Associations of multiple chronic health conditions with active life expectancy in the United States

Purpose: To estimate associations of eight common health conditions with life expectancy (LE) and disabled life expectancy (DLE), the percentage of life disabled in an activity of daily living. Methods: Data from the Panel Study of Income Dynamics represented Americans ages 55+ (1999–2011, n?=?2118, mean baseline age 63.3, 19?447 person-years). We estimated probabilities of death and disability with multinomial logistic Markov models adjusted for age, sex, race/ethnicity and education. We used the probabilities to create large populations with microsimulations, each individual having a known monthly disability status, age 55 through death. We calculated LE and DLE for the populations, repeating each microsimulation 100 times for confidence intervals. Results: Nearly half (48.8%) of the participants had two or more conditions, 24.7% had three or more, 11.5% had four or more. Having any one condition significantly reduced LE. For example, white women lived to age 87.3 (95% confidence interval 86.5–88.1) with no conditions, 75.8 (70.9–80.7) with heart disease. Multiple conditions did not further reduce LE but often increased DLE, which for white women was 12.2% (11.1–13.2) with no conditions, 39.1% (28.3–49.8) with heart disease and 47.0% (46.9–47.1) with heart disease, diabetes and hypertension. Conclusion: The increasing prevalence of multiple chronic conditions may substantially increase disability.

• Implications for Rehabilitation

• The growing number of individuals with multiple chronic conditions will greatly increase the prevalence of disability in later life.

• It is important for rehabilitation science, practice and policy to address this emerging epidemiological transition.

• Rehabilitation is especially important for people with pre-diabetes, developing heart disease or early stages of other cardiovascular-related diseases as avoiding the development of multiple chronic diseases through increased activity may greatly reduce disability and mortality.