Future Directions for the Demography of Aging Proceedings of a Workshop (2018) / Chapter Skim
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1 Trends in Mortality, Disease, and Physiological Status in the Older Population - Eileen Crimmins
1 Trends in Mortality, Disease, and Physiological Status in the Older Population - Eileen Crimmins
Pages 3-30
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From page 3... ...
These approaches are aimed at explaining variability in individual aging at a more basic biological level; our belief is that future research on mortality risk and health change among aging individuals is likely to increasingly incorporate these mechanisms in the coming decades to explain differences among subgroups and changes over time.
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So among these four population subgroups, White women have had the slowest increase in mortality over this period. Whereas life expectancy for the general population had been increasing fairly steadily over recent decades, the last 2 years have seen a change.
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While a decrease in life expectancy only occurred among White women in the lowest educational group, in each of the other three educational groups White women experienced the smallest increases. On the other hand, the increases in life expectancy were substantial among all educational groups for Black men, although there was an increasing educational differential with increase in educational level even for Black men.
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Non-Hispanic White Women Non-Hispanic White Men Non-Hispanic Black Women Non-Hispanic Black Men FIGURE 1-2 Change in life expectancy at age 25, by education, 1990–2010. SOURCE: Data from Sasson (2016b)
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estimated that smoking accounts for half of the increase in the mortality gap by education between the 1980s and 2006 for White women but does not explain the increasing gap for White men. Smoking behavior is important in the relatively low mortality of Hispanics (Lariscy
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(2008) ascribed increases in county-level female mortality to increases in chronic diseases related to smoking, overweight and obesity, and high blood pressure.
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Figure 1-3 extends and expands the comparisons shown in those studies to show the relative trend in life expectancy at birth from 1980 to 2015 for the 40 countries in the world with the highest life expectancy in 2015. The dark dashed line in the figure shows the continued relative decline of life expectancy in the United States relative to the other 39 countries.
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. This section discusses recent trends in disease prevalence and incidence, as well as changes in physiological status associated with the beginning of the process of morbidity progression.
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. Trends in incidence are better indicators than prevalence trends of the current health changes in the population, but data on incidence of health change are not as available.
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TRENDS IN PHYSIOLOGICAL STATUS Physiological deterioration and dysregulation is an upstream aspect of health that may precede disease diagnosis and mortality and may indicate a stage for initial medical or behavioral intervention in order to delay the progression to morbidity and mortality. Physiological dysregulation has been indicated by markers of the functioning of many systems and organs.
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diovascular health: blood pressure and cholesterol. We present trends over the longest period we can, more than 60 years, because the consistent pattern of change over this long period indicates that these are very long-term trends.
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. NEW APPROACHES TO INCORPORATING PHYSIOLOGICAL STATUS AND EPIGENETIC MARKERS IN MODELS OF AGING HEALTH OUTCOMES The discussion above of population health trends has demonstrated the use of population-level data to portray a picture of health differences and trends in the U.S.
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This section focuses on the growing interest in the biological mechanisms intervening between social factors and health outcomes, as these mediators are thought to clarify the biological pathways that explain why health changes with age. An interest in summarizing biological risk, such as the measures mentioned above in summarizing recent change in physiological status, initially developed as a way of incorporating multiple physiological and sometimes behavioral risk factors into a succinct indicator of relative risk for spe FIGURE 1-7 Multidisciplinary model for examining individual trajectories of health with aging.
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Allostatic load has been linked to a number of subsequent health outcomes including loss of functioning ability, cognitive loss, disease, and mortality (Seeman et al., 2001) , as well as being associated with SES and race (Geronimus et al., 2006)
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This would include epigenetic markers of DNA methylation as well as RNA expression. To date, three "biological clocks" have been defined, based on DNA methylation (Horvath, 2013; Hannum et al., 2013; Weidner et al., 2014)
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Unlike the RNA-based measures and the DNA methylation measures discussed above, these genetic characteristics are fixed and not changed by environments. Large population studies have been used to determine genetic markers for a number of risk factors for health outcomes such as body mass index (Locke et al., 2015)
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. TABLE 1-2 Significant Differences in Polygenic Risk Scores in White Health and Retirement Study Sample by Sex, Education, and Age Female/male Educationa Ageb Alzheimer's Disease General Cognition High Body Mass Index Low Younger Waist Circumference Low Waist-to-Hip Ratio Height High Older Mean Arterial Pressure Educational Attainment High Older Ever Smoker Low Younger Depressive Symptoms Low Major Depressive Disorder Low Neuroticism Low Schizophrenia +Female Low Subjective Well-being aHigh = education ≥ 12 years; Low = education ≤ 11 years.
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From page 20... ...
When women behave more like men, for instance by smoking more and taking illegal drugs, their health outcomes are likely to become more like those of men because this behavioral component of the mortality difference will be reduced. On the other hand, the extremely adverse trends among women of lower educational attainment might not have been predicted.
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It is possible that life circumstances of African Americans now reaching old age improved earlier in life with changes in civil rights, and these changed circumstances have resulted in improved mortality, relative to earlier cohorts of their peers or to Whites in the same cohort, in later life. If this is the explanation for the observed changes in life expectancy trends and differentials, the effect may play out in the future only as long as the relevant life circumstances improve over the life cycle.
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The development of multivariable measures such as multimorbidity, frailty, polygenic risk scores, biological risk, pace of aging, and biological clocks have helped capture the complexity and the multisystem nature of the process. Much of the reward in improved understanding that can result from these developments is still promise; but the near future is likely to bring rapid increases in understanding.
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. Integrating genetics and social science: Genetic risk scores.
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. Power and predictive accuracy of polygenic risk scores.
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. Trends and group differences in the association between educational attainment and U.S.
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. Modeling the rate of senescence: Can estimated biological age predict mortality more accurately than chronological age?
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White women from 1986 to 2006. American Journal of Public Health, 103(3)
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. Recent trends in hospitalization for acute myocardial infarction.
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From page 29... ...
. Population trends in the incidence and outcomes of acute myocardial infarction.
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