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Lifestyle Habits and Compression of Morbidity

^a Departments of Medicine, Stanford University School of Medicine, California
^b Departments of Health Research and Policy, Stanford University School of Medicine, California

Helen B. Hubert, Stanford University School of Medicine, 701 Welch Road, Suite 3305, Palo Alto, CA 94304 E-mail: hhubert{at}stanford.edu.

Background. There has been much debate regarding the degree to which healthy lifestyles can increase longevity and whether added years will be offset by increased morbidity at older ages. This study was designed to test the compression of morbidity hypothesis, proposing that healthy lifestyles can reduce and compress disability into a shorter period toward the end of life.

Methods. Functional status in 418 deceased members of an aging cohort was observed between 1986 and 1998 in relationship to lifestyle-related risk factors, including cigarette smoking, physical inactivity, and under- or overweight. Three risk groups were created based on the number of these factors at study entry. Disability scores prior to death were modeled for each risk group to compare levels and rates of change, as well as to determine if and when acceleration in functional decline occurred.

Results. The risk-factor-free group showed average disability scores near zero 10–12 years before death, rising slowly over time, without evidence of accelerated functional decline. In contrast, those with two or more factors maintained a greater level of disability throughout follow-up and experienced an increase in the rate of decline 1.5 years prior to death. For those at moderate risk, the rate of decline increased significantly only in the last 3 months of life. Other differences between groups provided no alternative explanations for the findings.

Conclusions. These results make a compelling argument for the reduction and postponement of disability with healthier lifestyles as proposed by the compression of morbidity hypothesis.

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