The temporal association between incident late-life depression and incident dementia.

OBJECTIVE: There is an established association between depression and subsequent dementia. The present study examined temporal associations between incident late-life depression and subsequent dementia, also considering age and sex. METHODS: We used longitudinal health claims data from the largest German health insurance provider ('Allgemeine Ortskrankenkasse') considering up to 9 follow-up years in piecewise exponential models. ICD-10 codes were used to define incident depression and dementia in individuals ≥65 years (n = 97 110). RESULTS: Incident depression was associated with a higher risk of subsequent dementia (incidence rate ratios (IRR) adjusted for age and sex: IRR = 1.58, 95% CI = 1.51-1.64). The strongest association was found for the shortest interval of 1 quarter (IRR = 2.04, 95% CI = 1.88-2.21), with significant associations up to an interval of roughly 3 years. The association was more pronounced and lasted for more quarters in the younger portion of this study group (ages from 65-74: IRR = 2.00, 95% CI = 1.83-2.18; 75-84: IRR = 1.64, 95% CI = 1.55-1.73; ≥85: IRR = 1.19, 95% CI = 1.08-1.31). It was stronger among men than women (men: IRR = 1.98, 95% CI = 1.84-2.14; women: IRR = 1.44, 95% CI = 1.37-1.51) with no sex-specific temporal association. CONCLUSION: This large claims data study confirmed that incident late-life depression is associated with a higher risk of dementia within the 3 years following diagnosis. Hence, incident late-life depression should prompt further cognitive examinations and referrals to specialists. This might apply especially to younger seniors and men.

Prevalence, incidence, and risk factors of primary open-angle glaucoma - a cohort study based on longitudinal data from a German public health insurance.

BACKGROUND: This study estimates the prevalence and incidence rates of primary open -angle glaucoma (POAG) as well as risk factors based on a dataset from the largest German health insurance company. METHODS: A random sample of 250,000 persons at age 50+ of the Allgemeine Ortskrankenkasse (AOK) from 2010 to 2013 was used. Selected risk factors of POAG incidence were analyzed using multivariate Cox proportional hazard models. RESULTS: The age-standardized prevalence of POAG at age 50+ in 2010 was 2.79% (95%-CI: 2.72-2.85%). The age-standardized total incidence rate was 0.38 (0.36-0.39) per 100 person-years. Sex differences were significant for total prevalence and total incidence rates, with higher prevalence and incidence rates for women compared to men. The Cox model revealed a strong age effect, a significantly 19% higher incidence for women (p ≤ 0.001), injuries of the eye and orbit (175%, p ≤ 0.001), degeneration of iris and ciliary body (155%, p = 0.022), myopia (155%, p ≤ 0.001), retinal vascular occlusions (134%, p ≤ 0.001), hypertension (13%, p ≤ 0.001) and diabetes mellitus (23%, p ≤ 0.001). CONCLUSION: Health claims data are an important data source for estimating POAG occurrence and help overcome the problems of small sample sizes. These results may help to understand the causal pathways of POAG and to develop intervention strategies to increase the awareness of patients and physicians with the aim of reducing POAG incidence.

Parkinson's disease in Germany: prevalence and incidence based on health claims data.

BACKGROUND: In Germany, epidemiological information on Parkinson's disease (PD) is rare and outdated. Considering aging populations, current prevalences and incidence rates about this age-related disease would be important for adequate public health planning. METHODS: We used newly available health claims data sets from the largest German health insurer dating 2004-2007 and 2007-2010 with an analysis population in the base years of 491 038 persons aged 50 and older. Quarter-specific information about ICD-10 diagnoses and PD drug prescriptions from the inpatient and outpatient sectors was used to validate PD cases. Estimations were presented for two validation strategies relying on repeated PD diagnoses (SIa) and on one PD diagnosis followed by at least one PD drug prescription (SIb). RESULTS: The standardized prevalence was 797 (SIb) to 961/100 000 persons (SIa), showing an age-specific increase up to category 85-89 and a decline thereafter. The standardized incidence rate was 192 to 229/100 000 person-years with a similar age-specific shape. Prevalences and incidences rates were higher for men compared to women in regard to age. CONCLUSIONS: Health claims data are found to be suitable for PD assessment using the repeated diagnoses or PD drug prescriptions as necessary criteria.

[Life years gained. Long-term trends in mortality by causes of death in Germany and in an international perspective]. / Gewonnene Lebensjahre. Langfristige Trends der Sterblichkeit nach Todesursachen in Deutschland und im internationalen Vergleich.

In Germany life expectancy is continuously increasing. Differently to the increases in the nineteenth century, which were mainly driven by decreasing mortality from infectious diseases, the recent rise in life expectancy is the result of a mortality decline in all major groups of causes of death. Contrary to mortality, the incidence and prevalence of a large number of diseases, in particular cancer and cardiovascular diseases (CVD), is rising. However, this increase is mainly the result of changes in the population's age structure, differences in lifestyle, improvements in diagnostic techniques, and increasing prevention. Age-standardized death rates and survival rates indicate significant improvements in most of the diseases over the last decades. Important exceptions are cancer of the lung and bronchia for females as well as mental diseases for both sexes. Therefore, these diseases will grow in importance for public health measures in the next decades. A major potential for a further increase in female life expectancy lies in the reduction of CVD mortality. In contrast, decreases in mortality due to various types of cancer, diseases of the respiratory system, and diseases of the digestive system in addition to CVD mortality may lead to a significant rise in male life expectancy. Although declining mortality is strongly linked to an increase in the prevalence of multi-morbidity and the number of years with disability, it is also paralleled by an increase in healthy life years.

[Live longer, suffer more? Trends in life expectancy and health]. / Länger leben, länger leiden? Trends in der Lebenserwartung und Gesundheit.

During the 20th century, life expectancy has been continuously increasing with the majority of the additional years resulting from decreasing mortality among the old and oldest old in the last few decades. Two phases of convergence and divergence in European mortality have been identified, with a possible new phase of divergence taking place among the oldest old. Over this period, women have always been living longer than men. Explanations for this phenomenon include not only biological factors and differences in lifestyle and health care utilization, but also differences in reporting patterns. Trends in health do not follow a clear direction. Reasons are the different dimensions of health as well as inadequate data. In general, the prevalence of morbidity has been increasing, while functional limitations and ADL disabilities have been decreasing. Due to a lack of data, no information exists for trends among the oldest old at age 80 and above. In absolute terms, the number of healthy years has been increasing with increasing life expectancy. In relative terms, they have been stable, probably slightly increasing in some countries. These trends suggest that increasing life expectancy does not result in an increase in morbidity.

[Prevalence and incidence of dementia in Germany--a study based on data from the public sick funds in 2002]. / Prävalenz und Inzidenz von Demenz in Deutschland--Eine Studie auf Basis von Daten der gesetzlichen Krankenversicherungen von 2002.

So far all calculations of the number of demented people are based on rates from meta-analyses, mean rates of meta-analyses or spatial analyses. This article presents age- and gender-specific prevalence and incidence rates of dementia that are based on a large sample of the German Sick Funds (Stichprobendaten von Versicherten der gesetzlichen Krankenversicherung (GKV)) with 2.3 million people from the year 2002. Prevalence rates increase from 0.8% and 0.6% for 60-64 year old men and women to 30% and 43% for men and women aged 100 or older, respectively. Incidence rates increase from 0.18 and 0.14 cases per 100 person-years for 60-64-year old men and women to 9.9 and 10.9 for over 95 year old men and women, respectively. Our results confirm rates from earlier studies on the basis of meta-analyses. Regional differences show for the first time that higher prevalence rates exist for East German women and men above age 85. In 2007 about 1.07 million moderately or severely demented people live in Germany of which about 244 000 are incident cases when we extrapolate our rates to the population of this year.

[The future of children's hospitals--demographic trends of children aged 0 to 15 in Germany up to 2050]. / Die Zukunft der Kinderkrankenhäuser--Die demografische Entwicklung der 0- bis 15-jährigen Kinder in Deutschland bis 2050.

The 11th coordinated population forecast of the German Federal Statistical Office shows that the number of children in the age group 0-15 is going to decrease considerably up to 2050. Depending on the assumptions, the number of children will decrease to 50-80% of today's level. There are only small regional differences in this development, i. e., all regions will be equally affected by the population decline. However, large cities and surrounding areas will face smaller reductions than other community types. The timing of the decline differs somewhat between the regions. An exception is the age group 10-15 in East Germany. After a strong reduction of births in the years after the reunification, birth rates have been rising since 1998, which will lead to a relative increase of that age group in the coming years. However, also in this age group, the number of children is going to decrease to 85% of today's level up to 2050. In parallel to the reductions in the young population, there will be a reduction in the frequency of diagnoses, whereby in a simplified "status quo" model, the amount of diagnoses will decrease in proportion to the number of the 0-15-year-olds.

Compression or expansion of morbidity? Trends in healthy-life expectancy in the elderly Austrian population between 1978 and 1998.

The aim of our study is to test the theories of compression or expansion of morbidity on the basis of data on the elderly population of Austria. Our data come from four microcensus surveys for the years 1978, 1983, 1991, and 1998. We use self-perceived health ratings to calculate healthy-life expectancy for the elderly population aged 60-89. Because our data are based on four cross-sectional surveys, we devote the first part of the paper to the consequences of possible sampling and non-sampling errors in our analysis of time trends. We come to the conclusion that, although the absolute number of years lived in good health may be overestimated, the time trend in healthy-life expectancy over the 20 years most probably is unbiased. The second part of the paper describes trends in healthy-life expectancy for the Austrian population. Our results suggest that both healthy-life expectancy and the ratio of healthy years to life expectancy increased between 1978 and 1998. Thus, in Austria ill health seems to be more and more compressed into the later years of life. Contrary to Fries's hypothesis, however, life expectancy does not seem to be approaching a maximum average life span in Austria, as mortality rates at older ages have been continuously decreasing over the last 20 years.

Lifespan depends on month of birth.

Month of birth influences adult life expectancy at ages 50+. Why? In two countries of the Northern Hemisphere-Austria and Denmark-people born in autumn (October-December) live longer than those born in spring (April-June). Data for Australia show that, in the Southern Hemisphere, the pattern is shifted by half a year. The lifespan pattern of British immigrants to Australia is similar to that of Austrians and Danes and significantly different from that of Australians. These findings are based on population data with more than a million observations and little or no selectivity. The differences in lifespan are independent of the seasonal distribution of deaths and the social differences in the seasonal distribution of births. In the Northern Hemisphere, the excess mortality in the first year of life of infants born in spring does not support the explanation of selective infant survival. Instead, remaining life expectancy at age 50 appears to depend on factors that arise in utero or early in infancy and that increase susceptibility to diseases later in life. This result is consistent with the finding that, at the turn of the last century, infants born in autumn had higher birth weights than those born in other seasons. Furthermore, differences in adult lifespan by month of birth decrease over time and are significantly smaller in more recent cohorts, which benefited from substantial improvements in maternal and infant health.

Seasonality of birth in nineteenth- and twentieth-century Austria.

We present an analysis of birth seasonality in nine geographical regions within Austria for two time periods, 1881-1912 and 1947-1959. In the early period, geography, climate, and agricultural patterns were related to birth seasonality. By the latter time period, these factors were no longer related to birth seasonality. We propose a "resilience hypothesis," which suggests two levels of causal influences on birth seasonality. First, underlying the three significant features of birth seasonality patterns around the world are only a small number of major causes. But, second, there are a multiplicity of minor causes that result in small perturbations in these otherwise resilient and consistent patterns.

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.

Longevity and month of birth: evidence from Austria and Denmark.

PIP: This study investigates the relationship between month of birth and life span. It uses 2 different data for total populations in Austria and Denmark. The Austrian data are based on vital statistics of the exact data of birth and the exact date of death for each person dying after age 50 between 1988 and 1996. The Danish data consist of the total population aged 50+ on April 1, 1968. These people were then followed until their death or until August 1998. Results suggest that life span and month of birth were in fact related. Evidences were presented to support or argue the three hypotheses being tested that explain the relationship between month of birth and longevity. Overall, many studies support that this pattern was not the result of the seasonal distribution of death. And the longevity cannot be explained by the so-called ¿birthday-effect¿--the alleged tendency of people to die shortly after their birthday. Instead, the study concluded by discussing the possible social and biological mechanisms related to a person's season of birth that might influence life expectancy.^ieng

Social inequalities in disability-free and healthy life expectancy in Austria.

The purpose of this study is to describe socioeconomic differences in the health status and mortality of the Austrian population. Socioeconomic differentials in disability and self-perceived health are studied on the basis of educational groups. The data are drawn from the 1991 Austrian micro-census on health and from linked death and census records for the years 1981/82. The maximum number of years lived between ages 30 and 75 is divided into years lost, years lived in disability or poor health and years lived without disability or in good health. Our findings clearly indicate a correlation between higher education and higher life expectancy and lower morbidity. Comparing the two indicators, more years are lived in poor health than in severe functional disability. The two concepts of health lead to different conclusions when results for men and women are compared: women live more years in disability than men but fewer years in poor health. Differences between educational groups are lower when the concept of self-perceived health is applied.