Abstract P336: Predicting Future Trends in Disability Individuals With Cardiovascular Disease: A Modelling Study to 2030
Authors: Guzman Castillo Maria , Ahmadi-Abhari Sara , Bandosz Piotr , Shipley Martin , Steptoe Andrew , Singh-Manoux Archana , Kivimaki Mika , Capewelll Simon , Brunner Eric , O’Flaherty Martin 
Published: July 2021

Background:
Most industrialised countries have experienced remarkable reductions in mortality from cardiovascular disease (CVD) and other chronic diseases since the 1970s. Yet CVD and dementia together account for half of all disability in the elderly in the US, UK and beyond. However recent trends in CVD morbidity and disability prevalence in the US and UK offer some encouragement: concerns regarding a potential increase in the burden of these diseases do not appear to be materialising. Meanwhile, clinicians and service planners urgently need reliable forecasts of the burden of CVD and disability. Previous studies have not modelled the complex interactions of CVD, dementia and disability over time. In this study, we therefore set out to forecast trends in CVD related disability in England and Wales up to 2030.

Methods:
As part of the IMPACT-Better Ageing Model study, we developed and validated a probabilistic Markov model. This model tracked health transitions in the England and Wales population (60 million) through ten states characterised by the presence or absence of CVD, dementia, disability and death from 2015 to 2030. Disease occurrence and age/sex/year specific transition probabilities were derived from the English Longitudinal Study of Ageing (ELSA). We estimated future CVD and disability prevalence. As observed in ELSA, we assumed continuing parallel downward trends in CVD incidence and mortality and a 2.7% annual decline in dementia incidence. Uncertainty was estimated using Monte Carlo simulation.

Findings:
By 2030, approximately 2,100,000 individuals (2,000,000-2,200,000 95% Uncertainty Intervals) will live with CVD in England and Wales (a 35% decrease from 2015). Standardised CVD mortality rates will plummet by 75%. However, approximately 910,000 (882,000- 946,000 95% UI) of these CVD patients will live with disabilities (a 19% decrease from 2015). Approximately 185,000 (178,000- 192,000 UI) CVD patients will additionally be living with dementia. Despite the rapid decreases in CVD and disability burden, the standardised prevalence of disability among CVD individuals will therefore increase from 35.2% to 39.6%.

Interpretation:
Our model predicts a 35% reduction in the total burden of CVD in England and Wales by 2030. However, over one third of the individuals with CVD will also be living with poor functional levels. That will represent a substantial burden for our already hard-pressed health and social care services. Our results suggest that recent efforts on CVD prevention might not be enough, thus emphasizing the need for more effective prevention of all non-communicable diseases and dementia as the major causes of disability. Policies focussing on the shared NCD risk factors of poor diet, tobacco, alcohol and inactivity could substantially reduce the burden of these dread diseases and greatly benefit the future functional level of senior citizens in the UK, USA and elsewhere.