03094nas a2200349 4500008004100000022001400041245010800055210006900163260001600232300000700248490000600255520208600261653002302347653002602370653002302396653002202419653002102441653002002462653001802482653001102500653002002511653001302531653002302544653001402567653001802581653004002599100001702639700001702656700001602673700002002689856003502709 2007 eng d a1471-245800aThe effect of different public health interventions on longevity, morbidity, and years of healthy life.0 aeffect of different public health interventions on longevity mor c2007 Apr 05 a520 v73 a

BACKGROUND: Choosing cost-effective strategies for improving the health of the public is difficult because the relative effects of different types of interventions are not well understood. The benefits of one-shot interventions may be different from the benefits of interventions that permanently change the probability of getting sick, recovering, or dying. Here, we compare the benefits of such types of public health interventions.

METHODS: We used multi-state life table methods to estimate the impact of five types of interventions on mortality, morbidity (years of life in fair or poor health), and years of healthy life (years in excellent, very good, or good health).

RESULTS: A one-shot intervention that makes all the sick persons healthy at baseline would increase life expectancy by 3 months and increase years of healthy life by 6 months, in a cohort beginning at age 65. An equivalent amount of improvement can be obtained from an intervention that either decreases the probability of getting sick each year by 12%, increases the probability of a sick person recovering by 16%, decreases the probability that a sick person dies by 15%, or decreases the probability that a healthy person dies by 14%. Interventions aimed at keeping persons healthy increased longevity and years of healthy life, while decreasing morbidity and medical expenditures. Interventions focused on preventing mortality had a greater effect on longevity, but had higher future morbidity and medical expenditures. Results differed for older and younger cohorts and depended on the value to society of an additional year of sick life.

CONCLUSION: Interventions that promote health and prevent disease performed well, but other types of intervention were sometimes better. The value to society of interventions that increase longevity but also increase morbidity needs further research. More comprehensive screening and treatment of new Medicare enrollees might improve their health and longevity without increasing future medical expenditures.

10aActuarial Analysis10aCost-Benefit Analysis10aDisease Management10aHealth Priorities10aHealth Promotion10aHealth Services10aHealth Status10aHumans10aLife Expectancy10aMedicare10aModels, Biological10aMorbidity10aUnited States10aUnited States Public Health Service1 aDiehr, Paula1 aDerleth, Ann1 aCai, Liming1 aNewman, Anne, B uhttps://chs-nhlbi.org/node/95303247nas a2200409 4500008004100000022001400041245007500055210006900130260001300199300001200212490000700224520212300231653003102354653000902385653002202394653002702416653002802443653002102471653001102492653002202503653002502525653001802550653001102568653000902579653001402588653002602602653001702628653001702645653001802662100002402680700001702704700001702721700002302738700002002761700002002781856003602801 2010 eng d a1532-541500aGeriatric impairments and disability: the cardiovascular health study.0 aGeriatric impairments and disability the cardiovascular health s c2010 Sep a1686-920 v583 a

OBJECTIVES: To determine the relative importance of geriatric impairments (in muscle strength, physical capacity, cognition, vision, hearing, and psychological status) and chronic diseases in predicting subsequent functional disability in longitudinal analyses.

DESIGN: Longitudinal data from the Cardiovascular Health Study were analyzed. Multivariable Cox hazards regression modeling was used to analyze associations between time-dependent predictors and onset of disability in activities of daily living (ADLs) and mobility.

SETTING: Four communities across the United States (Sacramento County, CA; Washington County, MD; Forsyth County, NC; and Allegheny County, PA).

PARTICIPANTS: Five thousand eight hundred eighty-eight elderly persons.

MEASUREMENTS: Data were collected annually through in-person examinations.

RESULTS: ADL disability developed in 15% of participants and mobility disability in 30%. A single multivariable model was developed that included demographics, marital status, body mass index, and number of impairments and diseases. The hazard ratios (HRs) of having one, two, and three or more geriatric impairments (vs none) for the outcome of ADL disability were 2.12 (95% confidence interval (CI)=1.63-2.75), 4.25 (95% CI=3.30-5.48), and 7.87 (95% CI=6.10-10.17), respectively, and for having one, two, and three or more chronic diseases were 1.75 (95% CI=1.41-2.19), 2.45 (95% CI=1.95-3.07), and 3.26 (95% CI=2.53-4.19), respectively. Similarly, the HRs of having one, two, and three or more impairments for the outcome of mobility disability were 1.48 (95% CI=1.27-1.73), 2.08 (95% CI=1.77-2.45), and 3.70 (95% CI=3.09-4.42), respectively, and for having one, two, and three or more diseases were 2.06 (95% CI=1.76-2.40), 2.80 (95% CI=2.36-3.31), and 4.20 (95% CI=3.44-5.14), respectively.

CONCLUSION: Number of geriatric impairments was more strongly associated than number of chronic diseases with subsequent ADL disability and nearly as strongly associated with the subsequent mobility disability.

10aActivities of Daily Living10aAged10aAged, 80 and over10aCardiac Rehabilitation10aCardiovascular Diseases10aDisabled Persons10aFemale10aFollow-Up Studies10aGeriatric Assessment10aHealth Status10aHumans10aMale10aMorbidity10aRetrospective Studies10aRisk Factors10aTime Factors10aUnited States1 aChaudhry, Sarwat, I1 aMcAvay, Gail1 aNing, Yuming1 aAllore, Heather, G1 aNewman, Anne, B1 aGill, Thomas, M uhttps://chs-nhlbi.org/node/1232