As populations age, more people worldwide will live and die with serious illness like cancer, heart disease and dementia. Prior projections of serious illness prevalence and end-of-life care needs have typically used static population-level methods. We estimated future disease prevalence and healthcare costs by applying dynamic microsimulation models to high-quality individual-level panel data on older adults (aged 50 + ) in Ireland. We estimated that the number of people living and dying with serious illness will increase approximately 70 % over 20 years. Per-capita annual costs both at end of life and not at end of life increase substantially due to ageing populations and growing complexity. Total health system expenditures on care for people with serious illness are projected to double before accounting for rising cost of inputs in real terms. Decomposition of these estimates suggests that 39 % of additional costs are accounted for by rising absolute numbers of older people, 37 % by changing age distribution and growing life expectancy, and 23 % due to rising individual complexity including morbidity and functional limitations. Our results and methods will be of interest to other countries planning for the future population health needs, and formidable health system resources associated with these needs, in the coming years.

中文翻译：

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到 2040 年，爱尔兰将有多少人因重病生存和死亡？使用微观模拟估计需求和成本


随着人口老龄化，全世界越来越多的人将死于癌症、心脏病和痴呆等严重疾病。先前对严重疾病患病率和临终关怀需求的预测通常使用静态人口水平方法。我们通过将动态微观模拟模型应用于爱尔兰老年人（50 岁以上）的高质量个人面板数据来估计未来的疾病患病率和医疗保健成本。我们估计，20 年内，患有严重疾病的人数和死亡人数将增加约 70%。由于人口老龄化和复杂性的增加，人均年成本（无论是在生命终结时还是在生命终结时）都大幅增加。在考虑实际投入成本上升的情况下，用于治疗重病患者的卫生系统总支出预计将增加一倍。对这些估计的分解表明，额外成本的 39% 是由于老年人绝对数量的增加造成的，37% 是由于年龄分布的变化和预期寿命的增长造成的，23% 是由于个人复杂性的增加（包括发病率和功能限制）造成的。我们的结果和方法将引起其他国家在未来几年规划未来人口健康需求以及与这些需求相关的强大卫生系统资源的兴趣。