Abstract
SummaryBackgroundThe life expectancy of the average American with diabetes has increased, but the level of health and functioning of those extra years are not known.MethodsComparing adults aged 50 to 70 with (n=3,027) and without diabetes (n=9,750), we assessed incident disability, remission from disability, and mortality between population-based Cohort 1 (born 1931-1941, followed 1992 to 2002) and Cohort 2 (born 1942-1947, followed 2002 to 2012), from the Health and Retirement Study. Disability was defined by mobility loss, some difficulty with ≥1 instrumental activities of daily living (IADL), and some difficulty with ≥1 activities of daily living (ADL). Age-specific probabilities representing the two birth cohorts in the U.S. were entered into a five-state Markov model to estimate the number of years of disabled and disability-free life by age 70.FindingsAmong persons with diabetes, compared with Cohort 1(n=1,071), Cohort 2 (n=300) experienced more disability-free and total years of life, later onset of disability, and fewer disabled years lost. Solutions to the simulations of the Markov models suggest that among 50 year old diabetic men this amounted to a 0.8 to 2.3 year delay in disability across the 3 metrics (mobility p=0.01, IADL p=0.24, ADL p=0.01), while living 0.7 to 1.3 years longer (mobility p<0.0001, IADL p=0.001, ADL p<0.0001); results were similar for women. Parallel improvements in disabled life were gained across cohorts of non-diabetic adults (cohort 1 n=9,218; cohort 2 n=2,727), although non-diabetic adults in both cohort 1 and cohort 2 had significantly more disability-free years (e.g., cohort 1: non-diabetic men from age 50: 17.0 vs diabetic men: 13.0; cohort 2: non-diabetic men from age 50: 17.9 vs diabetic men: 14.8) and fewer life years lost (e.g., cohort 1: non-diabetic men from age 50: 1.2 vs diabetic men: 2.8; cohort 2: non-diabetic men from age 50: 0.6 vs diabetic men: 1.5) than diabetic adults within the two cohorts (p< 0.0001).InterpretationRegardless of diabetes status, adults experienced compression of disability and gains in disability-free life years.FundingNone
Highlights
Incidence and prevalence of diabetes have more than doubled in the past two decades in virtually all demographic subgroups of the U.S population.[1]. These trends have been accompanied by large reductions in mortality rates that have increased the number of years spent with diabetes for the average person and for the population overall.[2]. As a result, the lifetime probability of diabetes has increased dramatically, reaching 40% for both men and women in the United States.[3] yearly rates of several diabetes-related complications declined during this period,(4) the impact of living more years of life with diabetes on the quality of those extra years of life remains unclear
The average time spent in an active state will increase, both in absolute terms and as a proportion of total life expectancy (TLE).(6) Alternatively, expansion of disability occurs if the gain in TLE is associated with longer periods of disability, implying that medical advances have extended life for those suffering from disabling diseases, without changing the age of disability onset or the number of healthy years of life
Age-adjusted diabetes prevalence did not differ between persons born in the 1940's with those born in the 1930's
Summary
Incidence and prevalence of diabetes have more than doubled in the past two decades in virtually all demographic subgroups of the U.S population.[1] These trends have been accompanied by large reductions in mortality rates that have increased the number of years spent with diabetes for the average person and for the population overall.[2] As a result, the lifetime probability of diabetes has increased dramatically, reaching 40% for both men and women in the United States.[3] yearly rates of several diabetes-related complications declined during this period,(4) the impact of living more years of life with diabetes on the quality of those extra years of life remains unclear. The average time spent in an active state (i.e., disability-free) will increase, both in absolute terms and as a proportion of total life expectancy (TLE).(6) Alternatively, expansion of disability occurs if the gain in TLE is associated with longer periods of disability, implying that medical advances have extended life for those suffering from disabling diseases, without changing the age of disability onset or the number of healthy years of life. We used a discrete Markov model to determine whether the net impact of recent trends in diabetes incidence, disability, and mortality have affected the average age of disability onset and the number of healthy and disabled years experienced by adults with and without diabetes
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