The number of healthy years a person lives is, on average, increasing even for people with common chronic conditions, according to a new study publishing March 15th in PLOS Medicine by Holly Bennett of Newcastle University, UK, and colleagues.
There have been advances in healthcare over recent decades that mean many people with chronic health conditions are living longer. In the new study, researchers wanted to determine whether this extension to life involves an increase in years with or without disability. The team analyzed data from two large population-based studies of people aged 65 or over in England. The studies, the Cognitive Function and Aging Studies (CFAS I and II) involved baseline interviews with 7,635 people in 1991-1993 and with 7,762 people in 2008-2011, with two years of follow-up in each case.
For both healthy people and those with health conditions, the average years of disability-free life expectancy (DFLE) increased from 1991 to 2011. Overall, men gained 4.6 years in life expectancy (95% CI: 3.7 – 5.5 years, p<0.001)) and 3.7 years in DFLE (95% CI: 2.7 – 4.8, p<0.001)). Men with conditions including arthritis, coronary heart disease, stroke and diabetes gained more years in DFLE than years with disability. The greatest improvements in DFLE in men were seen for those with respiratory difficulties and those living post-stroke.
Between 1991 and 2011, women experienced an increase in life expectancy at age 65 years of 2.1 years (95% CI: 1.1– 3.0 years, p<0.001), and an increase in DFLE of 2.0 years (95% CI: 1.0 – 2.9 years, p<0.001). Similar to men, most improvement in life expectancy for women with long-term conditions was in disability-free years. However, women with cognitive impairment experienced an increase in life expectancy with disability (1.6 years, 95% CI: 0.1 – 3.1, p=0.04) without any improvement in DFLE. Men with cognitive impairment experienced only a small increase in DFLE (1.4 years, 95% CI: -0.7 – 3.4, p=0.18) with an increase in life expectancy with disability that was comparable in magnitude (1.4 years, 95%CI: 0.2-2.5, p=0.02). Therefore, at age 65, the percentage of remaining years of life which were spent disability-free decreased for men with cognitive impairment (difference CFAS II – CFAS I: -3.6%, 95% confidence interval (CI): -8.2 – 1.0, p=0.12) and women with cognitive impairment (difference CFAS II – CFAS I: -3.9%, 95% CI: -7.6 – 0.0, p=0.04).
“While these findings are mostly positive, we found an increase in the percentage of remaining years spent with disability for men and women with cognitive impairment. Given cognitive impairment was also the only long-term condition where prevalence decreased this is a cause for concern and requires further investigation,” the authors say.
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Citation: Bennett HQ, Kingston A, Lourida I, Robinson L, Corner L, Brayne C, et al. (2022) A comparison over 2 decades of disability-free life expectancy at age 65 years for those with long-term conditions in England: Analysis of the 2 longitudinal Cognitive Function and Ageing Studies. PLoS Med 19(3): e1003936. https://doi.org/10.1371/journal.pmed.1003936
Author Countries: United Kingdom
Funding: This work was supported by the Dunhill Medical Trust (grant number RPGF1806\44 https://dunhillmedical.org.uk/ to CJ, FEM and AK) and presents independent research funded by the National Institute for Health Research (https://www.nihr.ac.uk/) Policy Research Unit in Older People and Frailty (PR-PRU-1217-21502 to FEM, CJ, LR and LC). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. CFAS II was supported by the UK Medical Research Council (MRC https://mrc.ukri.org/ research grant G0601022 to CB, FEM and CJ), Alzheimer’s Society (https://www.alzheimers.org.uk/ Grant Ref: 294 to CB, FEM and CJ), MRC CFAS (including CFAS I areas) was funded by the MRC and the UK National Health Service (Grant number G9901400 to CB and FEM). HB was supported for this project by the Dunhill Medical Trust (grant number RPGF1806\44). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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Competing interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: CB is an Academic Editor on PLOS Medicine’s editorial board. FM is a paid statistical consultant on PLOS Medicine’s statistical board.