PLoS One. 2013 May 31;8(5):e64928.

Age-specific trends in morbidity, mortality and case-fatality from cardiovascular disease, myocardial infarction and stroke in advanced age: evaluation in the Swedish population.

Modig K, Andersson T, Drefahl S, Ahlbom A.

Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. karin.modig@ki.se

 

Abstract

Background: It is not clear if the downward trend in cardiovascular disease (CVD) observed for ages up to 85 years can be extended to the oldest old, those 85 years and above.

Methods and Findings: This nationwide cohort study presents age specific trends of CVD as well as for myocardial infarction (MI) and stroke separately for the period 1994 to 2010 for individuals 85 to 99 years old in Sweden. Data were extracted from national registries. All analyses were based on one-year age- and sex- specific figures.

The risk for CVD increased with every age above 85 years although the rate of increase leveled off with age. Over time, the risk for CVD and MI decreased for all ages, and for stroke for ages up to 89 years. However, the risk of MI increased until around 2001 in all age groups and both sexes but decreased after that. The overall mortality improved for all outcomes over the period 1994 to 2010, so did the survival within 28 days from an event. The average annual decline in mortality over all ages, 85 and above was 3% for MI, 2% for stroke and for 2% CVD. Corresponding figures for ages 60-84 was 4% for each of MI, stroke and CVD. The results were similar for men and women.

Conclusions: Improvements in CVD risks observed among ages up to 85 years appear to have extended also to ages above 85 years, even if the rate of improvement plateaued with age.  The improvements in survival for all ages up to 99 years give no support to the hypothesis that more fragile individuals reach higher ages. Additional research is needed to find out if improvement in survival can be seen also for the second and third event of CVD, stroke and MI.

PMID: 23741426

 

Additional information:

Improvements in morbidity and mortality from stroke – also among the oldest old.

The main aim of this study were to describe the age-specific trends in total CVD, as well as in myocardial infarction (MI) and stroke separately, among the oldest (85 to 99 years of age) in the population, with respect to incidence (first events), case fatality, and overall mortality. A further aim was to compare the trends among those below 85 years of age to those above 85 years of age, to see if the improvements observed in younger ages have extended also to the oldest old.

We determined age-specific trends for disease risk (first event), death risk, and 28 day-case fatality for CVD, MI and stroke (all stroke combined, I60-I69 or G45 in ICD 10) for men and women aged 60-84 years and 85 to 99 years in Sweden for the period 1994 to 2010 using nationwide registry data.

Between 1994 and 2010 the improvements in stroke risks have been less pronounced than the risks of all cardiovascular diseases (CVD) or myocardial infarction (MI). Still there have been improvements, especially in survival from stroke. In disease risk, incidence, the relative risk per year for all ages above 85 was equal to 1 among males; i.e. no change. The corresponding figure for males aged between 60 and 84 years was 0.99; i.e. an average yearly decline of 1% (Table 1). For women, there was an average yearly decline of 1% in the risk of a stroke for both age-groups. The mortality risk decreased for both men and women aged 85 years and older with 2% per year. The corresponding figure for men and women in the 60-84 year-old cohort was 4% per year. The twenty-eight- day survival after a stroke improved by an average of 2% per year in both age-groups, men and women.

Even though our results are highly positive – presenting declining risks for both incidence (except the oldest males) and mortality from stroke, the larger improvement in survival versus disease risk may indicate a larger need for medical care among the oldest in the future.

Table 1. Average annual change in stroke between 1994 and 2010 in age group 60-84 years and 85+ years respectively, men and women.

  Incidence * men Incidence * women Mortality + men Mortality + women Case fatality ^  men Case fatality^    women
60-84 years -1% -1% -4% -4% -2% -2%
85+ 0% -1% -2% -2% -2% -2%

(*) One year risk of stroke; (+) Overall mortality risk of stroke; (^) 28 days case fatality of stroke.

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