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. 2020 May;35(5):381-388.
doi: 10.1007/s10654-020-00642-3. Epub 2020 May 16.

Rethinking morbidity compression

Rosie Seaman  1   2 , Andreas Höhn  3   4   5 , Rune Lindahl-Jacobsen  5   6 , Pekka Martikainen  3   7 , Alyson van Raalte  3 , Kaare Christensen  5   8
Affiliations

Rethinking morbidity compression

Rosie Seaman et al. Eur J Epidemiol. 2020 May.

Abstract

Studies of morbidity compression routinely report the average number of years spent in an unhealthy state but do not report variation in age at morbidity onset. Variation was highlighted by Fries (1980) as crucial for identifying disease postponement. Using incidence of first hospitalization after age 60, as one working example, we estimate variation in morbidity onset over a 27-year period in Denmark. Annual estimates of first hospitalization and the population at risk for 1987 to 2014 were identified using population-based registers. Sex-specific life tables were constructed, and the average age, the threshold age, and the coefficient of variation in age at first hospitalization were calculated. On average, first admissions lasting two or more days shifted towards older ages between 1987 and 2014. The average age at hospitalization increased from 67.8 years (95% CI 67.7-67.9) to 69.5 years (95% CI 69.4-69.6) in men, and 69.1 (95% CI 69.1-69.2) to 70.5 years (95% CI 70.4-70.6) in women. Variation in age at first admission increased slightly as the coefficient of variation increased from 9.1 (95% CI 9.0-9.1) to 9.9% (95% CI 9.8-10.0) among men, and from 10.3% (95% CI 10.2-10.4) to 10.6% (95% CI 10.5-10.6) among women. Our results suggest populations are ageing with better health today than in the past, but experience increasing diversity in healthy ageing. Pensions, social care, and health services will have to adapt to increasingly heterogeneous ageing populations, a phenomenon that average measures of morbidity do not capture.

Keywords: Age at morbidity onset; Ageing and health; Hospital admission; Morbidity compression.

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Figures

Fig. 1
Fig. 1
Cohort study population inclusion and exclusion criteria, using 1987 as an example
Fig. 2
Fig. 2
Average age at first hospital admission for men and women between 1987 and 2014
Fig. 3
Fig. 3
Percentage of first hospital admissions over age and threshold age for men and women in 1987, 2001, and 2014
Fig. 4
Fig. 4
Variation in average age at first hospital admission for men and women between 1987 and 2014
See this image and copyright information in PMC

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