Death as a multifactorial cumulative health event in older adults

死亡是老年人的多因素累积健康事件

• 批准号: 7369995
• 负责人: MARY E TINETTI
• 金额: $ 27.11万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-03-01 至 2010-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7369995
• 关键词: Acute; Address; Age; Cardiovascular system; Cause of Death; Cessation of life; Chronic; Clinical; Complement; Condition; County; Decision Making; Developed Countries; Developing Countries; Disease; Elderly; Event; Future; Head; Health; Health Policy; Individual; Measures; Medicare; Methods; Modeling; Participant; Persons; Population; Proportional Hazards Models; Purpose; Research; Sampling; Techniques; Testing; Time; Vital Status; Work; adjudication; beneficiary; burden of illness; cohort; concept; hazard; health economics; innovation; member; mortality

DESCRIPTION (provided by applicant): Description Most deaths in developed countries occur in persons over the age of 70 years who suffer from multiple health conditions. The contribution of these multiple conditions to death may not be accurately or completely captured with current methods. The predominant algorithmic, adjudication method approach may be misleading, both over- and under-estimating the contribution of co-existing diseases and conditions. It is time to complement existing methods for assigning cause of death by determining the cumulative chronic and acute conditions contributing to death. The two Subaims of this project are to: 1) test the hypothesis that multiple co-occurring chronic and acute conditions contributed to the deaths in two cohorts of older adults; and 2) determine the extent (amount) of the contribution of these conditions to the deaths. The participants are members of 2 longitudinal cohorts of older adults. The Cardiovascular Health Study (CHS) has 5,888 participants, age 65+ years from 4 U.S. counties. The Medicare Current Beneficiary Study (MCBS) includes representative participants age 65+ years sampled across the nation. Both CHS and MCBS collected a wealth of health information including chronic and acute conditions and vital status. Proportional hazards models, incorporating time-dependent variables (important for studying the onset, occurrence and/or reoccurrence of conditions), will be used to derive the ratio of the hazard of death for individuals with and without specific conditions, while controlling for the other conditions (Subaim 1). The second Subaim expands on methods for determining the extent to which each condition contributes to death. The product of the analyses will be the amount of contribution to death of each condition in the final model. Individual conditions likely will make an independent contribution but will also contribute to death dependent on the presence of other conditions. Using innovative analytical techniques we will estimate the total contribution attributed to the conditions. An empirically-derived method reflecting the multiple conditions contributing to death should encourage better informed clinical decision-making and better alignment of research and reimbursement dollars with actual disease burden. With baby boomers heading into their late years, accurate estimates of the conditions contributing to mortality are essential for health and economic planning.

描述（由申请人提供）： 描述发达国家的大多数死亡都发生在70岁以上患有多种健康状况的人中。这些多种条件对死亡的贡献可能不会准确或完全用当前方法完全捕获。主要的算法，裁决方法可能会引起误导，无论是高估和低估了共存疾病和条件的贡献。现在是时候通过确定导致死亡的累积慢性和急性状况来补充现有方法来分配死因的方法。该项目的两个子批次是：1）检验以下假设：多个同时发生的慢性和急性条件导致了两名老年人同龄人的死亡； 2）确定这些条件对死亡的贡献的程度（数量）。参与者是2个老年人纵向人群的成员。心血管健康研究（CHS）有5,888名参与者，年龄在美国4个县的65岁以上。 Medicare当前的受益人研究（MCB）包括全国各地65岁以上的代表参与者。 CHS和MCB都收集了大量的健康信息，包括慢性和急性条件以及生命状况。比例危害模型，结合了时间依赖性变量（对于研究疾病的发生，发生和/或重新发生的情况很重要），用于得出对具有和没有特定条件的人的死亡危害的比率，同时控制其他条件（Subaim 1）。第二个Subaim扩展了确定每种疾病导致死亡程度的方法。分析的乘积将是最终模型中每种状况的死亡的贡献。个体条件可能会做出独立的贡献，但也将导致死亡的贡献，取决于其他条件的存在。使用创新的分析技术，我们将估计归因于条件的总贡献。一种经验衍生的方法反映了导致死亡的多种状况，应鼓励更好地明智的临床决策，并更好地对研究和补偿金与实际疾病负担的补偿。随着婴儿潮一代进入末期，对导致死亡率的条件的准确估计对于健康和经济计划至关重要。