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Am J Epidemiol. 2018 Nov 8. doi: 10.1093/aje/kwy241. [Epub ahead of print]

Trajectories of Nonagenarian Health: Gender, Age, and Period Effects.

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Division of Epidemiology, Department of Health Research and Policy, School of Medicine, Stanford University.
School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University.
Department of Biostatistics, School of Public Health, University of Washington.
Cardiovascular Health Research Unit, and Departments of Medicine, Epidemiology, and Health Services, University of Washington, and Group Health Research Institute, Group Health Cooperative.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh.


The US population aged 90 years and older is growing rapidly and there are limited data on their health. The Cardiovascular Health Study is a prospective study of black and white adults ≥65 years recruited in two waves (1989-90 and 1992-93) from Medicare eligibility lists in Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania. We created a synthetic cohort of the 1,889 participants who had reached age 90 at baseline or during follow-up through July 16th, 2015. Participants entered the cohort at 90 years and we evaluated their changes in health after age 90 (median [IQR] follow-up: 3 [1.3-5] years). Measures of health included cardiovascular events, cognitive function, depressive symptoms, prescription medications, self-rated health, and measures of functional status. The mortality rate was high: 19.0 (95% CI: 17.8, 20.3) per 100 person-years in women and 20.9 (95% CI: 19.2, 22.8) in men. Cognitive function and all measures of functional status declined with age; these changes were similar by gender. When we isolated period effects, we found that medications use increased over time. These estimates can help inform future research and health care systems to meet the needs of this growing population.


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