title: Changes in health status among participants of the Framingham Heart Study from the 1960s to the 1990s: application of an index of cumulative deficits.
abstract: OBJECTIVE
  Health of the general population is improving along a number of major health dimensions. Using a cumulative deficits approach, we investigated whether such improvements were evident at the level of minor health traits.
  
  
  METHODS
  We selected 37 small-effect traits consistently measured in the 9th (performed in 1964) and 14th (1974) Framingham Heart and 5th (1991-1995) Offspring Study exams to construct indices of cumulative deficits (DIs).
  
  
  RESULTS
  We identified deficits-specific DIs characterizing health dimensions associated with no health changes (DI(NHC)), health worsening (DI(WRS)), and health improving (DI(IMP)) between the 1960s and 1990s. The risks of death attributable to the DI(NHC) dominate within shorter time horizons. For longer time horizons, both the DI(NHC) and DI(IMP) provide the same contribution to the risks of death. The mortality risks associated with the DI(WRS) are the weakest and least significant.
  
  
  CONCLUSIONS
  The analyses show that the cumulative deficits approach might be an efficient tool for analyzing the effects of a large number of health characteristics for which the individual effects are small, inconsistent, or non-significant. They show favorable trends such that health of the Framingham studies participants either did not change or improved over time for the most serious small-effect traits.
authors.affiliation: Center for Population Health and Aging, Duke University Population Research Institute, and Department of Sociology, Duke University.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Kulminski
authors.forename: Konstantin G
authors.initials: KG
authors.lastname: Arbeev
authors.forename: Svetlana V
authors.initials: SV
authors.lastname: Ukraintseva
authors.forename: Irina V
authors.initials: IV
authors.lastname: Culminskaya
authors.forename: Kenneth
authors.initials: K
authors.lastname: Land
authors.forename: Anatoli I
authors.initials: AI
authors.lastname: Yashin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D004812:Epidemiologic Methods; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*
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