Abstract
Lifespan increases observed in the United States and elsewhere throughout the developed world, have been attributed in part to improvements in medical care access and technology and to healthier lifestyles. To differentiate the relative contributions of these two factors, we have compared lifespan in the Old Order Amish (OOA), a population with historically low use of medical care, with that of Caucasian participants from the Framingham Heart Study (FHS), focusing on individuals who have reached at least age 30 years.Analyses were based on 2,108 OOA individuals from the Lancaster County, PA community born between 1890 and 1921 and 5,079 FHS participants born approximately the same time. Vital status was ascertained on 96.9% of the OOA cohort through 2011 and through systematic follow-up of the FHS cohort. The lifespan part of the study included an enlargement of the Anabaptist Genealogy Database to 539,822 individuals, which will be of use in other studies of the Amish. Mortality comparisons revealed that OOA men experienced better longevity (p<0.001) and OOA women comparable longevity than their FHS counterparts.We further documented all OOA hospital discharges in Lancaster County, PA during 2002–2004 and compared OOA discharge rates to Caucasian national rates obtained from the National Hospital Discharge Survey for the same time period. Both OOA men and women experienced markedly lower rates of hospital discharges than their non-Amish counterparts, despite the increased lifespan.We speculate that lifestyle factors may predispose the OOA to greater longevity and perhaps to lesser hospital use. Identifying these factors, which might include behaviors such as lesser tobacco use, greater physical activity, and/or enhanced community assimilation, and assessing their transferability to non-Amish communities may produce significant gains to the public health.
Highlights
Average lifespan in the United States (US), as in many other developed countries throughout the world, has been increasing over time [1]
This community was founded by hundreds of individuals who immigrated to this area from central Europe during the early 18th century, with the present day Lancaster County Old Order Amish (OOA) community comprised of their descendants
Informed consent was not obtained; the mortality component of the study was based on publicly available data maintained by NIH through the AGDB (Amish) and NHLBI BioLINCC Biorespository (Framingham Heart Study), and a waiver for informed consent was granted by the Directors of Research from Lancaster Regional Medical Center, Ephrata Community Hospital, and Ephrata Community Hospital because the study involved a review of medical records only, did not require collection of personal identifying information, and the research could not be reasonably conducted without a waiver of consent
Summary
Average lifespan in the United States (US), as in many other developed countries throughout the world, has been increasing over time [1]. The decrease in cardiovascular deaths has been attributed in part to improvements in rushing heart attack sufferers to the hospital and administering life-saving emergency treatments both in the ambulance and in the emergency room [4,5] Changes such as cholesterol-lowering drugs, decreases in smoking and heart healthier diets, are important contributors. The relative contributions to lifespan made by improvements in medical care access and technology versus improvements in lifestyle have been hard to quantify This is an important issue in public policy given that lifespan in the US lags behind that of many other developed nations despite health care costs in the US, estimated at $2.6 trillion in 2010 [6], that dwarf those in other countries.
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