title: Clinical disorders in a post war British cohort reaching retirement: evidence from the First National Birth Cohort study.
abstract: BACKGROUND
  The medical needs of older people are growing because the proportion of the older population is increasing and disease boundaries are widening. This study describes the distribution and clustering of 15 common clinical disorders requiring medical treatment or supervision in a representative British cohort approaching retirement, and how health tracked across adulthood.
  
  
  RESULTS
  The data come from a cohort of 2661 men and women, 84% of the target sample, followed since birth in England, Scotland and Wales in 1946, and assessed at 60-64 years for: cardio and cerebro-vascular disease, hypertension, raised cholesterol, renal impairment, diabetes, obesity, hypothyroidism, hyperthyroidism, anaemia, respiratory disease, liver disease, psychiatric problems, cancers, atrial fibrillation on ECG and osteoporosis. We calculated the proportions disorder-free, with one or more disorders, and the level of undiagnosed disorders; and how these disorders cluster into latent classes and relate to health assessed at 36 years. Participants had, on average, two disorders (range 0-9); only 15% were disorder-free. The commonest disorders were hypertension (54.3%, 95% CI 51.8%-56.7%), obesity (31.1%, 28.8%-33.5%), raised cholesterol (25.6%, 23.1-28.26%), and diabetes or impaired fasting glucose (25.0%, 22.6-27.5%). A cluster of one in five individuals had a high probability of cardio-metabolic disorders and were twice as likely than others to have been in the poorest health at 36 years. The main limitations are that the native born sample is entirely white, and a combination of clinical assessments and self reports were used.
  
  
  CONCLUSIONS
  Most British people reaching retirement already have clinical disorders requiring medical supervision. Widening disease definitions and the move from a disease-based to a risk-based medical model will increase pressure on health services. The promotion of healthy ageing should start earlier in life and consider the individual's ability to adapt to and self manage changes in health.
authors.affiliation: MRC Unit for Lifelong Health & Ageing, London, England. m.pierce@nshd.mrc.ac.uk
authors.forename: Mary B
authors.initials: MB
authors.lastname: Pierce
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Silverwood
authors.forename: Dorothea
authors.initials: D
authors.lastname: Nitsch
authors.forename: Judith E
authors.initials: JE
authors.lastname: Adams
authors.forename: Alison M
authors.initials: AM
authors.lastname: Stephen
authors.forename: Wing
authors.initials: W
authors.lastname: Nip
authors.forename: Peter
authors.initials: P
authors.lastname: Macfarlane
authors.forename: Andrew
authors.initials: A
authors.lastname: Wong
authors.forename: Marcus
authors.initials: M
authors.lastname: Richards
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hardy
authors.forename: Diana
authors.initials: D
authors.lastname: Kuh
mesh_terms: D000328:Adult; D017677:Age Distribution; D016000:Cluster Analysis; D015331:Cohort Studies; D004194:Disease; D004739:England / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D036801:Parturition; D012179:Retirement / Q000706:statistics & numerical data*; D057566:Self Report; D017678:Sex Distribution; D047789:World War II