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Compressie van morbiditeit: een veelbelovende benadering om de maatschappelijke consequenties van vergrijzing te verlichten?

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Tijdschrift voor Gerontologie en Geriatrie

Samenvatting

Er is een dringende behoefte aan strategieën die de maatschappelijke consequenties van vergrijzing kunnen verlichten. Een mogelijke strategie is het streven naar compressie van morbiditeit. De afgelopen decennia is een aantal van de oorspronkelijke aannamen voor compressie van morbiditeit ontkracht. De levensverwachting is namelijk veel sterker gestegen dan verwacht en de modale stervensleeftijd is de 85 jaar overschreden. Ook hebben trendstudies geen consistent bewijs gevonden voor een compressie van morbiditeit. Op de afdeling Maatschappelijke Gezondheidszorg wordt gezocht naar aanknopingspunten voor het bereiken van een compressie. Zo zijn op basis van gegevens van de Framingham Heart Study analyses gedaan met meerdimensionale overlevingstafels naar mogelijke bijdragen van veranderingen in blootstelling aan leefstijlfactoren (roken, hypertensie, lichamelijke inactiviteit en overgewicht/obesitas) aan compressie van hart- en vaatziekten. Hieruit bleek dat roken en lichamelijke inactiviteit de incidentie van hart- en vaatziekten verhoogt, maar ook de sterfte met en zonder hart- en vaatziekten. Hypertensie en overgewicht laten voornamelijk de incidentie van hart- en vaatziekten stijgen en zijn geassocieerd met een korter leven maar meer jaren met hart- en vaarziekten. Interventies op deze laatste risicofactoren zullen daarom resulteren in zowel een toename van de levensverwachting als een compressie van morbiditeit. Voor beleid en onderzoek in de gezondheidszorg is het van belang een mix van interventies te vinden waarmee een vergelijkbaar overall effect bereikt wordt.

Compression of morbidity: a promising approach to alleviate the societal consequences of population ageing?

There is an urgent need for strategies that alleviate the societal consequences of population ageing. A possible strategy is aiming for compression of morbidity. Some of the initial conditions for a compression of morbidity have been invalidated. This is, the life expectancy has shown a much stronger increase than was expected and the modal age at death has exceeded the age of 85. Additionally, trend studies have found no consistent evidence for a compression of morbidity. At the department of Public Health, we aim at identifying entry-points for a compression. For example, an analysis was performed on potential contributions of changes in exposure to life style factors (smoking, hypertension, physical inactivity and overweight/obesity) to compression of cardiovascular disease, using multi-state life tables with data from the Framingham Heart Study. It was shown that smoking and physical inactivity increased the incidence of cardiovascular disease, as well as mortality with and without cardiovascular disease. Hypertension and overweight mainly increased the incidence of cardiovascular disease and were associated with a shorter lifespan and more years with cardiovascular disease. Interventions on the latter risk factors will therefore increase the life expectancy, but will also result in a compression of morbidity. For policymakers and researchers it is important to find a mix of interventions that lead to a comparable overall effect.

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  1. www.bsl.nl/shop/tijdschrift-voor-gerontologie-en-geriatrie-0167-9228.html

    B. Klijs

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  1. B. Klijs
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  2. W. J. Nusselder
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  3. J. P. Mackenbach
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Correspondence to B. Klijs.

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Onderzoeker in opleiding, Afdeling Maatschappelijke Gezondheidszorg, Erasmus MC, Rotterdam Wetenschappelijk onderzoeker, Afdeling Maatschappelijke Gezondheidszorg, Erasmus MC, Rotterdam Hoogleraar, hoofd Afdeling Maatschappelijke Gezondheidszorg, Erasmus MC, Rotterdam Correspondentie: B. Klijs, Afdeling Maatschappelijke Gezondheidszorg, Kamer Ae- 132, Erasmus MC. Postbus 2040, 3000 CA Rotterdam. T:010-7038454.

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Klijs, B., Nusselder, W.J. & Mackenbach, J.P. Compressie van morbiditeit: een veelbelovende benadering om de maatschappelijke consequenties van vergrijzing te verlichten?. GEEG 40, 228–236 (2009). https://doi.org/10.1007/BF03088516

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