Does the Mortality of Individuals with Severe Disabilities Contribute to the Persistent East–West Mortality Gap Among German Men?

European Journal of Population - After three decades since reunification male life expectancy in East Germany still lags behind that of West Germany. Unlike most of the prior studies focusing on...     

Cause-of-Death Contributions to Educational Inequalities in Mortality in Austria between 1981/1982 and 1991/1992

This article uses census records and deaths records to analyze trends in educational inequalities in mortality for Austrian women and men aged 35–64 years between 1981/1982 and 1991/1992. We find an increasing gradient in mortality by education for circulatory diseases and especially ischaemic heart disease. Respiratory diseases and, in addition for women, cancers showed the opposite trend. Using decomposition analysis, we give evidence that in many cases changes in the age-structure within the 10-year interval had a bigger effect than direct improvements in mortality on the analyzed subpopulations.     

Extremity injuries and dementia disproportionately increase the risk for long-term care at older age in an analysis of German Health Insurance routine data for the years 2006 to 2010

Background

Extremity injuries (EI) and dementia are important causes of long-term care (LTC), but they can also cause each other and are often present concurrently. Mobility-limiting EI can increase the risk of dementia, and dementia increases the risk for falls, which are often the cause of EI. When EI and dementia are present together, they can increase their negative effect on long-term care risk. This study aims to assess the strength of this interaction and the role of different body regions and severities of EI regarding LTC risk.

Methods

We use Cox proportional-hazard models on LTC as dependent variable. EI (primarily fractures) and dementia (all types) are the central independent variables. We control for age, sex, rehabilitation and 18 relevant comorbidities. Analyses are based on health claims records for 2004–2010 for a random sample of about 122.000 insurants of Germany's largest public health insurance "AOK" aged 65+, about 25.000 of whom entered LTC.

Results

Without concurrent dementia, non-severe EI (NSEI) of the lower and both extremities and all kinds of severe EI (SEI) increase LTC risk (HR: hazard ratio with 95% confidence interval. Lower NSEI: HR?=?1.09 [1.05–1.14]; both NSEI: HR?=?1.36 [1.29–1.44]. Lower SEI: HR?=?1.67 [1.57–1.79]; upper SEI: HR?=?1.27 [1.19–1.37]; both SEI: HR?=?1.94 [1.81–2.07]). Dementia alone increases LTC risk more than fourfold (HR?=?4.23 [4.11–4.35]).Taking the interaction of EI and dementia into account, the concurrent presence of EI and dementia tends to increase the LTC risk more than expected for lower as well as upper NSEI and SEI. Summarily, when lower or upper EI and dementia are both present, the LTC risk tends to be higher than expected, suggesting synergistic effects.

Conclusions

EI and dementia are important independent risk factors for long-term care. When lower or upper EI and dementia are present together, the resulting long-term care risk is increased disproportionately. Since the concurrent presence of both conditions increases the risk for care need, and a working treatment for dementia is not in sight, preventing EI, lessening the impact of EI and improving the outlook after an EI could help to reduce LTC need in the coming decades.

     

Left-censored dementia incidences in estimating cohort effects

Lifetime Data Analysis - We estimate the dementia incidence hazard in Germany for the birth cohorts 1900 until 1954 from a simple sample of Germany’s largest health insurance company....     

Month of Birth and Dementia Late in Life

Dementia is one of the most common, still incurable diseases of old age, with high costs for the patient, the family and the society. Scholars of dementia have identified important risk factors in mid-life but little attention has been devoted to the earliest period in life. This article extends the research about risk factors of dementia to the time around birth. We start by discussing the influential theories of fetal programming and of the thrifty phenotype, and briefly contrast these theories with life-course approaches and the theory of the accumulation of advantage or disadvantage over the life course. Our own empirical study is based on an exogenous indicator of the early life environment, namely the month of birth. We present the theoretical background of using this indicator and discuss others such as famines, epidemics, and macro-economic fluctuations. Using data from the largest public health insurer in Germany we explore the relationship between the month of birth and dementia and find that the winter-born have the lowest risk of developing dementia. We present the pros and cons of using claims data in the study of dementia and discuss research findings that may shed light on the biological mechanisms underlying our finding.     

Cohort Changes in the Incidence of Care Need in West Germany Between 1986 and 2005

In Germany, the share of the older population has been continuously growing. Is the increase paralleled by a rising number of frail people, however? In search of an answer, we analyse the development of care need incidence in West Germany between 1986 and 2005 on the basis of longitudinal data from the German Socio-Economic Panel (SOEP). The results show a lower transition risk to care need for each successive cohort when all degrees of care need are taken into account. However, no change occurs when only severe care need is measured.     

Reproductive history and mortality later in life: a comparative study of England and Wales and Austria

Does a woman's reproductive history influence her life span? This study explores the question with data from the contemporary female populations of England and Wales and Austria. It is the first comparative study to investigate the relationship between fertility and mortality late in life. We find similar patterns and age-specific trends of excess mortality in both populations: parity significantly influences longevity, as do both an early and a late birth. These differences in longevity are not explained by differences in educational or family status. The impact of a woman's reproductive history on her life span is small, however, compared to the influence of her level of education or family status.