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Objectives We explored the male-female health-survival paradox in the context of health expectancy (HE) at age 65 and thereafter, using three different morbidity measures and different severity cut-offs with and without adjustments for the share of nursing home residents. Methods HE at ages 65, 70, 75, 80, and 85 was estimated with the Sullivan method, linking morbidity prevalence from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study to 2016 Bavarian mortality data. Morbidity measures comprised deficit accumulation (Frailty Index, FI, cut-offs 0.08 and 0.25), disability (Health Assessment Questionnaire-Disability Index, HAQ-DI, cut-off >0) and participation (Global Activity Limitation Indicator, GALI, “limited” vs “not limited”). Results Morbidity data were available for 4083 participants (52.7% female). HE was lower in women than in men at all ages. Differences in morbidity prevalence, absolute HE, and health proportions of life expectancy (relative HE) increased with age for FI ≥ 0.25 and GALI, but not for HAQ-DI > 0 and FI > 0.08. Accounting for the share of nursing home residents resulted in a slight reduction of HE estimates but had no impact on estimated sex differences. Conclusions In HE at age 65 and thereafter, women's health disadvantage was larger than their life expectancy advantage over men.

Introduction Aging is associated with increasing loss of physiological resilience and successive accumulation of physiological deficits. This can be measured through a frailty index which sums up symptoms, health conditions and impairments. One possible factor in preventing or delaying deficit accumulation is physical activity. The effect of leisure time physical activity on health is well investigated; however, the effect of household physical activity is less clear. The objective of this cross-sectional study was to examine the association of household physical activity with deficit accumulation while controlling for level of leisure time physical activity. Methods Data originates from the 2008 baseline assessment of the KORA (Cooperative Health Research in the Region of Augsburg)-Age study from Southern Germany. A frailty index of deficit accumulation (Deficit Accumulation Index, DAI) was constructed from 31 age-related health deficits. Physical activity was measured with the Physical Activity Scale for the Elderly (PASE). The association of deficit accumulation and physical activity was analyzed using negative binomial regression analysis. Results The participants' (n = 960, mean age 76 years, 49.0% female) DAI ranged from 0.00 to 0.68. Higher levels of both types of physical activity were statistically significantly associated with less deficit accumulation. Participants in the highest household (leisure time) physical activity quartile had 29% (30%) less deficits than participants in the respective lowest quartiles. Conclusion High levels of household physical activity might compensate for low levels of leisure time physical activity in the prevention of deficit accumulation. Further research efforts investigating the temporal sequence of this association are needed.

Retirement is a major life event potentially associated with changes in relevant risk factors for cardiovascular and metabolic conditions. This study analyzes the effect of retirement on behavioral and biomedical risk factors for chronic disease, together with subjective health parameters using Southern German epidemiological data. We used panel data from the KORA cohort study, consisting of 11,168 observations for individuals 45–80 years old. Outcomes included health behavior (alcohol, smoking, physical activity), biomedical risk factors (BMI, waist-to-hip ratio (WHR), glycosylated hemoglobin (HbA1c), total cholesterol/HDL quotient, systolic/diastolic blood pressure), and subjective health (SF12 mental and physical, self-rated health). We applied a parametric regression discontinuity design based on age thresholds for pension eligibility. Robust results after p-value corrections for multiple testing showed an increase in BMI in early retirees (at the age of 60) [β = 1.11, corrected p-val.

Objective Encouraging physical activity is an important public health measure to reduce disability prevalence in the aged. The aims of this study were to determine the association between midlife physical activity and late-life disability and to investigate gender-specific differences. Method This data originates from the KORA-Age cohort, a follow-up in 2008 of the MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Diseases)/KORA (Cooperative Health Research in the Region of Augsburg) S1–S4 surveys (1984–2001) situated in Augsburg, a city in Southern Germany. We applied a multivariable hurdle model to investigate the association of physical activity and disability. Results We analysed 3333 persons with a mean follow-up of 18 ± 5.5 years. Using hurdle models, moderate activity and high activity had a protective effect on the occurrence of disability (OR (odds ratio) = 0.80 and 0.73), but not on severity (i.e. number of limitations). We observed a strong gender-specific difference in this association, with men benefitting more from exercise. Conclusion Elevated physical activity reduces the risk of becoming disabled and postpones the onset of disability by several years, but we could not show an effect on the severity of disability. In addition, men seem to benefit more from leisure-time physical activity than women.

To examine the association between electrocardiographic (ECG) findings and disability status in older adults.KORA-Age, a population-based cross-sectional study of the MONICA/KORA project, a randomized sample from Southern Germany of people aged 65 years or older.A total of 534 (51.5%) of 1,037 participants were characterized as disabled. Disabled participants were on average 4.5 years older than those who were not disabled. Crude associations of left-axis deviation, ventricular conduction defects, atrial fibrillation, and QT prolongation with disability status were significant (P0.05). In models controlled for age and sex, these effects remained constant except for QT prolongation. In the models adjusted for the minimal sufficient adjustment set (consisting of the variables sex, physical activity, age, obesity, diabetes, education, heart diseases, income, lung diseases, and stroke) identified by a directed acyclic graph (DAG), no significant association could be shown.Associations between specific ECG findings and disability were found in unadjusted analysis and logistic models adjusted for age and sex. However, when adjusting for other possible confounders identified by the DAG, all these associations were no longer significant. It is important to adequately identify confounding in such settings.

Introduction Higher age is related to higher numbers of accumulated health deficits. However, to date it remains unclear how much of this association is due to age effects, how much is contributed by birth cohort effects and if a general trend of compression or expansion of morbidity can be assumed. The objective of this study was to investigate the role of cohort effects with regard to health deficit accumulation (DA) trajectories in people aged 65 and older. Methods Data originates from the baseline assessment of participants aged 65–71 years in 2008 (i.e. born 1937 to 1943) from the KORA (Cooperative Health Research in the Region of Augsburg)-Age study in Southern Germany as well as from an independent assessment in 2015 consisting of a younger birth cohort (aged 65–71 years in 2015, i.e. born 1944 to 1950). All participants were former participants of the population representative MONICA/KORA surveys conducted between 1984 and 2001. DA was measured with a Frailty Index (FI). This KORA-Age FI includes in total 33 items, covering 10 diseases, 13 measures of functioning and 10 signs and symptoms. All deficit items were coded as values between 0 (deficit absent) and 1 (deficit fully present). The FI for a person results as the number of the person-specific deficits divided by the total number of listed deficits. Thus, FI scores range from 0 (= no deficits present) to 1 (= all deficits present). If a participant scored missing on one or more of the deficit items, the denominator of the FI was reduced accordingly. Age-specific mean FI scores were graphically presented separately for the younger (born 1944 to 1950) and the older birth cohort (born 1937 to 1943), stratified by sex. The effects of birth cohort, age and sex (all coded as factor variables) on FI levels were analyzed using a generalized linear model (GLM) with the number of present health deficits as negative binomially distributed outcome and the number of possible health deficits as offset term. Significance level was set to 0.05. Results FI values were available for 1919 participants aged 65–71 years in 2008 (51% female) and for 1456 participants aged 65–71 years in 2015 (53% female). Participants from the younger birth cohort aged 65–71 years in 2015 had average FI values (FI = 0.141) comparable to participants from the older birth cohort aged 65–71 years in 2008 (FI = 0.136, P = 0.1071). Plotting birth cohort and sex-specific FI averages by age revealed that both birth cohorts started at the same FI levels, but thereafter, age-specific FI values were higher for the younger birth cohort and for women, specifically for those born in 1944 and 1945. These results were partly confirmed by the GLM. Higher age, especially for those aged 70 (RR: 1.23, KI [1.13; 1.34]) and those aged 71 years (RR: 1.23, KI [1.14; 1.34]) as compared to those aged 65 years, was associated with higher FI values. Also female sex (RR: 1.14, KI [1.09; 1.19]) was independently, significantly and positively associated with higher FI values. Having been born 1944–50 (RR: 1.04, KI [1.00; 1.09]) was positively associated with higher FI values, but the effect was not significant (P = 0.059926). Conclusion Based on our comparison of adults of the same age from different birth cohorts, an expansion of morbidity cannot fully be excluded. This seems to be largely due to the comparatively high levels of deficit accumulation for women born in 1944 and 1945, which coincides with the last years of World War II. Further research is warranted to investigate how specific life course experiences including deprivation in critical developmental periods for these cohorts may have contributed to these effects.