Highlights
- •Two-thirds of a large cohort of older Australian women had died by age 90–95, and only 3.8% of these died without disease and disability.
- •Women with chronic disease were more likely to experience disability than to die without disability.
- •At age 70–75, predicted life without disease and disability was eight years, while life with disease but no disability was four years, and life with disability was four years.
- •The factors difficulties managing on available income, less than secondary school qualification and obese/overweight at age 70–75 were associated with increased risk of disability.
Abstract
Objective
To estimate the probability of onset and progression of disease and disability, length
of life with or without disease and/or disability, and incidence of mortality, and
to identify factors associated with transitioning to disease and/or disability over
time.
Study design
A prospective cohort study. Data were provided by 12,432 participants (born 1921–26)
of the Australian Longitudinal Study of Women's Health linked with National Death
Index data from 1996 (age: 70–75) to 2016 (age: 90–95).
Main outcome measures
A five-state Markov model was fitted to estimate the transition probability, length
of life with or without disease and/or disability, and the association between baseline
characteristics and disease/disability/mortality risk.
Results
Over two-thirds of women had died by age 90–95, and only 3.8% of these had died with
no chronic disease and disability. Those reporting chronic disease were more likely
to have experienced disability (Transition Rate Ratio: 2•72, 95%CI= 2•52–2•93) than
those who died without disability. At age 70–75, the expected life without chronic
disease and disability was 7•68 (95%CI: 7•52–7•80) years, life with chronic disease
but no disability was 4•39 (95%CI=4•23–4•49) years, and life with disability was 3.76
(95%CI=3•66–3•92) years. The factors difficulties managing on available income (HR=1•18,
95%CI=1•02–1•38), did not complete secondary school (HR=1•19, 95%CI=1•03–1•37), and
overweight/obese (HR=1•36, 95%CI=1•20–1•55) were associated with an increased risk
of disability.
Conclusions
Our findings provide important insights on the onset and progression of disease and
disability in older women, underscoring the importance of addressing mid-/early old-life
risk factors, managing chronic conditions, and delaying disability onset and progression
through targeted intervention programs.
Keywords
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Article info
Publication history
Published online: November 26, 2021
Accepted:
November 4,
2021
Received in revised form:
August 31,
2021
Received:
April 15,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
