of older adults in the United States are living with at least one health condition [2], life expectancy in the United States has generally continued to increase [3]. The advancements in life expectancy have been attributed to many factors including improvements in the prevention and treatment of morbidity. Given that the older adult population is projected to grow 112% by the year 2060 [4], healthcare providers and policy makers need to continue accommodating the emerging health demands of this population for helping them live longer, and with more quality years. For example, public health programs have been developed for improving the wellbeing and longevity of aging adults. Healthy People 2020 and 2030 includes initiatives to prevent morbidity, improve quality of care, and delay mortality for older adults in the United States [5].
Disability-adjusted life years (DALYs) are used globally to quantify the number of healthy years of life lost from the presence of a disease, disability, or injury [6]. The burden of chronic, non-fatal health loss and early mortality is evaluated separately and compared across populations. Information for DALYs in the United States and globally is often provided in Global Burden of Disease studies [7]. Such information is used to inform healthcare providers about the impact of a health condition and guide interventions seeking to improve the health and life expectancy of a given population [8]. Being that this time-based metric measures the burden of a health condition in a population and compares to a healthy population that reaches full life expectancy, the specific burden of common health conditions for middle-aged and older adults in the United States has yet to be calculated.
Anzeige
More studies are needed for understanding how aging is linked with disease [1]. Calculating the years lived with a disease (YLDs) and years of life lost (YLLs) from premature mortality will provide insights into the burden of common health conditions for the growing aging adult population. This information can help to identify which health conditions contribute most to the number of healthy years of life lost for aging adults, thereby informing how healthcare providers and interventions prioritize treatment and prevention efforts. Such prioritization will help to guide health policy, and increase the quality of life and longevity for aging adults. Therefore, the purpose of this study was to determine the burden of 10 common health conditions for a nationally-representative sample of middle-aged and older adults in the United States.
Methods
Participants
Data from 37,495 participants in the 1998–2014 waves of the Health and Retirement Study (HRS) were used. Individual data files were joined to the cleaned and standardized RAND HRS dataset. The purpose of the HRS is to understand the health and economic implications of advancing age that can threaten or promote health and wealth at individual- and population-levels [9]. Participants in the HRS have been re-interviewed biennially since 1992. Further, the HRS includes surveys from over 23,000 households and has provided data for a nationally-representative sample of Americans aged over 50 years since 1998 [10]. New cohorts of participants have been added to the original HRS sample to preserve national representation and participants are followed longitudinally until death [10]. A multi-stage probability design is used by the HRS, including geographical stratification and oversampling of certain demographic groups. Additional details for the HRS are described elsewhere [11].
Written informed consent was acquired from all participants before entering the study and protocols were approved by the University of Michigan Behavioral Sciences Committee Institutional Review Board. Participant anonymity was ensured because data used in this secondary analysis contained no direct identifiers.
Health conditions
Participants self-reported their date of birth and sex. Interviewers asked participants questions related to their physical health at each wave. Individuals who reported having cancer, chronic obstructive pulmonary disease (COPD), congestive heart failure, diabetes or high blood sugar, back pain, high blood pressure or hypertension, a fractured hip, a heart attack or myocardial infarction, rheumatism or arthritis, or a stroke were included. The date of interview for the wave a health condition was first confirmed by participants was treated as a proxy for the date of diagnosis. These health conditions were selected by investigators because they were identified as having a corresponding disability weight from the Global Burden of Disease [12, 13]. Example interviewer questions for each health condition that were asked to participants are listed in Additional file 1: Table S1.
Anzeige
Mortality
Date of death was obtained through linkage to the National Death Index. The HRS also conducted an interview with a surviving spouse, child, or other informant for each decedent, successfully obtaining study exit information [10].
Statistical analysis
Procedures from the World Health Organization for determining DALYs with an incidence-based calculation were used [14]. Participants were first stratified by sex, then by age categories (50–59 years, 60–69 years, 70–79 years, ≥80 years). The age at which a health condition occurred determined age categories for all participants.
YLDs were calculated by multiplying the number of incident cases for each health condition, corresponding disability weight, and average duration of years lived with the health condition until death, or truncation. For those who were still alive or lost to follow-up (i.e., truncation), the average duration of years lived with the health condition was determined using their estimated life expectancy at age of truncation [15]. Disability weights for each health condition were from the Global Burden of Disease (back pain = 0.020, cancer = 0.288, COPD = 0.019, congestive heart failure = 0.201, diabetes = 0.015, fractured hip = 0.058, hypertension = 0.246, myocardial infarction = 0.439, rheumatism or arthritis =0.199, stroke = 0.266) [12, 13]. For each sex, YLDs were summed across age categories to determine total YLDs.
YLLs were calculated by taking the product of the number of deaths that occurred by the mean life expectancy at age of death in years. The Period Life Table was used to determine life expectancy at each age for men and women [16]. The YLLs were summed across age categories to determine total YLLs.
For men and women, YLDs and YLLs were added across age categories to determine DALYs for each health condition. Then, the DALYs estimates were summed for calculating overall DALYs. Sample weights were utilized in the analyses so DALYs were nationally-representative. The YLLs, YLDs, and DALYs are reported in thousands. All analyses were performed with SAS 9.4 software (SAS Institute; Cary, NC).
Results
After exclusions (Fig. 1), there were 30,101 participants included (n = 16,591 women, n = 13,510 men) from the 1998–2014 waves who reported having at least one of the health conditions we examined. The non-weighted and weighted descriptive characteristics of the participants are presented in Table 1. Overall, participants entered the study at 63.3 ± 10.6 years of age. Of the 10,504 participants that died, the age at death was 79.6 ± 10.5 years. Table 2 provides person-level DALY estimates and 95% confidence intervals for each health outcome.
Fig. 1
Flow Chart for Exclusions. †Exclusions occurred because races and ethnicities in the other category were stratified
Table 1
Non-Weighted and Weighted Descriptive Characteristics of the Participants
Overall (n = 30,101)
Weighted Overall (n = 114,610,740)
Women (n = 16,591)
Weighted Women (n = 59,183,770)
Men (n = 13,510)
Weighted Men (n = 55,426,970)
Age (years)
63.3 ± 10.6
60.9 ± 10.0
63.7 ± 11.1
61.8 ± 10.6
62.9 ± 10.0
60.1 ± 9.4
Age at Death (years)
79.6 ± 10.5
78.4 ± 11.0
81.2 ± 10.7
80.4 ± 10.8
77.9 ± 10.1
76.3 ± 10.9
Died (n (%))
10,504 (34.9%)
31,954,223 (27.8%)
5553 (52.8%)
16,504,100 (27.9%)
4951 (16.4%)
15,450,123 (27.8%)
Table 2
Person-Level Disability-Adjusted Life Year Means and 95% Confidence Intervals
Mean
95% Confidence Interval
Mean
95% Confidence Interval
Mean
95% Confidence Interval
Arthritis
Back Pain
Cancer
Males
50–59 Years
20.4
20.1, 20.8
20.6
20.2, 21.0
21.9
21.4, 22.5
60–69 Years
14.4
14.2, 14.6
13.4
13.2, 13.7
15.7
15.4, 16.0
70–79 Years
9.1
9.0, 9.2
8.4
8.2, 8.6
10.1
10.0, 10.3
≥80 Years
5.4
5.3, 5.4
4.5
4.4, 4.7
5.8
5.7, 6.0
Total
11.0
10.9, 11.2
10.5
10.2, 10.7
11.2
10.9, 11.4
Females
50–59 Years
23.0
22.7, 23.4
23.0
22.5, 23.5
24.8
24.2, 25.3
60–69 Years
16.1
15.9, 16.3
15.1
14.8, 15.4
17.5
17.2, 17.8
70–79 Years
9.9
9.8, 10.0
9.2
9.0, 9.4
11.1
10.9, 11.3
≥80 Years
5.8
5.7, 5.9
5.0
4.8, 5.1
6.5
6.4, 6.6
Total
11.0
10.8, 11.2
10.5
10.3, 10.7
12.5
12.2, 12.8
Overall
50–59 Years
21.8
21.6, 22.1
21.8
21.4, 22.1
23.5
23.1, 24.0
60–69 Years
15.2
15.1, 15.4
14.3
14.1, 14.5
16.6
16.4, 16.8
70–79 Years
9.5
9.5, 9.6
8.8
8.7, 9.0
10.6
10.5, 10.7
≥80 Years
5.7
5.6, 5.7
4.8
4.7, 4.9
6.2
6.1, 6.3
Total
11.0
10.9, 11.2
10.5
10.3, 10.7
11.8
11.6, 12.1
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure
Diabetes
Males
50–59 Years
19.8
19.1, 20.4
21.7
20.9, 22.4
19.6
19.1, 20.1
60–69 Years
13.5
13.2, 13.9
15.4
15.0, 15.8
13.4
13.1, 13.7
70–79 Years
8.6
8.4, 8.8
9.8
9.6, 10.0
8.2
8.0, 8.4
≥80 Years
5.0
4.8, 5.1
5.2
5.1, 5.4
4.8
4.6, 5.0
Total
10.4
10.1, 10.7
10.4
10.0, 10.8
11.1
10.8, 11.3
Females
50–59 Years
21.9
21.2, 22.6
24.5
23.7, 25.3
22.0
21.5, 22.6
60–69 Years
15.6
15.2, 16.0
17.2
16.7, 17.7
15.0
14.7, 15.3
70–79 Years
9.6
9.3, 9.8
11.0
10.7, 11.3
9.1
8.9, 9.3
≥80 Years
5.3
5.1, 5.5
5.8
5.6, 5.9
5.3
5.1, 5.4
Total
11.5
11.2, 11.9
10.4
10.2, 10.7
11.9
11.6, 12.2
Overall
50–59 Years
20.9
20.4, 21.4
23.1
22.5, 23.7
20.8
20.4, 21.2
60–69 Years
14.6
14.3, 14.8
16.3
16.0, 16.6
14.2
14.0, 14.4
70–79 Years
9.1
8.9, 9.2
10.4
10.2, 10.6
8.6
8.5, 8.8
≥80 Years
5.1
5.0, 5.3
5.6
5.5, 5.7
5.1
4.9, 5.2
Total
11.0
10.7, 11.2
10.4
10.1, 10.6
11.5
11.3, 11.7
Fractured Hip
Hypertension
Myocardial Infarction
Males
50–59 Years
–
–
21.3
21.0, 21.6
22.4
21.8, 22.9
60–69 Years
13.6
12.6, 14.5
14.8
14.6, 15.0
16.5
16.2, 16.8
70–79 Years
9.0
8.4, 9.5
9.5
9.4, 9.6
10.9
10.7, 11.1
≥80 Years
4.8
4.5, 5.1
5.7
5.6, 5.8
6.5
6.4, 6.7
Total
7.2
6.7, 7.7
11.9
11.8, 12.1
11.9
11.5, 12.2
Females
50–59 Years
–
–
23.8
23.5, 24.1
25.0
24.1, 25.8
60–69 Years
15.7
14.8, 16.6
16.6
16.4, 16.8
18.2
17.8, 18.7
70–79 Years
10.1
9.6, 10.5
10.3
10.2, 10.4
12.0
11.8, 12.3
≥80 Years
5.0
4.8, 5.2
6.1
6.0, 6.2
6.9
6.7, 7.1
Total
6.8
6.5, 7.1
11.7
11.5, 11.9
11.8
11.4, 12.3
Overall
50–59 Years
–
–
22.5
22.3, 22.7
23.5
22.9, 24.0
60–69 Years
15.0
14.3, 15.7
15.7
15.6, 15.8
17.1
16.9, 17.4
70–79 Years
9.7
9.3, 10.0
9.9
9.8, 10.0
11.4
11.2, 11.6
≥80 Years
5.0
4.8, 5.1
5.9
5.9, 6.0
6.7
6.6, 6.8
Total
6.9
6.7, 7.2
11.8
11.7, 12.0
11.8
11.6, 12.1
Stroke
Males
50–59 Years
21.5
20.8, 22.1
60–69 Years
15.8
15.4, 16.1
70–79 Years
9.7
9.5, 9.8
≥80 Years
5.5
5.3, 5.6
Total
10.6
10.3, 10.9
Females
50–59 Years
24.4
23.7, 25.1
60–69 Years
17.4
17.0, 17.8
70–79 Years
11.0
10.8, 11.2
≥80 Years
6.1
6.0, 6.2
Total
10.1
9.8, 10.4
Overall
50–59 Years
22.9
22.3, 23.4
60–69 Years
16.5
16.2, 16.8
70–79 Years
10.3
10.2, 10.5
≥80 Years
5.9
5.8, 6.0
Total
10.3
10.1, 10.5
×
Figure 2 presents the weighted YLDs and YLLs for each health condition stratified by sex. DALY estimates for men were: 4092 for hip fractures, 28,707 for congestive heart failure, 36,688 for myocardial infarction, 42,413 for COPD, 45,197 for stroke, 59,006 for diabetes, 68,237 for cancer, 86,392 for back pain, 144,991 for arthritis, and 178,055 for hypertension. Likewise, DALY estimates for women were: 13,621 for hip fractures, 27,855 for myocardial infarction, 33,874 for congestive heart failure, 47,802 for COPD, 48,587 for stroke, 58,101 for diabetes, 73,529 for cancer, 99,736 for back pain, 188,177 for arthritis, and 200,794 for hypertension. Of the ten health conditions examined herein, the number of DALYs for diabetes and myocardial infarction were only higher in men than women. In total, the 10 health conditions accounted for an estimated 693,778 DALYs in men and 792,076 DALYs in women.
Fig. 2
The Burden of the Health Outcomes for Middle-Aged and Older Adults Stratified by Sex. Note: Green Bars = Years of Life Lost; Yellow Bars = Years Lived with Disease. COPD = Chronic Obstructive Pulmonary Disease; DALYs = Disability-Adjusted Life Years
×
The weighted overall DALYs were: 17,660 for hip fractures, 62,630 for congestive heart failure, 64,710 for myocardial infarction, 90,337 for COPD, 93,996 for stroke, 117,534 for diabetes, 142,012 for cancer, 186,586 for back pain, 333,420 for arthritis, and 378,849 for hypertension. Detailed information for the weighted burden of each health condition by sex and overall is presented in Table 3. As a whole, there were an estimated 347,274 YLDs, 1,140,457 YLLs, and 1,487,734 DALYs for the 10 health conditions.
Table 3
Disability-Adjusted Life Years for Each Health Outcome
Cases
Number Dead
YLLs (in thousands)
YLDs (in thousands)
DALYs (in thousands)
Arthritis
Males
50–59 Years
13,140,604
1,767,444
33,628
19,243
52,871
60–69 Years
9,293,034
2,465,646
31,798
14,254
46,053
70–79 Years
5,768,620
3,415,221
26,344
8051
34,396
≥80 Years
2,600,532
2,069,681
9260
2411
11,671
Total
30,802,790
9,717,992
101,030
43,959
144,991
Females
50–59 Years
16,094,235
1,583,622
34,047
25,641
59,688
60–69 Years
11,064,877
2,422,174
35,011
18,417
53,428
70–79 Years
8,296,633
4,304,371
36,176
13,157
49,333
≥80 Years
5,291,347
4,199,135
20,000
5728
25,728
Total
40,747,092
12,509,302
125,234
62,943
188,177
Overall
50–59 Years
29,234,839
3351,066
68,226
44,842
113,068
60–69 Years
20,357,911
4,887,820
66,848
32,557
99,405
70–79 Years
14,065,253
7,719,592
62,446
21,085
83,532
≥80 Years
7,891,879
6,268,816
29,270
8145
37,415
Total
71,549,882
22,227,294
226,790
106,629
333,420
Back Pain
Males
50–59 Years
15,686,707
1,740,053
35,669
1980
37,648
60–69 Years
6,832,356
1,653,968
22,088
932
23,021
70–79 Years
4,396,870
2,113,526
17,575
530
18,105
≥80 Years
2,184,198
1,645,791
7424
194
7618
Total
29,100,131
7,153,338
82,756
3636
86,392
Females
50–59 Years
15,354,395
1,241,525
28,443
2126
30,569
60–69 Years
8,568,148
1,788,250
26,819
1221
28,040
70–79 Years
6,382,777
2,705,337
24,726
881
25,607
≥80 Years
4,351,801
3,076,734
15,084
436
15,520
Total
34,657,121
8,811,846
95,072
4664
99,736
Overall
50–59 Years
31,041,102
2,981,578
64,644
4104
68,747
60–69 Years
15,400,504
3,442,218
48,969
2151
51,120
70–79 Years
10,779,647
4,818,863
42,198
1400
43,598
≥80 Years
6,535,999
4,722,525
22,493
628
23,121
Total
63,757,252
15,965,184
178,304
8283
186,586
Cancer
Males
50–59 Years
2,522,588
636,050
12,994
3863
16,857
60–69 Years
3,755,041
1,213,733
17,078
6250
23,328
70–79 Years
3,472,371
1,731,529
14,875
5443
20,318
≥80 Years
1,618,157
1,236,842
5880
1854
7734
Total
11,368,157
4,818,154
50,827
17,410
68,237
Females
50–59 Years
3,700,463
591,564
13,619
6663
20,282
60–69 Years
3,429,015
1,027,035
16,203
6220
22,423
70–79 Years
3,072,482
1,655,490
15,535
5413
20,948
≥80 Years
1,988,047
1385,791
7186
2690
9876
Total
12,190,007
4,659,880
52,543
20,986
73,529
Overall
50–59 Years
6,223,051
1,227,614
26,898
10,487
37,385
60–69 Years
7,184,056
2,240,768
33,349
12,469
45,818
70–79 Years
6544,853
3,387,019
30,372
10,862
41,234
≥80 Years
3,606,204
2,622,633
13,055
4520
17,575
Total
23,558,164
9,478,034
103,674
38,338
142,012
Chronic Obstructive Pulmonary Disease
Males
50–59 Years
2,580,113
632,447
12,445
316
12,762
60–69 Years
2,591,636
986,541
13,276
324
13,600
70–79 Years
2,108,494
1,366,288
11,661
208
11,869
≥80 Years
1,039,325
830,476
4116
67
4182
Total
8,319,568
3,815,752
41,498
915
42,413
Females
50–59 Years
3,470,551
624,008
13,626
478
14,104
60–69 Years
2,847,547
906,558
14,095
375
14,469
70–79 Years
2,563,061
1,422,684
13,507
298
13,805
≥80 Years
1,407,161
1,011,150
5312
112
5424
Total
10,288,320
3,964,400
46,540
1263
47,802
Overall
50–59 Years
6,050,664
1,256,455
26,209
792
27,001
60–69 Years
5,439,183
1,893,099
27,426
697
28,124
70–79 Years
4,671,555
2,788,972
25,102
501
25,604
≥80 Years
2,446,486
1,841,626
9430
178
9608
Total
18,607,888
7,780,152
88,167
2168
90,337
Congestive Heart Failure
Males
50–59 Years
901,813
309,556
6407
928
7335
60–69 Years
1,093,609
452,061
6563
1020
7584
70–79 Years
1,359,220
924,139
8239
1249
9487
≥80 Years
956,151
794,466
3742
559
4301
Total
4,310,793
2,480,222
24,951
3756
28,707
Females
50–59 Years
783,103
218,141
5114
880
5994
60–69 Years
1,004,064
434,919
7028
1083
8111
70–79 Years
1,449,735
979,321
9791
1535
11,325
≥80 Years
1,716,177
1,411,609
7293
1151
8444
Total
4,953,079
3,043,990
29,226
4649
33,874
Overall
50–59 Years
1,684,916
527,697
11,634
1813
13,447
60–69 Years
2,097,673
886,980
13,590
2107
15,697
70–79 Years
2,808,955
1,903,460
17,972
2772
20,744
≥80 Years
2,672,328
2,206,075
11,033
1709
12,742
Total
9,263,872
5,524,212
54,229
8401
62,630
Diabetes
Males
50–59 Years
6,357,757
1,136,872
22,201
652
22,853
60–69 Years
5,109,121
1,327,408
17,770
535
18,305
70–79 Years
3,110,939
1,702,148
13,938
291
14,229
≥80 Years
1,111,108
743,942
3546
73
3619
Total
15,688,925
4,910,370
57,455
1551
59,006
Females
50–59 Years
5,545,897
856,217
18,801
635
19,436
60–69 Years
4,846,946
1,185,951
17,734
543
18,276
70–79 Years
3,287,663
1,603,639
14,515
340
14,855
≥80 Years
1,588,280
1,035,687
5430
104
5534
Total
15,268,786
4,681,494
56,480
1622
58,101
Overall
50–59 Years
11,903,654
1,993,089
41,352
1292
42,644
60–69 Years
9,956,067
2,513,359
35,588
1078
36,666
70–79 Years
6,398,602
3,305,787
28,432
629
29,061
≥80 Years
2,699,388
1,779,629
8986
177
9163
Total
30,957,711
9,591,864
114,358
3176
117,534
Fractured Hip
Males
50–59 Years
0
0
–
–
–
60–69 Years
146,403
41,458
554
39
593
70–79 Years
380,325
226,413
1969
118
2087
≥80 Years
441,705
287,456
1343
70
1412
Total
968,433
555,327
3866
227
4092
Females
50–59 Years
0
0
–
–
–
60–69 Years
324,722
115,798
1791
88
1879
70–79 Years
894,606
501,588
4931
267
5198
≥80 Years
1,814,079
1,272,571
6168
376
6544
Total
3,033,407
1,889,957
12,890
731
13,621
Overall
50–59 Years
0
0
–
–
–
60–69 Years
471,125
157,256
2324
127
2451
70–79 Years
1,274,931
728,001
6868
386
7254
≥80 Years
2,255,784
1,560,027
7509
446
7955
Total
4,001,840
2,445,284
16,701
959
17,660
Hypertension
Males
50–59 Years
17,589,184
2,219,853
43,583
30,454
74,037
60–69 Years
10,044,721
2,652,896
34,384
18,925
53,310
70–79 Years
6,329,398
3,587,473
27,980
10,942
38,922
≥80 Years
2,551,064
1,933,743
8767
3018
11,786
Total
36,514,367
10,393,965
114,714
63,339
178,055
Females
50–59 Years
15,159,062
1,560,757
34,321
28,232
62,554
60–69 Years
10,942,927
2,570,377
37,670
21,718
59,388
70–79 Years
8,588,794
4,388,589
36,871
16,804
53,674
≥80 Years
5,024,558
3,838,927
18,314
6864
25,178
Total
39,715,341
12,358,650
127,176
73,618
200,794
Overall
50–59 Years
32,748,246
3,780,610
77,904
58,686
136,591
60–69 Years
20,987,648
5,223,273
72,054
40,643
112,698
70–79 Years
14,918,192
7,976,062
64,851
27,746
92,596
≥80 Years
7,575,622
5,772,670
27,081
9882
36,964
Total
76,229,708
22,752,615
241,890
136,957
378,849
Myocardial Infarction
Males
50–59 Years
1,477,509
311,855
6054
4451
10,505
60–69 Years
1,472,041
555,368
7866
3466
11,332
70–79 Years
1,322,100
781,906
6584
3304
9888
≥80 Years
844,074
721,969
3578
1385
4963
Total
5,115,724
2,371,098
24,082
12,606
36,688
Females
50–59 Years
648,934
147,456
3181
2242
5422
60–69 Years
850,883
350,042
5548
2080
7628
70–79 Years
1,021,117
656,615
6217
2686
8903
≥80 Years
999,380
803,335
4090
1811
5902
Total
3,520,314
1,957,448
19,036
8819
27,855
Overall
50–59 Years
2126,443
459,311
9333
6800
16,133
60–69 Years
2,322,924
905,410
13,392
5548
18,940
70–79 Years
2,343,217
1,438,521
12,783
5993
18,776
≥80 Years
1,843,454
1,525,304
7669
3193
10,861
Total
8,636,038
4,328,546
43,177
21,534
64,710
Stroke
Males
50–59 Years
1,566,132
450,841
8890
2850
11,739
60–69 Years
1,849,572
736,604
10,615
2581
13,195
70–79 Years
2,200,265
1,326,626
10,864
3351
14,215
≥80 Years
1,464,604
1,019,878
4668
1380
6048
Total
7,080,573
3,533,949
35,037
10,162
45,197
Females
50–59 Years
1,257,018
250,971
5758
1891
7648
60–69 Years
1,644,126
581,634
9217
2658
11,875
70–79 Years
2,222,147
1,289,628
12,337
3357
15,694
≥80 Years
2,782,176
2,064,287
10,575
2794
13,370
Total
7,905,467
4,186,520
37,887
10,700
48,587
Overall
50–59 Years
2,823,150
701,812
14,901
4718
19,619
60–69 Years
3,493,698
1,318,238
19,853
5224
25,077
70–79 Years
4,422,412
2,616,254
23,174
6709
29,883
≥80 Years
4,246,780
3,084,165
15,239
4178
19,417
Total
14,986,040
7,720,469
73,167
20,829
93,996
Note: DALYs Disability-Adjusted Life Years, YLDs Years Lived with Disease, YLLs Years of Life Lost
Anzeige
Discussion
The principal findings of this investigation revealed that over 1-million years of healthy life were lost for middle-aged and older Americans from the 10 health conditions evaluated over the 16 year study period. Although aging adults were impacted by each health condition, hypertension accounted for the greatest burden; whereas, hip fractures had the lowest number of DALYs. These results were similar when evaluating the DALY estimates for each of the health conditions by sex. Our findings should be used to inform healthcare providers and interventions seeking to prevent morbidity and extend life expectancy in aging adults. Using DALYs to guide healthcare policy will also help to improve quality of life during aging through continued evolutions of disease prevention and treatment.
The Global Burden of Disease studies have identified hypertension as the leading risk factor by attributable disease burden [17]. The prevalence of hypertension increases with age, and is highest in older adults [18]. Of the ten health conditions evaluated in this investigation, hypertension had both the highest number of cases and DALYs. Likewise, those with hypertension had a large amount of YLDs, thereby indicating middle-aged and older adults are living with this disease for long periods of time after diagnosis. The large number of years lived with hypertension can be attributed to the evolution and adherence to hypertension medications [19, 20]. Like all medications, persons considering usage of promising hypertension medications should have discussions with a healthcare provider, and other non-pharmacological modes of treatment and prevention such as engaging in healthy behaviors remains a critical factor for reducing hypertension [18, 21]. Like hypertension, participants indicating they had arthritis or rheumatism also lived with this health condition for long periods of time after diagnosis as demonstrated by the large number of YLDs. These results align with another investigation that revealed rheumatoid arthritis causes significant YLDs and high overall disease burden [22]. It is projected that as smoking rates decline, the number of healthy years of life lost from rheumatoid arthritis will also decrease [22]. Future studies monitoring DALYs for arthritis in middle-aged and older adults are needed to confirm such projections and assess if arthritis medications lower the burden of arthritis in aging adults.
Back pain is generally a prevalent health condition all adults experience as they age and pain management is often challenging [23]. The health implications of back pain are also pronounced, as the Global Burden of Disease project demonstrated that back pain has a large burden in the United States, and is relatively lower in Asian countries [24, 25]. Although our results also suggest the burden of back pain is high for middle-aged and older adults in the United States, our findings for YLDs are lower compared to those of other similar investigations [24, 25]. We believe that this result is attributed to participants reporting back pain before entering the HRS, as indicated by the large number of cases for those aged 50–59 years. Cancer is also a leading cause of morbidity and mortality in older adults [26]. The rise of cancer rates for the older adult population in the United States is projected to increase, thereby posing challenges to healthcare systems and cancer patients [27]. Our results show that the burden of cancer in aging adults is high. Future investigations should continue monitoring DALYs for cancer and specific cancer types in aging adults to assess advancements in cancer treatment, care, and prevention.
About 33% of adults aged at least 65 years in the United States have diabetes and older adults with diabetes are at an elevated risk for mortality than those without diabetes [28]. According to the Global Burden of Disease, diabetes is a leading cause of DALYs in the United States [29], and men are more frequently diagnosed with diabetes than women at younger ages [30]. Our findings indicate the number of diabetes cases were higher in men than women, particularly at ages 50–59 and 60–69 years, which may explain why the burden of diabetes was higher for men than women. While our DALY estimates for diabetes were large, other countries in the Global Burden of Disease, such as Mexico, may have a higher burden from diabetes [25]. Similarly, our results revealed the number myocardial infarction cases and DALYs from this health condition were higher in men compared to women. These results align with another investigation that suggests the prevalence of myocardial infarctions is higher in men than women [31].
Anzeige
Stroke is a leading cause of disability and death for aging adults that is also responsible for billions of dollars in healthcare costs [32]. Persons that sustain a stroke have reduced mobility and are at an increased risk of experiencing another stroke [33]. Therefore, it is not unusual that the burden of stroke has remained high in the United States and globally [24, 25]. Our DALY results for stroke also indicate many healthy years of life lost in middle-aged and older adults. Although advancements in COPD prevention and treatment have been made [34], COPD remains a leading cause of death [35], and the Global Burden of Disease suggests COPD has a tremendous disease burden in the United States [29]. Given that COPD is progressive, persons living with this disease have a large amount of health-related costs [36]. While our findings indicate that the burden of COPD is already high, the burden of COPD is projected to increase [37]. As smoking cessation remains important for preventing and limiting the health effects of COPD, the burden of DALYs should continue to be monitored for helping to inform COPD treatments.
Heart failure is a worldwide health problem that is linked to high morbidity, mortality, and costs of care [38]. As the older adult population increases, the prevalence of heart diseases such as congestive heart failure has also risen [39]. Our results indicating the high burden of congestive heart failure are similar to those of other investigations evaluating DALYs [40]. Although hip fractures are common during aging, the incidence of hip fractures and mortality rates associated with hip fractures have declined in the United States [41, 42]. Another study evaluating DALYs for hip fractures determined that over 200,000 years of healthy life were lost from hip fractures in older adults [43]. While the burden of hip fractures was lowest of the ten health conditions for this investigation, prevention and treatment for hip fractures should remain a priority for aging adults.
Some limitations should be noted. Those who were lost from follow-up or died may have had a health condition that was not recorded before this event, thereby creating underestimations for our results. Moreover, the date of interview served as a proxy for diagnosis date, thereby allowing our results to be further underestimated. The use of an incidence-driven DALY calculation allowed us to determine how the burden of specific health conditions impacted middle-aged and older adults longitudinally; however, we were unable to control for multimorbiditiy in our disability weights. It is also possible that participants may have disputed their records for having a diagnosis or were no longer living with a health condition after initial diagnosis. Self-report biases may have occurred for participant responses. The HRS only includes adults aged 50 years and over; therefore, some participants may have had health conditions at younger ages before entering the study. Statistical tests of inference were not used for making comparisons between DALY estimates because DALYs are often used as a stand-alone statistic.
Likewise, our DALY estimates were influenced by cases, and YLD does not confirm that quality of life was compromised. Future investigations should examine the impact of a health condition on YLD because a smaller YLD may imply that a health condition exacerbates time to death; whereas, a larger YLD may suggest treatment and management of a health condition delays early mortality (depending on age of diagnosis and other important factors). As such, social and policy concerns for aging adults including living arrangements, finances, completion of autonomous living and basic self-care tasks, and care giving should be considered based on disease and health status. Comparing our findings with those of other burden of disease investigations performed in the United States and globally will be helpful for making comparisons across populations and diseases [44]. Moreover, expanding parts of the DALY calculation to other important health outcomes during aging and examining prevalence-based DALYs will help to advance our understanding of health burden.
Anzeige
Conclusions
The burden of the health conditions evaluated for this investigation accounted for over a million years of healthy life lost for middle-aged and older Americans during the study period. Overall, participants experienced different levels of non-fatal health loss and early mortality for each health condition. These results should be used to help improve the efficiency and effectiveness of disease prevention and treatment strategies for aging adults. Trends in DALYs should continue to be monitored for middle-aged and older adults so that health-related policies and resources match DALY trends, and for informing healthcare providers so they can accommodate the health needs of the growing aging population in the United States. Encouraging healthcare providers to continue evolving prevention, treatment, and early detection for disease, and healthcare policy makers to invest in promising solutions will help to reduce health-related costs, improve quality of life, and extend life expectancy for the aging adults in the United States.
Acknowledgements
Not applicable.
Funding
This study was funded by a grant (P2CHD065702) from the National Institutes of Health – National Institute of Child Health and Human Development (National Center for Medical Rehabilitation Research), the National Institute for Neurological Disorders and Stroke, and the National Institute of Biomedical Imaging and Bioengineering. Funds were utilized for all aspects of the manuscript including design of the study, statistical analyses, and dissemination.
The authors have no conflicts of interest to disclose.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.
Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.
Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.
Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.
Update Innere Medizin
Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.
