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. 2008 Sep;18(9):696-701.
doi: 10.1016/j.annepidem.2008.06.005.

Changes in health status among participants of the Framingham Heart Study from the 1960s to the 1990s: application of an index of cumulative deficits

Alexander M Kulminski  1 , Konstantin G Arbeev, Svetlana V Ukraintseva, Irina V Culminskaya, Kenneth Land, Anatoli I Yashin
Affiliations

Changes in health status among participants of the Framingham Heart Study from the 1960s to the 1990s: application of an index of cumulative deficits

Alexander M Kulminski et al. Ann Epidemiol. 2008 Sep.

Abstract

Purpose: Health of the general population is improving along a number of major health dimensions. Using a cumulative deficits approach, we investigated whether such improvements were evident at the level of minor health traits.

Methods: We selected 37 small-effect traits consistently measured in the 9th (performed in 1964) and 14th (1974) Framingham Heart and 5th (1991-1995) Offspring Study exams to construct indices of cumulative deficits (DIs).

Results: We identified deficits-specific DIs characterizing health dimensions associated with no health changes (DI(NHC)), health worsening (DI(WRS)), and health improving (DI(IMP)) between the 1960s and 1990s. The risks of death attributable to the DI(NHC) dominate within shorter time horizons. For longer time horizons, both the DI(NHC) and DI(IMP) provide the same contribution to the risks of death. The mortality risks associated with the DI(WRS) are the weakest and least significant.

Conclusions: The analyses show that the cumulative deficits approach might be an efficient tool for analyzing the effects of a large number of health characteristics for which the individual effects are small, inconsistent, or non-significant. They show favorable trends such that health of the Framingham studies participants either did not change or improved over time for the most serious small-effect traits.

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Figures

Figure 1
Figure 1
(a–b) Age patterns of the DIs constructed using (a) all 37 deficits selected for the analyses and (b) reduced set of 35 deficits with group 4 (see Table 1) excluded for participants of the 9th and 14th exams of the FHS and 5th exam of the FHSO as denoted in the inset. (c–f) Age patterns of the DIs characterizing health dimensions associated with (c) no health changes (DINHC), (d) health worsening (DIWRS), and (e and f) health improving (DIIMPA and DIIMP, respectively) over time. Bars show 95% confidence intervals.
Figure 2
Figure 2
Relative risks of death evaluated for a 10% increase in (a) the DINHC, (b) the DIWRS, and (c) the DIIMP. Insets show means, standard deviations, and range for the respective DIs.
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