Contribution of common chronic conditions to midlife physical function decline: The Study of Women’s Health Across the Nation

Abstract

Background: Chronic conditions are associated with worse physical function and commonly develop during midlife. We tested whether the presence of 8 chronic conditions, or the development of these conditions, is associated with declines in physical function among midlife women as they transition into early late life. Methods: Participants (N = 2283) were from the Study of Women's Health Across the Nation. Physical function was assessed at 8 visits starting at the study's fourth clinic visit in 2000/2001 through follow-up visit 15 (2015/2017) using the Short Form-36 Physical Function subscale. Chronic conditions included diabetes, hypertension, osteoarthritis, osteoporosis, stroke, heart disease, cancer, and depressive symptoms. Repeated-measures Poisson regression modeled associations between 1) prevalent chronic conditions at analytic baseline (visit 4) and longitudinal physical function, and 2) change in physical function associated with developing a new condition. Models were adjusted with the total number of other chronic conditions at visit 4. Results: In separate fully-adjusted longitudinal models, prevalent heart disease and osteoporosis were associated with 18% (IRR = 0.815, 95% confidence interval [CI]: 0.755-0.876) and 12% (IRR = 0.876, 95% CI: 0.825-0.927) worse initial physical function, respectively. Prevalent osteoarthritis was associated with approximately 6% (IRR = 0.936, 95% CI: 0.913-0.958) worse initial physical function, and a slight additional worsening over time (IRR = 0.995, 95% CI: 0.994-0.996). A 12% (IRR = 0.878, 95% CI: 0.813-0.950) decrease in physical function concurrent with stroke development was evident, as was accelerated decline in physical function concurrent with heart disease development (IRR = 0.991, 95% CI: 0.988-0.995).

Disparities in Reproductive Aging and Midlife Health between Black and White women: The Study of Women’s Health Across the Nation (SWAN)

“…Development of an incident chronic medical condition was associated with an additional 1.9% poorer score and a 0.33% yearly rate of decline per condition [ 96 ]. As noted above, Black were women more likely than White women to start the study with prevalent, and then to develop, incident hypertension, diabetes mellitus, MetS, and OA [ 97 ]. Additionally, at the 12 th follow-up visit the Michigan site administered the World Health Organization Disability Assessment Schedule (WHO-DAS): Black women were twice as likely as White women to report moderate to extreme global disability [ 98 ].…”

“…Chronic medical conditions negatively influence physical function and performance; Black-White disparities in the prevalence and incidence of major diseases account for some of the observed disparity in physical performance and physical disability [95][96][97][98]. In the full SWAN sample, each additional chronic medical condition present at baseline was associated with a 4.0% poorer self-reported baseline physical functioning score; each additional baseline medical condition also increased the score's annual rate of decline by 0.20% yearly.…”

Pre- and Early Peri-menopausal Physical Function and Risk of Cardiovascular Events: The Study of Women’s Health Across the Nation

“…We investigated associations between PF and CVD risk, but PF is also known to decline as a result of CVD (Keeney et al, 2019; Levine et al, 2014). Previous work in SWAN demonstrated that women experience declines in PF in conjunction with the development of new chronic conditions, (Lange-Maia et al, 2020b) with incident stroke being associated with a 12% subsequent drop in PF, and an accelerated decline in PF concurrent with incident heart disease (Lange-Maia et al, 2020a). From a prevention standpoint, there are shared intervention targets that are related to PF improvement as well as CVD risk reduction and diabetes prevention and control.…”

Physical and Behavioral Factors Associated With Improvement in Physical Health and Function Among US Women During Midlife

“… 2 , 3 , 4 Furthermore, evidence suggests that these limitations or decreases in physical health and function are associated with chronic conditions that develop before or during midlife. 5 However, other work has shown the highly dynamic nature of functional status during midlife, 6 demonstrating that some women may improve their physical health and functioning during this time. 7 , 8 …”