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Population Health Metrics
Published in: Population Health Metrics 1/2017

Open Access 01-12-2017 | Research

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

Authors: Nisha C. Hazra, Martin Gulliford

Published in: Population Health Metrics | Issue 1/2017

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Abstract

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.
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Metadata
Title
Evolution of the “fourth stage” of epidemiologic transition in people aged 80 years and over: population-based cohort study using electronic health records
Authors
Nisha C. Hazra
Martin Gulliford
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Population Health Metrics / Issue 1/2017
Electronic ISSN: 1478-7954
DOI
https://doi.org/10.1186/s12963-017-0136-2

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