Recent increases in age-specific survival among the elderly are expected to generate enormous demands for health care. Predictions of the extent of these demands, however are hampered by a death of empirical data on time- trends in age-specific morbidity and the impact of these changes on utilization. A valuable opportunity to investigate such trends exists with the unique medical records linkage system of the Rochester Epidemiology Project (REP) and the demonstrated capacity for population-based epidemiologic and health services research in Olmsted County, MN. Over the past 2 decades Olmsted County has mirrored the U.S. in that mortality rates have declined for persons > 65 years of age, while hospital use rates have increased, especially among the oldest old. These observations provide provisional support for the argument that greater demands for health care services will accompany increased longevity as a result of higher levels of age-specific morbidity. This proposal begins to tap the potential of the REP for testing this hypothesis by focusing specifically on individuals characterized by the chronic disease, non-insulin dependent diabetes mellitus (NIDDM). This retrospective, longitudinal study will compare 3 prevalence cohorts consisting of all Rochester, MN, residents > 45 with a diagnosis of NIDDM as of January for the years 1970, 1980, 1990. Individuals will be followed from data of prevalence until 1/1/94. Differences among cohorts for age-specific survival and duration of NIDDM will be estimated, as will the association between survival and 2 distinct measures of morbidity: (1) incidence of comorbidity following date of prevalence, and (2) a summary measure of morbidity defined as overall disease severity. Cohorts will be compared for risk of hospitalization and hospitalization incidence density. Disease duration, morbidity, and hospital use rates will be determined with review of patient-based medical records (outpatient and inpatient). Multiple regression and Cox proportional hazards models will be employed to determine trends in the independent association between overall morbidity and hospital utilization. Extensive experience in REP studies of numerous diseases verifies the ability to determine appropriate clinical and epidemiologic parameters and to provide nearly 100% follow-up to 1/1/94 for each of the prevalence cohorts. This retrospective study of clinically defined disease and hospitalization rates will also provide a foundation for future prospective studies of active life expectancy and long term care use.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
First Independent Research Support & Transition (FIRST) Awards (R29)
Project #
5R29AG008729-03
Application #
3453393
Study Section
Social Sciences and Population Study Section (SSP)
Project Start
1990-09-30
Project End
1995-07-31
Budget Start
1992-08-01
Budget End
1993-07-31
Support Year
3
Fiscal Year
1992
Total Cost
Indirect Cost
Name
Mayo Clinic, Rochester
Department
Type
DUNS #
City
Rochester
State
MN
Country
United States
Zip Code
55905
Thomas, Randal J; Palumbo, Pasquale J; Melton 3rd, L Joseph et al. (2003) Trends in the mortality burden associated with diabetes mellitus: a population-based study in Rochester, Minn, 1970-1994. Arch Intern Med 163:445-51
Burke, James P; O'Brien, Peter; Ransom, Jeanine et al. (2002) Impact of case ascertainment on recent trends in diabetes incidence in Rochester, Minnesota. Am J Epidemiol 155:859-65
Leibson, C L; Williamson, D F; Melton 3rd, L J et al. (2001) Temporal trends in BMI among adults with diabetes. Diabetes Care 24:1584-9
Hass, S L; Ransom, J E; Brown Jr, R D et al. (2001) The impact of stroke on the cost and level of care in nursing homes: a retrospective population-based study. Mayo Clin Proc 76:493-500
Larson, T S; Santanello, N; Shahinfar, S et al. (2000) Trends in persistent proteinuria in adult-onset diabetes: a population-based study. Diabetes Care 23:51-6
Leibson, C (1999) Loss of the female advantage with cardiovascular disease for women with diabetes. Lupus 8:351-5
Leibson, C; Owens, T; O'Brien, P et al. (1999) Use of physician and acute care services by persons with and without Alzheimer's disease: a population-based comparison. J Am Geriatr Soc 47:864-9
Leibson, C L; Ransom, J E; Brown, R D et al. (1998) Stroke-attributable nursing home use: a population-based study. Neurology 51:163-8
Leibson, C L; Rocca, W A; Hanson, V A et al. (1997) The risk of dementia among persons with diabetes mellitus: a population-based cohort study. Ann N Y Acad Sci 826:422-7
Leibson, C L; Rocca, W A; Hanson, V A et al. (1997) Risk of dementia among persons with diabetes mellitus: a population-based cohort study. Am J Epidemiol 145:301-8

Showing the most recent 10 out of 17 publications