Abstract and Introduction
Abstract
Objectives: To use primary care electronic health records (EHRs) to evaluate the health of men and women at age 100.
Design: Population-based cohort study.
Setting: Primary care database in the United Kingdom, 1990–2013.
Participants: Individuals reaching the age of 100 between 1990 and 2013 (N = 11,084, n = 8,982 women, n = 2,102 men).
Measurements: Main categories of morbidity and an index of multiple morbidities, geriatric syndromes and an index of multiple impairments, cardiovascular risk factors.
Results: The number of new female centenarians per year increased from 16 per 100,000 in 1990–94 to 25 per 100,000 in 2010–13 (P < .001) and of male centenarians from four per 100,000 to six per 100,000 (P = .06). The most prevalent morbidities at the age of 100 were musculoskeletal diseases, disorders of the senses, and digestive diseases. Women had greater multiple morbidity than men (odds ratio (OR) = 1.64, 95% confidence interval (CI) = 1.42–1.89, P < .001). Geriatric syndromes, including falls, fractures, hearing and vision impairment, and dementia, were frequent; 30% of women and 49% of men had no recorded geriatric syndromes. Women had greater likelihood of having multiple geriatric syndromes (OR = 2.14, 95% CI = 1.90–2.41, P < .001).
Conclusion: Fewer men than women reach the age of 100, but male centenarians have lower morbidity and fewer geriatric syndromes than women. Research using EHRs offers opportunities to understand the epidemiology of aging and improve care of the oldest old.
Introduction
The number of individuals reaching advanced ages is growing rapidly. Recent estimates indicate that the number of centenarians in the United Kingdom has quintupled over the past three decades; in the United States, the number of centenarians increased from 32,194 in 1980 to 53,364 in 2010. This trend is projected to continue over the coming years, to approximately 1 million centenarians worldwide by 2030 and 3 million by 2050. Older age is the single most important risk factor for chronic diseases and long-term conditions, including cardiovascular disease (CVD), cancer, diabetes mellitus, and chronic respiratory disease. There is an expectation that population aging will place a substantial burden on the healthcare system, but population-based evidence concerning the epidemiology of chronic illnesses in centenarians is scarce.
Existing studies of centenarians are highly heterogeneous, often relying on self-reported illness and including small and highly selected samples of participants, often healthy centenarians. This limits their generalization to more-diverse centenarian populations. Estimates of the prevalence of common morbidities among centenarians vary greatly, with the prevalence of dementia estimated to range from 27% to 89%, congestive heart failure from 27% to 60%, and diabetes mellitus from 1% to 12%.
Differences in health according to sex are important throughout the life-course, with generally greater morbidity in women but higher mortality in men up to younger old age. The extent to which differences persist into extreme old age has not been investigated in large population-based samples. Most evidence derives from studies of voluntary participants, potentially underestimating the extent of physical and mental health conditions in centenarian populations. Often these studies rely on self-reported information of uncertain validity. Existing studies on differences in centenarians according to sex in Italy, Greece, and the United States have used modest sample sizes of less than 2,000 (commonly ~200–400 participants) or focused on limited geographical areas, raising the question of the generalizability and reliability of their findings.
Electronic health records (EHRs), which collect complete clinical and pharmacological data from clinical consultations, have been identified as an important resource for research into the population effect of changing demography on the epidemiology of chronic illnesses. The present study aimed to use primary care EHR data from the Clinical Practice Research Datalink (CPRD) to evaluate the health status of a nationally representative sample of centenarians in the United Kingdom. The study included a population-based cohort of people registered in primary care who reached the age of 100 between 1990 and 2013 and contrasted the health status of men and women at age 100 and older.