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Factors influencing end-of-life morbidity: an epidemiological evaluation of population aging theories

Jacob, Mini E. (2015) Factors influencing end-of-life morbidity: an epidemiological evaluation of population aging theories. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Population aging theories were proposed to explain the effect of an increasing life expectancy on the duration of the morbid period at the end of life. Despite several decades of research, the epidemiological basis of these theories has not been investigated adequately. This dissertation uses data from the Cardiovascular Health Study, a community based cohort of older adults, to explore the epidemiologic basis of the basic tenets of these theories.
Hospital stay at the end of life is an economically important measure of terminal morbidity. We examined the effect of lifestyle factors measured late in life on the duration of hospital days in the last 5 years of life. We found that alcohol consumption, smoking, obesity and social networks were independently associated with hospital stay, indicating that a late-life lifestyle could impact end-of-life morbidity after accounting for the accumulated disease burden.
Cardiovascular mortality rates have been falling but it is not clear whether the morbidity associated with these events have reduced. We compared the risks for disability and death associated with cardiovascular events and found that angina, MI, CHD and CHF had stronger associations with death than disability. Cardiovascular events, therefore, do not seem to increase the disability burden in the population.
The relationship between age at death and the duration of terminal morbidity has not been elucidated in community based populations with average life expectancy. We examined the association between age at death and the length of terminal self-rated poor health and found that survival is associated with the duration of end-of-life morbidity in a curvilinear fashion; morbid period is shorter for those who die in their seventies and nineties. Identifying factors that promote survival to the nineties would help delineate factors associated with a compressed period of morbidity.
What are the public health implications of these findings? First, some preventive health behaviors can be harnessed to reduce the public health burden of terminal morbidity. Second, chronic diseases with low mortality risk need to be targeted to reduce the disability burden in populations. Third, survival to the nineties might hold the key to compressing morbidity in the older population.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Jacob, Mini E.mej49@pitt.eduMEJ49
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairNewman, Anne B.newmana@edc.pitt.eduANEWMAN
Committee MemberGanguli, Marygangulim@upmc.eduGANGULIM
Committee MemberAlbert, Stevensmalbert@pitt.eduSMALBERT
Committee MemberBoudreau, Robertboudreaur@edc.pitt.eduROB21
Committee MemberZgibor, Janice C.edcjan@pitt.eduEDCJAN
Date: 29 June 2015
Date Type: Publication
Defense Date: 30 March 2015
Approval Date: 29 June 2015
Submission Date: 6 April 2015
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Number of Pages: 125
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Epidemiology
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: Epidemiology, Aging, Morbidity, End-of-life, Older adults, Lifestyle, Cardiovascular disease, Disability, Hospital days, Self-rated health, Population aging theories, Compression of morbidity
Date Deposited: 29 Jun 2015 15:23
Last Modified: 01 May 2020 05:15


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