The elimination of selected chronic diseases in a population: the compression and expansion of morbidity.
OBJECTIVE
This study evaluates the effect of eliminating a specific disease on the mortality, long-term disability, and overall health status of a population. Primarily, it examines whether elimination leads to a compression of morbidity.


METHODS
The Sullivan method was used to calculate disability-free life expectancy. Cause-deleted disability prevalence was estimated with a multiple logistic regression model that used data from the Dutch National Survey of General Practice. Cause-deleted probabilities of dying were derived with the cause-elimination life-table technique, assuming independence among competing causes of death.


RESULTS
Eliminating disabling nonfatal diseases such as arthritis/back complaints results in a decline in life expectancy with disability--that is, an absolute compression of morbidity. Eliminating highly fatal diseases such as cancer leads to an increase in the number of years and the proportion of life with disability--that is, a relative expansion of morbidity.


CONCLUSIONS
While eliminating fatal diseases leads to an increase in disability-free life expectancy, life expectancy with disability may increase as well. This represents an increasing burden to society. On the other hand, eliminating nonfatal disabling diseases leads to absolute compression of morbidity.
Nusselder
W J
WJ
Netherlands Institute for Primary Health Care, Utrecht, The Netherlands.
van der Velden
K
K
van Sonsbeek
J L
JL
Lenior
M E
ME
van den Bos
G A
GA
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology / Q000401:mortality; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities; D005260:Female; D006306:Health Surveys; D006801:Humans; D008017:Life Expectancy; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012494:Sampling Studies