Evolution of the "fourth stage" of epidemiologic transition in people aged 80 years and over: population-based cohort study using electronic health records.

Publisher: BioMed Central Country of Publication: England NLM ID: 101178411 Publication Model: Electronic Cited Medium: Internet ISSN: 1478-7954 (Electronic) Linking ISSN: 14787954 NLM ISO Abbreviation: Popul Health Metr Subsets: MEDLINE

Original Publication: London : BioMed Central, [2003]-

Aged, 80 and over/*statistics & numerical data ; Electronic Health Records/*statistics & numerical data; Age Factors ; Cognitive Dysfunction/epidemiology ; Cohort Studies ; Coronary Disease/epidemiology ; Dementia/epidemiology ; Diabetes Mellitus, Type 2/epidemiology ; Female ; Humans ; Male ; Morbidity ; Musculoskeletal Pain/epidemiology ; Neoplasms/epidemiology ; Proportional Hazards Models ; Pulmonary Disease, Chronic Obstructive/epidemiology ; Stroke/epidemiology ; United Kingdom/epidemiology

Background: In the "fourth stage" of epidemiological transition, the distribution of non-communicable diseases is expected to shift to more advanced ages, but age-specific changes beyond 80 years of age have not been reported.
Methods: This study aimed to evaluate demographic and health transitions in a population aged 80 years and over in the United Kingdom from 1990 to 2014, using primary care electronic health records. Epidemiological analysis of chronic morbidities and age-related impairments included a cohort of 299,495 participants, with stratified sampling by five-year age group up to 100 years and over. Cause-specific proportional hazards models were used to estimate hazard ratios for incidence rates over time.
Results: Between 1990 and 2014, nonagenarians and centenarians increased as a proportion of the over-80 population, as did the male-to-female ratio among individuals aged 80 to 95 years. A lower risk of coronary heart disease (HR 0.54, 95% confidence interval [CI]: 0.50-0.58), stroke (0.83, 0.76-0.90) and chronic obstructive pulmonary disease (0.59, 0.54-0.64) was observed among 80-84 year-olds in 2010-2014 compared to 1995-1999. By contrast, the risk of type II diabetes (2.18, 1.96-2.42), cancer (1.52, 1.43-1.61), dementia (2.94, 2.70-3.21), cognitive impairment (5.57, 5.01-6.20), and musculoskeletal pain (1.26, 1.21-1.32) was greater in 2010-2014 compared to 1995-1999.
Conclusions: Redistribution of the over-80 population to older ages, and declining age-specific incidence of cardiovascular and respiratory diseases in over-80s, are consistent with the "fourth stage" of epidemiologic transition, but increases in diabetes, cancer, and age-related impairment show new emerging epidemiological patterns in the senior elderly.

Erratum in: Popul Health Metr. 2017 Aug 4;15(1):30. doi: 10.1186/s12963-017-0147-z. (PMID: 28778203)

BMJ Open. 2011 Jan 1;1(2):e000269. (PMID: 22021893)
Diabetes Care. 2015 Mar;38(3):482-7. (PMID: 25552418)
J Public Health (Oxf). 2014 Dec;36(4):684-92. (PMID: 24323951)
Nephrol Dial Transplant. 2013 Nov;28(11):2670-7. (PMID: 23975843)
J Am Geriatr Soc. 2016 Jul;64(7):1425-31. (PMID: 27295278)
Lancet. 2016 Apr 9;387(10027):1513-30. (PMID: 27061677)
J Clin Hypertens (Greenwich). 2010 Aug;12(8):621-4. (PMID: 20695939)
Lancet. 2012 Jul 7;380(9836):37-43. (PMID: 22579043)
Fennia. 1981;159(1):35-42. (PMID: 12312123)
Eur Respir J. 2016 Jan;47(1):186-93. (PMID: 26541539)
Lancet. 2016 Apr 2;387(10026):1377-96. (PMID: 27115820)
Glob Health Action. 2014 May 15;7:23574. (PMID: 24848657)
J Epidemiol Community Health. 1994 Aug;48(4):329-31. (PMID: 7964327)
Hypertension. 2016 Jul;68(1):97-105. (PMID: 27160194)
PLoS Med. 2012;9(6):e1001237. (PMID: 22719232)
PLoS One. 2012;7(1):e29776. (PMID: 22276128)
J Public Health (Oxf). 2007 Jun;29(2):191-8. (PMID: 17456532)
Prev Med. 2016 Oct;91:158-163. (PMID: 27539072)
PLoS One. 2013;8(3):e59608. (PMID: 23527228)
Am J Epidemiol. 2006 Jul 1;164(1):77-84. (PMID: 16624968)
Milbank Q. 1986;64(3):355-91. (PMID: 3762504)
PLoS One. 2009 Sep 24;4(9):e7168. (PMID: 19777060)
Int J Epidemiol. 1996 Apr;25(2):357-65. (PMID: 9119561)
Soc Biol. 2006 Spring-Summer;53(1-2):61-80. (PMID: 21516951)
Milbank Mem Fund Q. 1971 Oct;49(4):509-38. (PMID: 5155251)
Age Ageing. 2013 Jul;42(4):494-500. (PMID: 23482353)
Br J Gen Pract. 2010 Jul;60(576):277-84. (PMID: 20594429)
Br J Gen Pract. 2011 Jul;61(588):438-9. (PMID: 21722461)
J R Soc Med. 2016 Mar;109(3):109-16. (PMID: 26980412)
Milbank Q. 2005;83(4):731-57. (PMID: 16279965)
Lancet Neurol. 2016 Jan;15(1):116-24. (PMID: 26300044)
Lancet. 2014 May 31;383(9932):1912-9. (PMID: 24881995)
PLoS One. 2013 May 31;8(5):e64928. (PMID: 23741426)
Lancet. 2000 Feb 26;355(9205):675-87. (PMID: 10703799)
J Am Geriatr Soc. 2016 May;64(5):1079-84. (PMID: 27130965)
Int J Epidemiol. 2015 Jun;44(3):827-36. (PMID: 26050254)
J Gerontol A Biol Sci Med Sci. 2007 Jul;62(7):738-43. (PMID: 17634321)
J Am Geriatr Soc. 2015 Jul;63(7):1331-7. (PMID: 26096699)
Ther Adv Drug Saf. 2012 Apr;3(2):89-99. (PMID: 25083228)
Glob Health Action. 2014 May 15;7:22443. (PMID: 24848648)
Circulation. 2016 Feb 9;133(6):601-9. (PMID: 26858290)

United Kingdom Department of Health

Keywords: Chronic disease; Epidemiological transition; Epidemiology; Incidence; Morbidity; Primary care; Senior elderly; UK; Very old

Date Created: 20170514 Date Completed: 20180322 Latest Revision: 20181113

20250114

PMC5429583

10.1186/s12963-017-0136-2

28499387