Original Article| Volume 158, P25-33, April 2022

Onset and progression of chronic disease and disability in a large cohort of older Australian women


      • 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.



      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.


      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.


      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.


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