Clinical Disorders in a Post War British Cohort Reaching Retirement: Evidence from the First National Birth Cohort Study

Abstract

BackgroundThe medical needs of older people are growing because the proportion of the older population is increasing and disease boundaries are widening. This study describes the distribution and clustering of 15 common clinical disorders requiring medical treatment or supervision in a representative British cohort approaching retirement, and how health tracked across adulthood.Methods and FindingsThe data come from a cohort of 2661 men and women, 84% of the target sample, followed since birth in England, Scotland and Wales in 1946, and assessed at 60–64 years for: cardio and cerebro-vascular disease, hypertension, raised cholesterol, renal impairment, diabetes, obesity, hypothyroidism, hyperthyroidism, anaemia, respiratory disease, liver disease, psychiatric problems, cancers, atrial fibrillation on ECG and osteoporosis. We calculated the proportions disorder-free, with one or more disorders, and the level of undiagnosed disorders; and how these disorders cluster into latent classes and relate to health assessed at 36 years. Participants had, on average, two disorders (range 0–9); only 15% were disorder-free. The commonest disorders were hypertension (54.3%, 95% CI 51.8%–56.7%), obesity (31.1%, 28.8%–33.5%), raised cholesterol (25.6%, 23.1–28.26%), and diabetes or impaired fasting glucose (25.0%, 22.6–27.5%). A cluster of one in five individuals had a high probability of cardio-metabolic disorders and were twice as likely than others to have been in the poorest health at 36 years. The main limitations are that the native born sample is entirely white, and a combination of clinical assessments and self reports were used.ConclusionsMost British people reaching retirement already have clinical disorders requiring medical supervision. Widening disease definitions and the move from a disease-based to a risk-based medical model will increase pressure on health services. The promotion of healthy ageing should start earlier in life and consider the individual's ability to adapt to and self manage changes in health.

Age at Onset of Walking in Infancy Is Associated With Hip Shape in Early Old Age

“…Together with the previous observations of smaller size and bone mass in men in this cohort, these are all features found to be risk factors for fracture of the femoral neck attributed to osteoporosis . Although osteoporosis was prevalent at other sites in this cohort, there was no evidence of hip osteoporosis in individuals included in this study (minimum Z ‐score −2.4) and few fractures; therefore, associations between walking age, hip shape, and fractures could not be explored. There was no effect of adjustment for hip BMD on associations between walking age and hip shape, although only weak associations between hip BMD and hip mode scores in this cohort have been reported .…”

The MRC National Survey of Health and Development reaches age 70: maintaining participation at older ages in a birth cohort study

“…At age 60–64, we used a count of the number of clinical disorders (0, 1, 2, 3, 4, 5+) as a measure of recent health status [26]. To be included in this variable, study members required complete data on many health variables from the postal questionnaire and the home or clinic visit; therefore we included an item missing category.…”

A life-course approach to healthy ageing: maintaining physical capability

“…We recently showed that, on average, study participants had at least two out of fifteen common clinical disorders assessed at age 60–64 years, and less than one in six were disorder free ( 97 ) . Using cross-sectional data at 60–64 years, associations between each measure of physical capability and many of these fifteen disorders are observed; Fig.…”