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Morbidity compression in myocardial infarction 2006 to 2015 in terms of changing rates and age at occurrence: A
Siegfried Geyer1, Sveja Eberhard2, Bernhard Magnus W Schmidt3
1Medical Sociology Unit, Hannover Medical School, Hannover, Germany.
Insights
Morbidity compression, indicated by decreasing myocardial infarction (MI) rates and delayed onset age, has improved healthy lifetime, particularly in men. This phenomenon is multifaceted, with variations observed between genders.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Morbidity compression, defined by Fries, occurs when morbidity decreases more than mortality or onset age increases faster than death age.
- This population-level concept has rarely been applied to specific diseases.
- Myocardial infarction (MI) serves as the disease model for this investigation.
Purpose of the Study:
- To investigate morbidity compression in myocardial infarction (MI) using German claims data from 2006-2015.
- To analyze trends in MI morbidity and mortality rates, and age at onset versus age at death.
- To assess gender-specific differences in these trends.
Main Methods:
- Utilized German health insurance claims data (2006-2015) for individuals aged 18+.
- Analyzed approximately 2 million cases annually.
- Employed proportional hazards regression and linear regression models.
Main Results:
- Morbidity rates decreased more significantly than mortality rates for both men (HR 0.66 vs. 0.75) and women (HR 0.71 vs. 1.0).
- Age at MI onset increased more than age at death for men (10.5 vs. 10.4 months), indicating compression.
- Changes in age at onset were smaller and not statistically significant for women, despite decreasing morbidity rates.
Conclusions:
- Morbidity compression is evident in myocardial infarction, particularly in men, through decreasing incidence and increasing age at onset, leading to extended healthy lifespans.
- While women show decreasing MI morbidity rates, the lack of significant change in onset age highlights the multifaceted nature of morbidity compression.
- Morbidity rates and age at onset can vary independently, underscoring the complexity of measuring healthy life extension.
Background:
According to James Fries morbidity compression is present if morbidity rates are decreasing to a larger extent than mortality rates. Compression also occurs if age at onset is increasing at a faster pace than age at death. These two variants of the compression hypothesis were formulated as a population concept. Compression has seldom been studied with a specific disease as application.
Methods:
Morbidity compression was examined in terms of myocardial infarction (MI) by using German claims data covering the years 2006 to 2015. The findings are based on an annual case number of about 2 m women and men aged 18 years and older. Analyses were performed by means of proportional hazards regression and by using linear regression.
Results:
Decreases of morbidity rates were more pronounced than those of mortality. For men, the hazard ratio for contracting MI in 2015 as compared to 2006 was hr = 0.66 and hr = 0.71 for the female population. The respective results for mortality were hr = 0.75 in men and hr = 1.0 in women. They can be interpreted in favor of morbidity compression. For the subgroup of women and men with MI, changes of onset age revealed marked gender differences. For 2015 as compared with 2006, age at MI-occurrence in men increased by 10.5 months as compared to an increase of 10.4 months for age at death. In women changes were smaller and statistically not significant. The findings referring to women have to be interpreted against the backdrop of higher onset age and higher age at death than in men.
Conclusions:
Taken together, morbidity compression has occurred in terms of decreasing MI-rates as well as in terms of increased onset age in men. It can be concluded that both processes have led to an improvement of healthy lifetime. Decreasing morbidity rates in women are also pointing towards morbidity compression, a finding that is not complemented by changes of onset age. Our data are demonstrating that morbidity rates and age at onset may vary independently. From this perspective morbidity compression is a multi-faceted phenomenon.
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