Chronic conditions and mortality among the oldest old

Abstract

Objectives: We sought to determine whether chronic conditions and functional limitations are equally predictive of mortality among older adults.

Methods: Participants in the 1998 wave of the Health and Retirement Study (N=19430) were divided into groups by decades of age, and their vital status in 2004 was determined. We used multivariate Cox regression to determine the ability of chronic conditions and functional limitations to predict mortality.

Results: As age increased, the ability of chronic conditions to predict mortality declined rapidly, whereas the ability of functional limitations to predict mortality declined more slowly. In younger participants (aged 50-59 years), chronic conditions were stronger predictors of death than were functional limitations (Harrell C statistic 0.78 vs. 0.73; P=.001). In older participants (aged 90-99 years), functional limitations were stronger predictors of death than were chronic conditions (Harrell C statistic 0.67 vs. 0.61; P=.004).

Conclusions: The importance of chronic conditions as a predictor of death declined rapidly with increasing age. Therefore, risk-adjustment models that only consider comorbidities when comparing mortality rates across providers may be inadequate for adults older than 80 years.

FIGURE 1—

Ability of chronic conditions and functional limitations to predict mortality for the Harrell C statistic (a), adjusted Royston R² (b), likelihood ratio χ² (c), and McFadden pseudo-R² (d): Health and Retirement Study, 1998.