While life expectancy in the UK has continued to increase, it is unclear whether these additional years are being lived in good or poor health. If the increase is mainly attributable to elderly people surviving longer with longstanding disease, this would imply that additional years of life gained are primarily being lived in poor health. However, if people are developing diseases later, then the amount of time spent in ill health during one's life may be falling. This is known as a compression of morbidity. These scenarios present different healthcare implications for the NHS; it is therefore important to understand how these trends are developing.
Our study will investigate patterns of illness before death for patients who died during 2000-2015. Using information recorded on their patient electronic record, linked to other key health data, we will summarise their disease levels and wellbeing during their last 5 years of life. We will compare disease levels and wellbeing between patients who have died across different periods in the study. This will allow us to see if people dying recently are spending more or less of their final years in good health compared to patients who died at the beginning of the study.
It is unclear whether continued increases in life expectancy in the UK have been accompanied by an expansion or contraction of morbidity in later life. To investigate this further, we will use linked ONS mortality data to identify date of death for approximately 200,000 patients from 150 CPRD practices recording up-to-standard data between 2000 and 2015. Additionally, we will identify a comparison group of age-sex matched patients (2 per death, 1 matched on practice) alive at the time of the case death.
We will focus on the last 5 years of life and estimate morbidity in patients, primarily using a broad range of chronic conditions, but additionally using frailty measures. We will compare morbidity between periods to see whether patients who died recently have more morbidity before death than those dying 10-15 years previously. Analyses will control for age at death, which will have increased by approximately 2 years from 2000 to 2015. A matched comparison group will be used to account for any temporal trends in recording.
Our comparison of morbidity across time, will investigate trends by practice region and deprivation. Additional outcomes will include levels of consultations, prescribing and hospital admissions, which have financial implications for the NHS.
Morbidity in pre-defined periods before death. We will explore using a count of co-morbidities, existing indices (e.g. electronic frailty index), and customise our own morbidity index to summarise this.
-Markers of health care utilisation (hospital admissions, primary care consultations, prescribing)
Iain Carey - Chief Investigator - St George's, University of London
Iain Carey - Corresponding Applicant - St George's, University of London
David Strachan - Collaborator - St George's, University of London
Derek Cook - Collaborator - St George's, University of London
Fay Hosking - Collaborator - St George's, University of London
Stephen DeWilde - Collaborator - St George's, University of London
Tess Harris - Collaborator - Polycystic Kidney Disease Charity
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation