Original articlePrevalence of morbidity and multimorbidity in elderly male populations and their impact on 10-year all-cause mortality: The FINE study (Finland, Italy, Netherlands, Elderly)
Introduction
The study of elderly cohorts has become relatively common during recent years, in relation with the interest in these strata of the population, whose numerical and social importance are increasing. Prolongation of life expectancy, prevention and/or delayed occurrence of chronic diseases and an improvement of their prognosis are receiving increasing attention in public health research.
Within the Seven Countries Study of Cardiovascular Diseases 1, 2, 3 five cohorts (two in Finland, two in Italy and one in the Netherlands) joined a new study on the elderly that started in the mid-1980s, in coincidence with the 25-year anniversary examination. At that time men were aged 65 to 84 years. The adopted baseline field examination of this new study was followed by collection of mortality data for 10 years.
Reports on 5- and 10-year mortality experience as a function of cardiovascular risk factors have been published 4, 5 or submitted. The purpose of the present analysis was to investigate another aspect of the problems among the elderly (i.e., the prevalence of some major chronic diseases) and its relevance in conditioning the expectancy of life. The age range at entry examination (65–84 years) covers, in most European populations, about 95% of all men aged 65 or more. In addition, the interest of this analysis is bound to the possibility to describe the disease–mortality relationship in cohorts of three countries differing in prevalence of chronic disease and mortality.
We hypothesized that major chronic diseases in these aged populations are important determinants of all-cause mortality and that the coexistence of more diseases in the same individual (multimorbidity) could represent an extra risk for mortality. Therefore, by multimorbidity we mean a combination of several diseases, without a single focal disease as reference.
Section snippets
Methods
The FINE study represents an extension of the Seven Countries Study of Cardiovascular Diseases beyond the deadline of 25 years. It includes the two rural Finnish cohorts known as East Finland (EF) and West Finland (WF), the Dutch cohort from the small town of Zutphen (ZU), and the two rural cohorts located in the villages of Crevalcore (CR) and Montegiorgio (MO), in northern and central Italy, respectively.
The original Seven Countries Study started in the late 1950s and early 1960s with the
Prevalence of chronic diseases
Age-adjusted prevalence rates per 100 for single and combined groups of diseases are given in Table 1. The statistical difference between each pair of rates in comparing countries is also reported in Table 1.
The Finnish cohorts had the highest rates for all conditions except heart failure, diabetes mellitus and COPD, which were more prevalent in Italy than in the other cultures, although the differences for heart failure and diabetes mellitus were not statistically significant. The cohort in
Discussion
Prevalence of a selection of chronic diseases is high in these population samples, although different among them. A higher prevalence from coronary heart disease and cardiovascular diseases in Finland was expected on the basis of previous long-term experience during the early periods of follow-up in the Seven Countries Study 2, 3. However, cancer and diabetes mellitus are also commonly prevalent in Finland, whereas COPD is more common in Italy.
Higher all-cause death rates in Finland, compared
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