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Cited by 449Insurance, Mortality, Demography, Risk ManagementChronic Disease Management StrategiesGlobal Health Care Issues

The DOI matches its Crossref record; 52 of the 52 references it cites were found in a registry or an index; none of the 43 sources its claims cite is checked for support yet.

The Compression of Morbidity

Open access
FRIES, JAMES F.·2005·The Milbank Quarterly
DOI 10.1111/j.1468-0009.2005.00401.xPMC PMC2690269
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Abstract

I n this century we are progressing through three separate eras with dramatically different characteristics of health and illness.We entered the century in an era of infectious disease, with tuberculosis the number one killer of our population, and smallpox, diphtheria, tetanus, and other infectious illnesses extremely prevalent.A reduction in mortality from these diseases of over 99 percent (Fries and Crapo 1981;Cooper 1982) has led to the present era, where the major burdens of illness of the United States are the chronic diseases.Atherosclerosis and its complications, neoplasia, emphysema, diabetes, cirrhosis, and osteoarthritis have increased in prevalence even as the infectious illnesses which preceded them declined.It is one thesis of this discussion that this chronic disease era in its turn will slowly decline in significance, leaving a third era in which the major health problems of the United States will be directly related to the process of senescence, and where the aging process itself, independent of specific disease, will constitute a major burden of illness for the United States.The ultimate constraint within which we must develop health policy for the future is, of course, the limit of life itself.Man is mortal, and the limits to what presently may be accomplished in decreasing mortality are set by the life span of our species.In the following discussion, we will This paper was first delivered as a keynote address to the Institute of Medicine, National Academy of Sciences, Washington, October 20, 1982.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

Fries argues that chronic disease and senescence can be postponed, compressing morbidity into a shorter period before a finite human life span. He synthesizes mortality, physiologic, and epidemiologic evidence to claim that the period of infirmity can shrink even as life expectancy rises modestly.

Key findings

  • U.S. life expectancy from birth rose from 47 to 73 years over the century, but gains were much smaller at older ages: +13 years from age 20, +8 from age 40, +5 from age 60, +2.5 from age 80, and +0.7 from age 100.
  • The human life span appears to be approximately 85 years, with 99% of natural longevity between ages 70 and 100; maximum life potential was 113 years, 214 days, and Gompertz’s law implies mortality doubles about every eight years.
  • Organ reserve declines about 1.5% per year, and natural death may occur when reserve falls to roughly 20% above basal needs; chronic diseases are described as universal, early-onset, progressive, multifactorial, and marked by a symptom threshold.
  • Compression of morbidity is already suggested by data: average age at first heart attack for men increased about four years in sixteen, while life expectancy from age 40 increased only about two years over twenty; heart attack hospital discharges over age 65 rose from 47% to 52% of the total from 1968 to 1978.

Methods

  • Conceptual/keynote synthesis rather than a primary empirical study; the text states it was first delivered as a keynote address to the Institute of Medicine, National Academy of Sciences, in October 1982.
  • Uses national mortality and life-expectancy statistics, Gompertz’s law, physiologic studies of organ reserve decline, chronic disease epidemiology, athletic age-group records, and cited literature.
  • Main analysis builds an incremental model of chronic disease and aging, defines absolute and relative compression of morbidity, and interprets rectangularization of survival curves.

Limitations

  • The paper states that data on incidence of morbidity markers have not been systematically collected, there are no cross-sectional prevalence figures for “quality of life,” and it is not even clear what morbidity measures should be used.
  • The paper states that demographic projections may be faulty if they use a competing-risk model without a hazard function for natural death, and that natural deaths are hidden in categories such as bronchopneumonia, heart failure, and generalized atherosclerosis.
  • The paper notes that the Hayflick phenomenon of cellular senescence may be allegorical or a laboratory artifact and says its discussion is not based on it; evident from the text, the argument relies on selected evidence and illustrative examples rather than a systematic review or meta-analysis.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/j.1468-0009.2005.00401.x

Cites

52 of 52 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

0 of 43 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The point on the age axis at which the survival curves intersect has remained approximately the same.

    “The point on the age axis at which the curves intersect has remained approximately the same, the differences lying within the width of the lines used to plot such curves.”
    Quote in the paperSubstantial claim
  • Findingreasoning

    The major medical problems are now chronic illnesses: atherosclerosis, cancer, emphysema, diabetes, cirrhosis, osteoarthritis.

    “In turn, the major medical problems are now well-known to be chronic illnesses: atherosclerosis in all of its guises, cancer in its many forms, emphysema, diabetes, cirrhosis, osteoarthritis.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Life expectancy from birth in the United States increased from 47 to 73 years in this century, an increase of 26 years.

    “Life expectancy from birth in this century in the United States has increased from 47 to 73 years (Fries 1980)-an increase of 26 years (Figure 3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fries 1980 source
  • Findingcitation

    The acute infectious diseases have ceased to be statistically major causes of mortality in the United States.

    “The acute infectious diseases have ceased to be statistically major causes of mortality in the United States.”
    Quote in the paperSubstantial claim
  • Findingcitation

    Tuberculosis, smallpox, diphtheria, tetanus, polio, typhoid fever, and others have declined by 99 percent to 100 percent in this century.

    “Tuberculosis, small pox, diphtheria, tetanus, polio, typhoid fever, and others have declined by 99 percent to 100 percent in this century (Fries and Ehrlich 1980).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fries and Ehrlich 1980

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one. 42
  • Probably not a substantial claim. 27

  • It may state two separate claims as one.

    Findingnone given

    The rate of progression of chronic disease may be very low, as in atherosclerosis in native Japanese on native diets, or higher, as in Japanese on American diets.

    “This rate may be very low (as in atherosclerosis in native Japanese on native diets) or higher (as in Japanese on American diets).”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingcitation

    Life expectancy from age 20 increased only about 13 years, from age 40 eight years, from age 60 five years, from age 80 2.5 years, and from age 100 0.7 years.

    “life expectancy from age 20, which has increased only some 13 years; life expectancy from age 40, which has increased eight years; life expectancy from age 60, which has increased 5 years; from age 80, 2.5 years; or from age 100, 0.7 years (Faber 1982).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Faber 1982

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Findingnone given

    Chronic illnesses have their onset early in life; signs may be found in autopsy studies of individuals in their twenties.

    “Moreover, the chronic illnesses have their onset early in life; signs of such problems may be found in autopsy studies of individuals in their twenties.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    In 1900 mortality occurred at a relatively steady rate throughout the life span; in successive decades survival curves have become increasingly rectangular, with a flat top and sharp downslope.

    “In 1900 mortality occurred at a relatively steady rate throughout the life span.In successive decades, the curves have begun to bend upwards and to the right, each considerably different from the last.The form of the curve is increasingly rectangular, having an increasingly flat top and an increasingly sharp downslope.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingcitation

    National mortality figures show a smooth decline in number of deaths and a smooth increase in mortality rates with age.

    “National mortality figures demonstrate a smooth decline in number of deaths and a smooth increase in mortality rates as we move toward higher ages (Fries and Crapo 1981).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fries and Crapo 1981

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Findingcitation

    In the United States, deaths in the 85th year of age number 41,000 per year and decrease to 24 by age 110, in a smooth progression with no exceptions.

    “The 41,000 deaths per year in the United States in the eighty-fifth year of age has decreased to 24 by age 110, in a smooth progression which shows no exceptions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingcitation

    Alzheimer's disease is a major problem currently increasing in prevalence, is heavily age dependent, and has a specific pathology.

    “Alzheimer's disease, a major problem currently increasing in prevalence, is difficult to classify, and clearly deserves both preventive and curative study.This condition is heavily age dependent, and has a specific pathology (Beck et al. 1982;Blass and Weksler 1983).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Beck et al. 1982 source
    • cites Blass and Weksler 1983 source

  • It may state two separate claims as one.

    Findingcitation

    Life expectancy at age 100 is projected to increase from 2.45 years in 1980 to 3.01 years in 2000 and 3.35 years in 2020.

    “Life expectancy at age 100 is projected to increase from 2.45 years in 1980 to only 3.01 years in 2000, and 3.35 years in 2020.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Faber 1982

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Findingreasoning

    Patients with chronic disease such as the heavy-smoking brother appear to require up to four times the medical resources of the average individual.

    “Such patients appear to require, not surprisingly, up to four times the medical resources of the average individual.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationcitation

    Life expectancy at age 100 has changed at most 0.7 years over 80 years, and much of this improvement must have been due to reduction of premature death, not change in life span.

    “Life expectancy at age 100 has changed at most 0.7 years over 80 years (Faber 1982), and much of this improvement must have been due to reduction of premature death, not change in life span.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Faber 1982

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Interpretationnone given

    The chronic disease era will slowly decline in significance, leaving a third era in which the major health problems of the United States will be directly related to senescence, and aging itself will constitute a major burden of illness.

    “It is one thesis of this discussion that this chronic disease era in its turn will slowly decline in significance, leaving a third era in which the major health problems of the United States will be directly related to the process of senescence, and where the aging process itself, independent of specific disease, will constitute a major burden of illness for the United States.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Different species have very different life spans due to species life span rather than increased disease or accident among animals.

    “Different species, on the other hand, have very different life spans; the obvious fact that we tend to outlive our pets is not due to increased disease or accident among the animals, but rather to the difference in species life span (Rockstein 1958).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rockstein 1958 source

  • It may state two separate claims as one.

    Interpretationreasoning

    As the slope of chronic disease progression decreases, the date of crossing the symptomatic threshold can be postponed; death due to the disease can be postponed or prevented; and severity of symptoms can be decreased.

    “As the slope decreases, the date of crossing the symptomatic threshold (Figure 7) can be postponed; death due to the disease can be postponed or even prevented; and the severity of symptoms experienced can be decreased.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: In the multiple risk factor, universal susceptibility model, modifying risk factors decreases the slope of chronic disease progression.

  • It may state two separate claims as one.

    Interpretationreasoning

    Both the absolute amount and the percentage of life spent in less than good health may be decreased.

    “Both the absolute amount and the percentage of life spent in less than good health may, thus, be decreased.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: In the multiple risk factor, universal susceptibility model, modifying risk factors decreases the slope of chronic disease progression.

  • It may state two separate claims as one.

    Interpretationcitation

    The presently most important illnesses are universal, have early onset, are progressive, are generally characterized by a symptom threshold, and are multifactorial in cause.

    “Thus, our presently most important illnesses are universal, have early onset, are progressive, are generally characterized by a symptom threshold at which time they become clinically obvious, and are multifactorial in cause (Fries and Crapo 1981).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fries and Crapo 1981

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Premisecitation

    Physiologic decline is about 1.5 percent per year and begins early in life in healthy individuals before specific chronic disease effects.

    “Studies of this physiologic decline, about 1.5 percent per year, uniformly indicate that the decline begins early in life in healthy individuals-well before it is reasonable to postulate any specific chronic disease effects (Figure 1).”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    Present gains in life expectancy accrue by postponement of chronic disease and are reflected in life expectancy increases at all ages; historically more slowly rising life expectancy from advanced ages will show a larger percentage, although smaller absolute, gain.

    “Present gains, accruing by postponement of chronic disease, are reflected in life expectancy increases at all ages; hence, the historically more slowly rising life expectancy from advanced ages will show a larger percentage, although smaller absolute, gain.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Premisecitation

    The organ reserve potential is greatest in early life and shows a functional decline that is essentially linear and roughly parallel for all major organs.

    “The organ reserve potential, greatest in early life, shows a functional decline which is essentially linear and which is roughly parallel for all major organs.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    Several methods of estimating the human life span all suggest an average life span of approximately 85 years, with a distribution including 99 percent of individuals between ages 70 and 100.

    “All suggest an average life span of approximately 85 years, with a distribution which includes 99 percent of individuals between the ages of 70 and 100 (Figure 5).”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    The model presented predicts that the male-female gap in life expectancy eventually may decrease, but does not anticipate dramatic change in the next few years.

    “The model presented here predicts that the male-female gap eventually may decrease, but does not anticipate dramatic change to occur in the next few years; such change requires that premature death in males decreases more rapidly than in females, and may occur if the present cardiovascular disease decline broadens, lung cancer rates follow anticipated trends, and traumatic deaths of males in early”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    Every individual has the potential for increasing atherosclerosis, an increasing statistical possibility of malignant change, and slow degeneration of the articular cartilage.

    “Every individual has, to a greater or lesser degree, the potential for increasing atherosclerosis, an increasing statistical possibility of malignant change, and slow degeneration of the articular cartilage.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    World-class performance is optimal in the twenties and early thirties and then shows a linear decline.

    “World-class performance is optimal in the twenties and early thirties and then shows a linear decline (Fries 1980), up to the point where sample size is inadequate for estimation.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Fries 1980 source

  • It may state two separate claims as one.

    Premisecitation

    Capacities such as rigidity of the arterial wall, cataract formation, graying of hair, loss of glomeruli in the kidney, thinning of hair, and loss of elasticity of skin appear to be insidiously and irreversibly lost with age.

    “These capacities appear to be insidiously and irreversibly lost with age, according to present data (Fries and Crapo 1981).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Fries and Crapo 1981

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationnone given

    The model may be used to describe the senescent changes of aging in multiple organ systems as well as the accelerated decrepitude in a particular organ associated with a chronic disease.

    “Importantly, this model may be used to describe the senescent changes of aging in multiple organ systems as well as the accelerated decrepitude in a particular organ associated with a chronic disease.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: In the multiple risk factor, universal susceptibility model, modifying risk factors decreases the slope of chronic disease progression.

  • It may state two separate claims as one.

    Premisecitation

    Mortality rates increase exponentially with age, doubling approximately every eight years.

    “Gompertz noted a linear increase in mortality rates with age when rates were plotted on a logarithmic scale.That is, the mortality rate increases exponentially with age, doubling approximately every eight years of age.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gompertz (1825)

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Interpretationnone given

    Any reduction in the average slope of lines representing individuals in a population will result in a decrease in age-specific mortality rates and an increase in the average age at which the first symptom is experienced.

    “Another significant attribute of this model is that any reduction in the average slope of lines representing individuals in a population will result in a decrease in age-specific mortality rates.And, it will also result in an increase in the average age at which the first symptom is experienced.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: In the multiple risk factor, universal susceptibility model, modifying risk factors decreases the slope of chronic disease progression.

  • It may state two separate claims as one.

    Interpretationnone given

    The human life span appears to be approximately 85 years, with natural longevity for individuals falling nearly entirely within 70 to 100 years.

    “The human life span appears to be approximately 85 years, with a broad distribution in which natural longevity for individuals falls nearly entirely within the range of from 70 to 100 years.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    Anthropological analyses suggest a formula by which mammalian life spans may be predicted by brain size/body weight ratio; such models suggest an approximately constant human life span for the past 100,000 years.

    “Anthropological analyses (Cutler 1979) suggest a formula by which mammalian life spans may be predicted by the brain size/body weight ratio; such models suggest an approximately constant life span for the human species for the past 100,000 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Cutler 1979 source

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    Utopias may be envisioned, but not totally achieved.

    “Utopias may be envisioned, but not totally achieved.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.

    Premisenone given

    Studies of plasticity suggest strongly the health and vitality benefits of continuing challenge, problem solving, perception of productivity, continued activity, and more money.

    “Studies of plasticity suggest strongly the health and vitality benefits of continuing challenge, problem solving, perception of productivity, continued activity, and more money; for some, these features will be best obtained by continued employment.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    Aging programs directed only at the aged will have less impact than those addressing the same problems earlier.

    “Aging programs directed only at the aged will have less impact than those addressing the same problems earlier.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    There is a level of optimal human performance in each faculty, approximated by world-class performance at each age.

    “There is a level of optimal human performance in each faculty, approximated by world-class performance at each age.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationnone given

    Our health insurance programs take money from those with good health habits and give it to those with poor health habits.

    “Our health insurance programs take money from those with good health habits and give it to those with poor health habits.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationreasoning

    The same individual, untrained and expending less than maximal effort, will show a similar curve but at a lower level of performance.

    “The same individual, untrained and expending less than maximal effort, will show a similar curve but at a lower level of performance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationreasoning

    The paradigm of increasing vitality and finite life, with the consequent compression of morbidity into a shorter period prior to the end of life, offers a framework within which to view these problems, and within which we may begin to develop some constructive solutions.

    “The paradigm of increasing vitality and finite life, with the consequent compression of morbidity into a shorter period prior to the end of life, offers a framework within which to view these problems, and within which we may begin to develop some constructive solutions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationnone given

    Increasing birth cohorts will continue to discharge ever larger numbers of individuals into the older age groups until equilibrium is reached after some 50 years, and the problems we have been experiencing will grow worse before they grow better.

    “Increasing birth cohorts will continue to discharge ever larger numbers of individuals into the older age groups until equilibrium is reached after some 50 years, and the problems we have been experiencing will grow worse before they grow better.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisenone given

    The average age at first heart attack for men appears to have increased approximately four years in the past sixteen, while life expectancy from age 40 increased but two years over the past 20.

    “For example, the average age at first heart attack for men appears to have increased approximately four years in the past sixteen, while life expectancy from age 40 increased but two years over the past 20.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Many psychologists favor a life span concept with regard to cognitive and social functions.

    “As an additional factor tending to reduce the effects of biological senescence, it should be observed that many psychologists favor a life span concept with regard to cognitive and social functions (Labouvie-Vief and Blanchard-Fields 1982).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Labouvie-Vief and Blanchard-Fields 1982 source

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.

    Interpretationcitation

    The rectangular morbidity curve represents, in many ways, a social ideal.

    “The rectangular morbidity curve represents, in many ways, a social ideal-a long, vigorous life culminating, as in Oliver Wendell Holmes's One-Hoss Shay (1908), with a sudden terminal collapse; vitality until the end, and death coming without fear or fury at the natural end of the individual life span.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Holmes 1908

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Premisenone given

    The decline in optimal performance is linear.

    “The decline in optimal performance is linear.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationreasoning

    With maximum training and effort, there is a theoretically optimum performance for each individual, and this curve should be expected to have the same characteristics as do the measurable curves.

    “That is, with maximum training and effort, there is a theoretically optimum performance for each individual, and this curve should be expected to have the same characteristics as do the measurable curves.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    The compression of morbidity and the plasticity of aging are related concepts, and are applicable both to the problems of chronic disease and to the problems of senescence.

    “The compression of morbidity and the plasticity of aging are related concepts, and are applicable both to the problems of chronic disease and to the problems of senescence.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationreasoning

    The compression of morbidity is an achievable phenomenon; it is already occurring in some areas, and it can be made to grow importantly.

    “But the compression of morbidity is an achievable phenomenon; it is already occurring in some areas, and it can be made to grow importantly.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.

    Interpretationnone given

    It is not even clear what measures of morbidity should be used.

    “Indeed, it is not even clear what measures of morbidity should be used.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisenone given

    In these models, a variety of stages occur, one following the other.

    “In these models, a variety of stages occur, one following the other.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Premisecitation

    The stroke data are more equivocal, but appear to show the same thing (morbidity and mortality reduced).

    “The stroke data are more equivocal, but appear to show the same thing (Kramer, Diamond, and Lilienfeld 1982;Robins and Baum 1981).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kramer, Diamond, and Lilienfeld 1982 source
    • cites Robins and Baum 1981

  • It may state two separate claims as one.

    Premisecitation

    With time and age, one may improve, regress, or stay the same within surprisingly broad limits of performance; the limits are evidenced by the wide variation in interindividual performances, and by the increase in such variation with age.

    “With time and age, one may improve, regress, or stay the same within surprisingly broad limits of performance; the limits are evidenced by the wide variation in interindividual performances, and by the increase in such variation with age (Dittman-Kohli and Baltes 1983).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Dittman-Kohli and Baltes 1983

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Interpretationreasoning

    Some emerging data suggest that the compression of morbidity may be a present, as well as a future, phenomenon.

    “Some emerging data suggest that the compression of morbidity may be a present, as well as a future, phenomenon.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.

    Interpretationreasoning

    Projection of health needs under the scenario presented are more favorable than sometimes supposed.

    “Projection of health needs under the scenario presented are more favorable than sometimes supposed.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.

    Interpretationreasoning

    By inference, each individual must have his or her own particular curve of optimum performance.

    “By inference, each individual must have his or her own particular curve of optimum performance.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationnone given

    The many problems of our increasingly elderly population continue to exist and require vigorous attack from many directions.

    “But the many problems of our increasingly elderly population continue to exist and require vigorous attack from many directions.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationnone given

    Athletic performance is only the most measurable faculty; optimal performance is possible for almost any endeavor, from shopping to playing chess.

    “Athletic performance is only the most measurable faculty; optimal performance is possible for almost any endeavor, from shopping to playing chess.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper may give no reason why it holds.

    Interpretationnone given

    Clinical observation of our most vital older citizens suggests a usual terminal decline of months to even a few years, not an abrupt collapse as that of the one-hoss shay.

    “Clinical observation of our most vital older citizens suggests a usual terminal decline of months to even a few years, not an abrupt collapse as that of the one-hoss shay.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.

    Interpretationnone given

    The means for affecting positive change in an aging population are to be found in the variability of the population, as well as in the average values.

    “Fourth, the means for affecting positive change in an aging population are to be found in the variability of the population, as well as in the average values.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.

    Interpretationreasoning

    Solutions are hampered by the existence of certain adverse incentives within our society.

    “Finally, solutions are hampered by the existence of certain adverse incentives within our society.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.

    Interpretationreasoning

    We subsidize bad health habits and we encourage disuse of the mental and physical faculties of older individuals.

    “We subsidize bad health habits and we encourage disuse of the mental and physical faculties of older individuals.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    Studies showing declines in cognitive function with age are felt by those workers as due largely to the use of youth-oriented measurements of factual cognitive function which do not account for the more complex and less easily measurable manifestations of mature wisdom.

    “Studies showing declines in cognitive function with age are felt by those workers as due largely to the use of youth-oriented measurements of factual cognitive function which do not account for the more complex and less easily measurable manifestations of mature wisdom (Dittman-Kohli and Baltes 1983).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Dittman-Kohli and Baltes 1983

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Premisereasoning

    Lung cancer age-specific incidence rates appear to have similarly changed and the risk-factor model based heavily on cigarette smoking (pack/years) suggests that as smoking decreases the effect will first be postponement of onset.

    “Lung cancer age-specific incidence rates appear to have similarly changed and the risk-factor model based heavily on cigarette smoking (pack/years) suggests that as smoking decreases the effect will first be postponement of onset; that is, the requisite number of pack/years will be reached later in life.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The risk-factor model based heavily on cigarette smoking (pack/years) is valid for predicting lung cancer onset.

  • It may state two separate claims as one.

    Premisecitation

    Despite the decreasing prevalence of heart attack over the period of 1968 to 1978, the percentage of hospital discharges for this condition over the age of 65 has risen from 47 to 52 percent of the total.

    “Despite the decreasing prevalence of heart attack over the period of 1968 to 1978, the percentage of hospital discharges for this condition over the age of 65 has risen from 47 to 52 percent of the total (National Center for Health Statistics 1965Statistics , 1968Statistics , 1974Statistics , 1978;;Faber 1982;Elvebach, Connolly, and Kurland 1981;Connolly et al. 1981).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites National Center for Health Statistics 1965

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Faber 1982

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Elvebach, Connolly, and Kurland 1981

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

59 of 59

  • The authors state this as an assumption.

    In the multiple risk factor, universal susceptibility model, modifying risk factors decreases the slope of chronic disease progression.

    “In this model, as risk factors are modified, the slope of the progression is decreased.”

  • The authors state this as an assumption.

    The age at first heart attack, the age at development of identifiable lung cancer, and the average age at admission to nursing homes are valid measures of morbidity.

    “If we accept as such measures the age at first heart attack or the age at development of identifiable lung cancer or the average age at admission to nursing homes, available data suggest that the onset age of these markers may be increasing more rapidly than is life expectancy from age 40 in the United States.”

  • The paper relies on this without support.

    The risk-factor model based heavily on cigarette smoking (pack/years) is valid for predicting lung cancer onset.

    “Lung cancer age-specific incidence rates appear to have similarly changed and the risk-factor model based heavily on cigarette smoking (pack/years) suggests that as smoking decreases the effect will first be postponement of onset; that is, the requisite number of pack/years will be reached later in life.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Figure 8 caption reverses the effect of better health habits

    Minor

    The caption identifies the lower example as having better health habits but says its period of adult vigor is reduced. The text says the light-smoking brother remains vigorous for a longer period.

1 of 1

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Baltes P.B., 1980, Determining the Effects of Aging on the Central Nervous System
  2. Bowerman W.G, 1939, Centenarians, Transactions of the Actuarial Society of America, 40, 360
  3. Dittman‐Kohli F., 1983, Beyond Formal Operations: Alternative Endpoints to Human Development
  4. Robins M., 1981, Incidence of Stroke, Stroke, 12, 145

Cited by

Sorted by citations

Related

Metadata

Authors
FRIES, J. F.
Affiliations
Stanford Medicine (US)
Corresponding author
FRIES, JAMES F.
Venue
The Milbank Quarterly
Publisher
Wiley
Published
2005-11-09
Volume
83
Issue
4
Pages
801-823
ISSN
  • 0887-378X (ISSN-L)
  • 1468-0009
DOI
10.1111/j.1468-0009.2005.00401.x
PMC
PMC2690269
OpenAlex
W2110353535
Cited by
449
References
50
Citations by year
2026: 6 · 2025: 19 · 2024: 13 · 2023: 12 · 2022: 11 · 2021: 23 · 2020: 13 · 2019: 22 · 2018: 22 · 2017: 15 · 2016: 16 · 2015: 19 · 2014: 15 · 2013: 19 · 2012: 18
FWCI
36.72
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Milbank Quarterly (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Global Health Care Issues
Keywords
compression of morbidity, chronic disease, infectious disease decline, aging, senescence, lifespan, mortality trends, health policy, atherosclerosis, cancer, diabetes mellitus, osteoarthritis, emphysema, liver cirrhosis
MeSH terms
Aging, Chronic Disease, Health Services for the Aged, Health Status, Humans, Life Expectancy, Morbidity, Primary Prevention, Public Health, Public Health Administration, United States, History, 20th Century

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-11-10, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-11-10 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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