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Compression of Morbidity 2006 James F. Fries, MD Brussels March 22, 2006 0308061.

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Presentation on theme: "Compression of Morbidity 2006 James F. Fries, MD Brussels March 22, 2006 0308061."— Presentation transcript:

1 Compression of Morbidity 2006 James F. Fries, MD Brussels March 22,

2 Vision and Opportunity The health of seniors is our greatest national health problem The health of seniors is our greatest economic problem We know how to postpone ill-health and infirmity by ten or more years We know how to moderate medical costs by reducing the illness burden

3 Reduction in Need and Demand for Medical Care Healthy People Need Less Medical Care The Health and Economic Solutions are on the Demand Side The Period of Maximum Employee Vigor may be Extended by Health Enhancement Programs

4 Reduction of Need and Demand Questions Sometimes Asked Will healthier people cost more by living longer? What is the length of the lag period between health risk reduction and positive health and cost benefits? Will we just make people healthier for their next employer?

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6 The Compression of Morbidity: Central Thesis The age at first appearance of aging and chronic disease symptoms can increase more rapidly than life expectancy

7 Scenarios for Future Morbidity and Longevity Morbidity Death Present Morbidity I. Life Extension II. Shift to the Right III. Compression of Morbidity

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9 Chartbook on Trends in the Health of Americans / Health, United States 2005 Life expectancy at birth and at 65 years of age by sex: United States, Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System Life expectancy at birth Life expectancy at 65 years Male Female Life expectancy in years

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11 Groups Threatened by the Paradigm of Compression of Morbidity Bioscientists Fearing Displacement of Funding Humanists Opposed to “Blaming the Victim” Geriatricians Worried about Lack of Preparation Pessimists Believing Goal Unachievable Demographers Vested in Contrary Predictions

12 Evidence for Compression of Morbidity Multiple longitudinal studies documenting morbidity compression by social class, exercise level, education level, risk factors for heart disease Multiple national surveys of disability since 1982 Multiple randomized trials showing disability and cost reductions with risk factor reduction

13 POSTPONEMENT OF DISABILITY The University of Pennsylvania Alumni Statistics 1741 subjects studied over 50 years to age 77 Three groups - low, medium, high risk based on smoking, body weight, and lack of exercise health risks at ages 40 and 62. The low risk group had only one-half the cumulative lifetime disability of the high-risk group. Vita et al, NEJM,

14 Cumulative Disability, Mean Values Bars Represent S.E. of the Mean Disability Index Vita et al, NEJM,

15 Disability Index by Year and Risk Factor Category Disability Index Vita et al, NEJM,

16 Disability Index by Age and Risk Factor Category Age Disability Index Vita et al, NEJM,

17 Running and Osteoarthritis (OA): A 13-Year Study Wang et al, Archives Internal Medicine, November Runners 423 Controls Average Age 58 in 1984 Followed Annually for: Disability Pain Osteoporosis X-ray Progression of OA

18 Disability by Age and Runner Status Age Category Community Control (n=249) Runners Club (n=369) Mean Disability Score Wang et al,

19 0.3 — — 0.25 — — 0.2 — — 0.15 — — 0.1 — — 0.05 — — Disability Average Age, years 12.8y (95% CI, 8.3 to 20.6y) 8.7y (CI, 5.5 to 13.3y) 4.6y (CI, 2.5 to 7.3y) | | | | | | | | | | | | | | Runners (n=370) Community Controls (n=249) Postponement of disability (years)

20 National Long-Term Care Surveys Over-65 Disability Distributions (%) Manton and Gu, Disabled Mild Disab (IADL) Moderate Disab (1-2) Severe Disab (3-4) Very Severe (5-6) Institutionalized

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22 Self-Assessed Health Status as Excellent or Good: United States, Total, % Age, y < > > Source: Breslow, AJPH, 2006;96:

23 increasedunchangeddecreased increased AIDS smoking migraine headaches heart transplant decreased suicide cure osteoarthritis exercise weight loss Mortality Morbidity

24 A General Theory of Morbidity and Mortality Perturbations to the individual health may be classified quantitatively as increasing or decreasing morbidity and as increasing or decreasing mortality The individual is subject to many perturbations and it is usual for some to have positive and some negative effects Population morbidity and population mortality are the integrated sums of the positive or negative effects of perturbations on individuals

25 Need and Demand Reduction Randomized Trials in Seniors Fries et al, Health Affairs,

26 The Key Targets for First Year Health Improvement and Cost Reduction Perceived Self-Efficacy Self-Management Skills High-Risk Persons Chronic Disease Patients Last Year of Life Low Birthweight Babies Absenteeism Productivity Corporate Image Employee Turnover

27 Conclusions Theory, Longitudinal Studies and Surveys and Scientific Trials document that: Illness, infirmity, and frailty in populations may be postponed by at least 8 to 12 years Disability is decreasing by 2% or more per year in many developed countries. Mortality is decreasing at only 1% a year, documenting Compression of Morbidity Health enhancement programs can improve health and reduce costs in worksites, health plans, and in mature adult populations Continued Compression of Morbidity is feasible


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