Author Affiliations: Departments of Family Medicine (Dr King) and Epidemiology (Dr Shankar), West Virginia University School of Medicine, Morgantown; and Department of Family Medicine, Medical University of South Carolina, Charleston (Drs Matheson and Ms Chirina). Mr Broman-Fulks is a medical student at Medical University of South Carolina.
From 1946 through 1964, 78 million children (“baby boomers”) were born in the United States. In 2010, baby boomers made up 26.1% of the US population.1 Medicine has improved significantly during baby boomers' lifetimes. Although these advantages have led to a progressively increasing life expectancy,2 previous studies have shown mixed results regarding whether baby boomers are healthier than prior generations.3,4 The present study examined the health status of aging baby boomers relative to the previous generation to provide a vitally important context for health workforce and policy planning in the coming years.
We analyzed data from the National Health and Nutrition Examination Survey (NHANES), including NHANES III (1988-1994) (for previous generation) and the NHANES for 2007 to 2010 (for baby boomers), focusing on respondents who were aged 46 to 64 years during either period. The 2 cohorts were compared with regard to health status, functional and work disability, healthy lifestyle characteristics, and presence of chronic disease. Further details of the methods can be found in the eAppendix.
The demographic characteristics of the cohorts were very similar except for the proportions in each racial/ethnic group, with greater proportions of non-Hispanic blacks (11.3% vs 9.4%) and Hispanics (9.8% vs 3.7%) in the 2007-2010 group compared with the 1988-1994 group (P < .001). The mean (SD) ages were 54.1 (0.03) years in the 2007-2010 group and 54.5 (0.03) years in the 1988-1994 group; there was no difference in sex between the 2 cohorts (49.1% male [2007-2010 group] vs 47.5% male [1988-1994 group]). Overall health status was lower in baby boomers, with 13.2% reporting “excellent” health compared with 32% of individuals in the previous generation (P < .001). Of the sampled baby boomers, compared with the previous generation, 6.9% vs 3.3% used a walking assist device (P < .001), 13.8% vs 10.1% were limited in work (P = .003), and 13.5% vs 8.8% had a functional limitation (P < .001).
With regard to healthy lifestyle factors, obesity was more common among baby boomers (38.7% obese vs 29.4% [previous generation]; P < .001) (Figure), and regular exercise was significantly less frequent (35.0% vs 49.9% exercise >12 times per month; P < .001); more than half of baby boomers reported no regular physical activity (52.2% vs 17.4%; P < .001). Moderate drinking was higher in the baby boomer cohort compared with the previous generation (67.3% vs 37.2%; P < .001). There were fewer current smokers in the baby boomer cohort than in the previous generation (21.3% vs 27.6%; P < .001).
Figure. Proportion of each cohort (baby boomers and previous generation at age 46-64 years) with hypertension, hypercholesterolemia, diabetes, or obesity in the 1988-1994 and 2007-2010 NHANES. The difference between cohorts was statistically significant for prevalence of hypertension (P < .001), hypercholesterolemia (P < .001), diabetes (P = .003), and obesity (P < .001). Obesity is defined as the proportion of individuals who exceeded a body mass index of 30 (calculated as weight in kilograms divided by height in meters squared). NHANES indicates National Health and Nutrition Examination Survey.
The percentage of individuals with hypertension (Figure) was more common among baby boomers than among individuals from the previous generation (43.0% vs 36.4%; P < .001), as was the percentage of individuals who take medication for hypertension (35.4% vs 23.2%; P < .001). Among baby boomers, hypercholesterolemia was more common (73.5% vs 33.8%; P < .001[Figure]),and medication use for hypercholesterolemia was more than 10 times greater (25.9% vs 1.5%; P < .001). Baby boomers were also more likely to have diabetes (15.5% vs 12.0%; P = .003 [Figure]) and take medication for diabetes (11.3% vs 6.2%; P < .001). The slight trend toward higher prevalence of cancer in baby boomers vs the previous generation was not significant (10.6% vs 9.5%; P = .25). The frequency of emphysema decreased in the baby boomer generation (2.3%) relative to the previous generation (3.5%) (P = .03). Baby boomers were also less likely to have had a myocardial infarction (3.6%) compared with the previous generation (5.3%) (P = .004).
A logistic regression was conducted to control for changes in demographic characteristics (age, sex, race, and socioeconomic status) of the population between 1988-1994 and 2007-2010. The results indicated, after adjustment, that baby boomers remained more likely than the previous generation to have diabetes (odds ratio [OR], 1.46; 95% CI, 1.16-1.83); hypertension (OR, 1.38; 95% CI, 1.14-1.67); and hypercholesterolemia (OR, 5.94; 95% CI, 4.94-7.14).
Despite their longer life expectancy over previous generations, US baby boomers have higher rates of chronic disease, more disability, and lower self-rated health than members of the previous generation at the same age. On a positive note, baby boomers are less likely to smoke cigarettes and experience lower rates of emphysema and myocardial infarction than the previous generation.
The findings from the present study documenting poorer health status and increased rates of obesity, hypertension, diabetes, and hypercholesterolemia support an increased likelihood for continued rising health care costs and a need for increased numbers of health professionals as baby boomers age.5,6 Given the link between positive healthy lifestyles and subsequent health in this age group,7 the present study demonstrates a clear need for policies that expand efforts at prevention and healthy lifestyle promotion in the baby boomer generation.
Correspondence: Dr King, Department of Family Medicine, West Virginia University School of Medicine, Robert C. Byrd Health Sciences Center, 1 Medical Center Dr, PO Box 9152, Morgantown, WV 26506 (email@example.com).
Published Online: February 4, 2013. doi:10.1001 /jamainternmed.2013.2006
Author Contributions:Study concept and design: King and Chirina. Analysis and interpretation of data: King, Matheson, Chirina, Shankar, and Broman-Fulks. Drafting of the manuscript: King, Matheson, Chirina, and Broman-Fulks. Critical revision of the manuscript for important intellectual content: Chirina and Shankar. Statistical analysis: Chirina. Study supervision: King and Matheson.
Conflict of Interest Disclosures: None reported.
Funding/Support: This study was supported in part by grants 1R01ES021825-01 and 5R03ES018888-02 from the National Institutes of Health.
Additional Contributions: Alexander Brown, MA, assisted in the preparation of the manuscript.
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This is an interesting and thought provoking paper, and the overall message of more prevention for the health of the baby boomers generation is welcomed. Nevertheless, while the authors control for several demographic factors, they forgot to control for the most relevant factor, namely survivorship.
With every new generation, the proportion of people surviving longer increases. People who earlier would have died by diseases, which can now be treated more effectively, are surviving to reach higher ages. This means that the baby boomer generation is more heterogeneous in terms of health, because more frail persons have survived until now. This is different from previous cohorts, where higher mortality levels executed a selection to old age process.
Given the rich historical data on mortality available, for instance in the Human Mortality Database, the exact survivorship of cohorts can be calculated. These data show that the survival of the generation of baby boomers up to the age of the NHANES surveys is 5% higher than that of previous cohorts, e.g. those born in the 30s. This increased survival observed in the baby boomer generation implies that people with a higher level of frailty, who likely would have died if mortality had not reduced, are now alive. The increased survivorship of the baby boomer generation has an impact on the many weak disparities presented in the paper by King et al., for which they have not accounted. The baby boomers’ health is negatively affected by the survival of the more frail population segments. A simple way of examining this would be to exclude the lowest 5% of NHANES’ results for health of the population of baby boomers and test if the results still hold. Amazingly the lower smoking prevalence found for the baby boomers, and noted in the paper, will be even more extreme in their favor.
The authors write in their comment “Despite their [baby boomer’s] longer life expectancies over previous generations…”. However, these are cohorts that are still alive today and it is not possible to calculate life expectancy for the whole life span, but only a “temporary life expectancy from birth to age 50 or 60”. To calculate those life expectancies, it is necessary to first have the survival of the cohorts. If the authors had made these steps, they would have faced the result of having to control for the extra survival of the baby boomer generation.
An additional comment is that there seems to be an overlap between the two generations studied: the “previous cohort”, those reaching ages 46 to 64 in NHANES III (1988-1994), were born from 1924 to 1948; the baby boomers’ years of birth as defined by the authors are 1943 to 1964, or those reaching ages 46 to 64 in NHANES (2007-2010). Those born 1943 to 1948 are present in both cohorts, which seems problematic if not properly defined. I agree with the authors that more prevention is needed to improve the health of baby boomers, and of all Americans!
King DE, Matheson E, Chirina S, Shankar A, Broman-Fulks J. The status of baby boomers’ health in the United States: the healthiest generation? JAMA Intern Med.. Published online February 4, 2013. doi:10.1001/jamainternmed.2013.2006
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