Upsala J Med Sci 83: 153-162, 1978

Health and Disease at the Age of Sixty
Findings in a Health Survey of 60-year-old Men in Uppsala
and a Comparison with Men 10 Years Younger

URBAN WAERN
From the Department of Internal Medicine, University Hospital, Uppsala, Sweden

ABSTRACT
A health investigation was performed among 331 men aged
60 years in Uppsala. The investigation was performed in the
same way as in 50-year-old men ( n = 2 3 2 2 ) in the same
community, previously described. Thus it was possible to
make certain comparisons between these two populations of
middle-aged men. A considerably higher morbidity, glven
as point prevalence, was found for diseases of the
cardiovascular system and of the endocrine organs, in the
older population compared with the younger. Parallel to
this a higher consumption of pharmaceuticals was reported
by the older men. Only 39% among the older men versus
51 % of the younger men were smokers. Nearly the same
number (two-thirds) of men in both age groups were with-
out codable ECG abnormalities in their resting ECG.
Among the older men, however, there were more subjects
having multiple pathological ECG flndings than in the
youngeragegroup.

It is concluded that it is possible to reach approximately
80% of the actual population in special health investiga-
tions, in middle-aged men. Future studies, preferably in
younger subjects, should aim at an early detection and
primary prevention of cardiovascular and endocrine dis-
eases.

INTRODUCTION

During recent decades numerous studies have been
performed to elucidate factors that increase the risk
of cardiovascular disease and death. Cardiovascu-
lar disease has been accorded special importance
due to its large and increasing contribution to
morbidity and mortality in modern society.

In Sweden, studies have been carried out in
Gothenburg (34), Stockholm and Uppsala (IS),
among other places. This paper deals with general
findings in a health survey of 60-year-old men in
Uppsala. They were investigated in much the same
way as another group of men, at the age of 50 (15) in
the same community. These men were born in the
period 1920-24. They numbered 2 322 subjects and
were investigated in 1970-1973. Comparisons with
this younger age group will be made, with respect to

blood pressure (37) and glucose tolerance and
serum lipid levels.

Some additional studies were made on the same
population, including the occurrence of cardiac
arrhythmias in daily life, alcohol intake and patterns
of urinary electrolytes. These will be reported on
elsewhere.

MATERIAL
The population consisted of all men born in 1915 living in
Uppsala in 1975. They numbered 422. At the time of
screening they were living within the same area as were
the 50-year-old men of the previous study.

The population of the corresponding area of Uppsala on
1st January 1975 was 108 676. Of the above-mentioned 422
men called for health examination, 331 arrived, which
meant a participation rate of 78.4%.

From the registers of the County Council in Uppsala,
the names and addresses of all men born in 1915 were
collected. In order to get a relevant list, this collection was
made 3 months in advance of the forthcoming examina-
tion.

METHODS
A letter was sent to each man in the population one week
in advance, inviting him to the health survey and explain-
ing its purpose. In the letter the subject was asked to fast
and also refrain from smoking from midnight prior to the
morning of the investigation. This started at 7.00 am. The
examination was performed by the author, with the as-
sistance of the same registered nurse as in the study of
50-year-old men (15). It took place in the outpatient clinic
of the Department of Internal Medicine at the University
Hospital of Uppsala.

Non-participants were all offered another appointment
by direct telephone contact.

The investigation started in the middle of August 1975
and was completed by the end of November the same
year.

Questionnaire
A self-administered questionnaire modified after Collen
(7) was used. It contained 145 questions, including family

Upsala J M e d Sci 83

154 U . W a e r n

Table I. L a b o r a t o r y i n v e s t i g a t i o n s p e r f o r m e d in the h e a l t h i n v e s t i g a t i o n of 6 0 - y e a r - o l d m e n
Mean values, standard deviations and laboratory methods used by the laboratory

System Component n Mean S.D. Method

Serum
Serum

Urine

Serum
Serum
Urine
Urine
Blood

Serum

Urine
Serum

Urine

Serum
Serum
Blood

Albumin
Calcium

Calcium

Cholesterol
Creatinine
Creatinine
Ethanol
Glucose

Glut. trans-

Magnesium
Phosphate

Phosphate

Potassium

Sodium

Triglycerides
Urate
Erythrocyte

ferase

331 4 . 2 811
33 1 2.4 mmol/l

326 5.4 mmol/d

33 1 6.2 mmol/l
33 1 83.4 pmolll
327 1 1 980.8 pmol/d
36 251.7 mgll

33 1 5.4 mmol/l

3 24

327
33 1

326

329
33 1
330

0.33 pkat/l

3.8 mmol/d
0 . 9 mmolll

29.4 mmol/d

70.6 mmol/d

159.7 mmol/d

1.7 mmolll
269.9 pmol/l

8.1 mm/h
sed. rate

Blood Haematocrit 330 44.9 %

0.35
0.08

2.8

1.2 Auto-Analyzer N-70

Brom cresol green binding technique
Atomic absorption method using internal

Atomic absorption method using internal
standardization with strontium

standardization with strontium

13.6 Jaffk reaction after dialysis
Jaffk reaction after dialysis

Glucose oxidase method after zinc hydroxide

3 007.8

1.6
408.1 Alcohol dehydrogenase method

0.27

1.7
0.3

8.9

24.4

61.5

1.0
64.9
7.2

preparation

to Szasz
Kinetic photometric method according

Atomic absorption method
Dialysis of sample and reduction of

Dialysis of sample and reduction of

Flame photometric method using internal

Auto-Analyzer N-24 a
Uricase method
Westergren’s method

phosphomolybdate with Elon

standardization with lithium

3.2 Micromethod in duplicate using international
microcapillary centrifuge

history, previous
symptoms among

diseases, smoking habits, and stress
other things.

Personal interview
This procedure included questions about marital and pro-
fessional status, consumption of medicines, dietary regi-
mens, etc. Contacts with a physician and the reasons
therefore were also noted. Each subject was also asked if
he took advantage of the general health survey in the
county that is offered by the local health authorities every
third year.

Blood pressure measurements
Blood pressure (J3P) was measured on the right arm after
10 min in the recumbent position and after another 2 min
in the sitting position. The pulse rate was counted im-
mediately prior to the first BP measurement. A mercury
wall manometer (Kifa Ercameter) was used. The cuff had
a rubber bladder 12 cm wide and 35 cm long. Systolic BP
(SBP) and diastolic BP (DBP) were recorded to the nearest
5 mmHg. DBP was recorded at the disappearance of the
Korotkoff sounds (phase 5 ) .

Anthropometric measurements
The height without shoes and the weight in undershorts
were measured in whole centimetres and kilograms, re-
spectively. In order to define relative body weight, three
weight indices were used: 1) an index described by Lind-

berg et al. (24), 2) an index based on the findings of
insurance holders in the USA ( 5 ) . 3) Finally the heights
and weights of the 50-year-old men in the same commun-
ity (15) were used as a reference to relative body weight
index in the 60-year-old men.

Body fat was estimated with a Harpender (9) caliper.
Three parts of the body were measured: to the right of the
umbilicus, under the angle of the scapula and at the back
of the mild-upper arm. All these measurements were made
in the sitting position and were recorded in whole mil-
limeters.

Laboratory investigations
All blood samples were taken in the fasting state. The
laboratory investigations performed are shown in Table I
together with the methods used by our central laboratory.
The mean values are also presented in this table.

The morning urine was examined qualitatively for glu-
cose and albumin, using paper sticks. Each participant
was then asked to collect all urine for 24 h following
screening, in a plastic bottle.

An intravenous glucose tolerance test (IVGTT) was
performed in a randomized subgroup of 67 (20.2%) of the
subjects who denied diabetes mellitus and all other dis-
eases requiring chronic medication and dietary treatment.
These findings will be described separately (38) and will
include a comparison towards 50-year-old men concerning
insulin secretion at IVGTT.

Wnsula J M e d Sci 83

Health and disease at sixty 155

Table 11. Percentage of positive replies t o some
questions in the sev-administered questionnaire, in
health surveys of 50- and 60-year-old men in Upp-
sala

Questions

50-year- 60-year-
old men old men
( n = 2 322) (n=331)

Does (did) your father have

Does (did) your mother have

Have you suffered from oppres-
sion of the chest when walking
at normal speed on flat
ground? 2.8

walking outdoors in cold
weather? 3.5

chest when walking outdoors
in cold weather? 3.3

Have you been in hospital for
myocardial infarction? 0.9

Do you have the diagnosis angina
pectoris established by a
physician? 2.2

Do you take nitroglycerin
tablets? 1 . 1

Are you a smoker? 51.0
Have you gained more than 10 kg

elevated blood pressure? 11.2

elevated blood pressure? 25.2

Do you get chest pains when

Do you get oppression of the

body weight since the age
of 30? 6.6

Do you feel absolutely well? 80.1
Are you retired for medical
reasons? 1 . 1

6.1

16.3

10.9

11.8

11.2

4.2

11.5

6.7
39.6

34.4
51.4

10.0

Electrocardiogram
A resting 12-lead electrocardiogram (ECG) was recorded
in all men. This included standard leads I , 11, and 111,
unipolar leads aVF, aVL and aVR and finally leads V1-V6,
The conventional amplification 1 mV=lO mm was used,
with a paper speed of 50 mm/sec. The paper speed and
amplification were frequently tested. The ECGs were in-
terpreted by two independent physicians at the Depart-

ment of Clinical Physiology according to the Goldmann
criteria (13) and to the Minnesota code (31).

A long-term ECG recording covering 6 hours was made
(8) but will be discussed elsewhere (23).

RESULTS

Questionnaire and interview
Some results are summarized in Table I1 concern-
ing questionnaire data obtained for the 60-year-old
men, as compared with the 50-year-olds.

For the questions concerning angina pectoris
(AP) there was a consistently higher percentage of
positive replies in the older age group. Only 2 . 2 % of
the younger men reported AP confirmed by a physi-
cian, compared with 1 1.5 % in the older group. This
five-fold increase was also noted with respect to
hospitalization for myocardial infarction.

Only 39.6% of the older men smoked as against
51.0% of the 50-year-olds. However, among the
60-year-old men 13.6% reported that they had
stopped smoking after the age of 50. This would
mean that 53.2% of those participating in the
screening were smokers at the age of 50. Nearly
two-thirds (64.9%) of the 60-year-old men who
were smokers at the time of screening were not
interested in smoking withdrawal trials.

Concerning body weight changes after the age of
30, almost one third (34.2%) of the older men re-
ported an increase in body weight of more than 10
kg after the age of 30. In the younger group 6.6%
reported a similar increase in a period of 20 years.

Half (50.8%) of the older men had access to a
physician through their employer. Slightly more
than three-quarters of the participants (77.8 %) took
advantage of the local health examination the last
time they were called.

Table 111. Prevalence of diagnoses, reported as s p e c 8 c diagnosis, in health surveys of 50- and 60-year-old
men in Uppsala
Code number classification according to ICD. Only diagnoses established by a physician are included

Code
number Diagnosis

50-year-old men 60-year-old men
( n = 2 322) (n=331)

Subjects Number Subjects Number
per cent of men per cent of men

40 1 Essential hypertension
412 Ischaemic heart disease
250 Diabetes mellitus
443 Intermittent claudication

3 .l 81 12.4 41
0.6 15 4.2 14
0.9 21 4.8 16
0.1 3 0.9 3

156 U. Waern

Table IV. Prevalence of diagnoses, reported as groups of diagnoses in health surveys of 50- and
60-year-old men in Uppsala
Code number classification according to ICD (International Classification of Diseases, 3rd Rev. Ed.). Only diagnosis
established by a physician are included

50-year-old men 60-year-old men
(n=2 322) (n=331)

Code
number Groups of diagnoses

Subjects Number Subjects Number
per cent of men per cent of men

140-239
240-279
290-316
320-389
390458
460-5 19
520-577
710-738

Tumours
Endocrine, metabolic
Mental disorders
Nervous diseases
Circulatory diseases
Respiratory diseases
Gastrointestinal diseases
Musculoskeletal disorders

0.2
1.2
1.5
0.8
5.9
0.3
0.1
0.7

5 1 .5 5
27 12.1 40
34 3.0 10
18 3.6 12

136 31.1 103
7 2.4 8
2 2.1 7

16 7.9 26

In Tables 111 and IV the occurrence of various
diagnostic groups and specific diagnoses are shown.

An increase in general morbidity between the
ages of 50 and 60 is apparent. Of particular im-
portance, however, is the increase in diseases of the
circulatory system and of endocrine and metabolic
disorders.

In Table 111 the relative increase in specific
diagnosis is seen. A five-fold increase in the preva-
lence of diabetes mellitus and a four-fold increase in
the prevalence of hypertension was found.

This tendency is also reflected by the increase in

the use of medical preparations between the ages of
50 and 60. In the younger age group 224 men (9.6%)
reported a daily drug intake, compared with 126
(38.1 %) in the older group. The consumption of
various classes of drugs in the two age groups is
shown in Table V .

About 10% of the men born in 1915 were taking
diuretics and/or beta blocking agents. No increase
was noted in the use of insulin, while the consump-
tion of oral antidiabetic agents was 10 times higher
in the older age group.

The higher prevalence of musculoskeletal dis-

Table V. Pharmaceutical classipcation, according to FASS 1976, of drugs used by 50- and 60-year-old men
as revealed in health surveys in Uppsala
Only daily drug consumptions are included

Pharma- ( n = 2 322) ( n =33 1)
ceutical
classification Number of Subjects Number of Subjects
tion Type of drug subjects per cent subjects per cent

50-year-old men 60-year-old men

02 A
02 B
02 B
02 c
02 E
02 F
02 H
06 C
10 D
10 J 05
10 J 10
11 A
1 1 B
1 1 c
12 B

Cardiac glycosides
Quinidine
Beta blocking agents
Vasodilators
S ympathicol ytics
Diuretics
Lipid lowering agents
Anticoagulants
Steroids
Insulin
Oral antidiabetics
Sedatives
Neuroleptics
Antidepressives
Analgesics

33
8

33
53
23

1
7

10
9
6

10
10
16

0.3

1.4
0.3
1.4
2.3
1 .o
0.3
0.4
0.4
0.3
0.4
0.4
0.6

36
32
13
35
17
2
1
2

13
22
4
4

3.9

10.9
9.7
3.9

10.6
5.1
0.6
0.3
0.6
3.9
6.6
1.2
1.2
6.9

Upsula J M e d Sci 83

Health and disease at sixty 157

J 100

S.D= 16.2
n.331

)o 180 >200
rnrnHg

Fig. 1 . Distribution of supine systolic blood pressure in
the total population.

orders in the older group is reflected by the greater
consumption of analgesics. The more extensive use
of hypnotics and sedatives in the older age group
should also be noted.

Blood pressure
The distributions of SBP and DBP are shown in
Figs. 1 and 2. The mean SBP was 145 mmHg and
the mean DBP 87 mmHg in the entire studied popu-
lation.

In addition to 41 (12.4%) men who were known
as hypertensives at the time of screening, 23 (6.9%)
were found to have a DBP of 3105 mmHg. Thus the
prevalence of hypertension was 19.3 %, comprising
the sum of these two population groups.

When the WHO criterion (39) for hypertension
was applied, the prevalence increased to 35.0% of
the population.

Thirty-six persons (10.9%) could not say if they

70
I

Mean = 87.2
S.D= 11.7

n = 331 1

ilb 3 %P 110 mmHg 120
Fig. 2 . Distribution of supine diastolic blood pressure in
the total population.

had been told previously that their BP was elevated.
This should be compared with the other questions
in the self-administered questionnaire, where the
possible answer “do not know” was given only 12
times altogether concerning previous diseases,
stress symptoms etc.

A derailed report of the group with hypertension
will follow (37).

Anthropometric measurements
The results obtained on application of three weight
indices are given in Table VI.

Using the index based on the 50-year-old men in
the same community, 59.3 % of the 60-year-old men
fell within _+ 10% of the “ideal” weight. When the
U.S. insurance index ( 5 ) was used, this figure was
59.8%. Using the standards applied by Lindberg et
al. (24), however, only 37.8% of the 60-year-old
men fell within these limits.

Table V1. Distribution of 50- and 60-year-old men in Uppsala according t o relative weight in p e r cent
Populations: SO-year-old men, n=2322; 60-year-old men, n=331. Weight index 1 according to Lindberg et al. (24),
Weight index 2 according to Build and Blood pressure study, Chicago (9, Weight index 3 based on anthropometric
studies of 50-year-old men in Uppsala (15)

Index 1 Index 2 Index 3

Weight index 50 year 60 year 50 year 60 year 50year 60year

C0.90 4.4 5.7 17.2 13.0 28.0 22.4
0.90-0.99 14.7 9.4 32.3 32.0 34.2 35.1
1.00-1.09 28.8 28.4 28.3 27.8 23.9 24.2
1.1b1.19 27.3 26.0 15.0 18.7 9.2 13.0
21.20 24.9 30.5 7.3 8.4 4.7 5.4

Upsulu J Med Sci 83

U . Waern 158

-
10

c
Q

m -
$ 5
ln

Mean =8 I
n = 330

3 6 9 12 15 18 Z20
8 - E S R m m l h

Fig. 3. Distribution of erythrocyte sedimentation rates in
the total population.

Laboratory investigations
The distributions of the values for erythrocyte
sedimentation rate (ESR) and of venous
haematocrit are shown in Figs. 3 and 4, respective-
ly. The mean ESR was 8.1 mmlh, and 43 men
(13.0%) had a value of I5 mm/h or more. The mean
venous haematocrit was 44.9%. Only 15 men
(4.5 %) had a haematocrit below 40%.

The values for fasting serum cholesterol are pre-
sented in Fig. 5. The mean value was 6.20 mmol/l.
Subjects with values of 7.50 mmol/l or higher were
re-tested ( n = 4 0 ) , and if they exceeded this limit
again they were referred to the Department of
Geriatrics for further evaluation.

Fig. 6 shows the distribution of serum tri-
glycerides. This shows skewness to the right. How-
ever, after logarithmic conversion the distribu-
tion was normal (Fig. 7). The mean value was 1.68
mmol/l. Subjects with a value of 2.4 mmol/l or
higher ( n =46) were re-tested and followed the pro-
cedure mentioned above for serum cholesterol.

< 36 LO
H c t

Mean= LL 9

n = 330
SD. 3.2

h L0 per cent 3 0
Fig. 4. Distribution of venous haematocrit values in the
total population.

U p s a l u J Med Sci 83

c
bl

b
;lo
c

4
5

MeanZ6 2

n-331
SD=12

8 m m o l l l
fS-Chol

Fig. 5 . Distribution of serum cholesterol values in the total
population.

Finally, it should be mentioned that 36 ( 1 1 .O %) of
the men had detectable amounts of ethyl alcohol in
their urine. Urinary electrolytes will be discussed in
another article (37).

Electrocardiographic findings
The ECG findings were considered pathological in
52 (15.7%) of the subjects. In a further 19 men
(5.7%) the ECG was considered to be possibly
pathological.

In Table VII the ECG results, coded according to
the Goldmann (13) criteria and to the Minnesota
code (31) are shown, together with ECG findings in
50-year-old men in the same community. No cod-
able abnormality was found in 67.1% of the men.
The dominating findings were high QRS amplitude,
which occurred in 1 1 . 8 % and QRS axis deviation in
8.5%.

al i
< 0.7 1.5

Mean=1.68
S.D=1.03
n.329 nJ 2.5 Z3.1

fS-Tg mrnol/l

Fig. 6. Distribution of serum triglyceride values in the
total population. Arithmetically plotted.

Health and disease at sixty 159

2o 1

i?
rn

04 L 2 0 8
< - O L 0

fS-Tg log mmol/L

Fig. 7. Distribution of serum triglyceride values in the
total population. Geometrically plotted.

DISCUSSION

The participation rate in this study was somewhat
lower (78.4 %) than in the health examination of
50-year-old men in the same community (15), where
it reached 81.7%. The somewhat lower figure could
be explained by the larger number of older men who
were already under the care of another physician.
Another reason for abstaining from the screening
might have been access to health controls provided
by employers.

In the general health examination provided by the
local health authorities, the male participation rate
is about 70% for males aged 50 as well as 60 years
(19).

In a primary preventive study in Gothenburg in
1970 (38) the participation rate reached 74% for
men born in 1915. Almost the same figure was re-

ported by Isokoski (20) from a health survey in
Finland. In that study the highest participation was
found for ages between 35 and 44 years, after which
it levelled off. This is in accordance with the find-
ings reported by Napier (10) in their Tecumseh
community study.

The questionnaire seemed to be an adequate
method of getting information which could in many
ways be confirmed by the personal interview. Con-
cerning hereditary questions it has been found (36)
that middle-aged men in Uppsala have a good
knowledge of their parents’ age at and cause of
death. As mentioned previously, very few ques-
tions were given the answer “do not know” in the
self-administered questionnaire. One exception was
that 36 (10.9%) of the subjects were uncertain about
previous information on a high BP. This is surpris-
ing and suggests uncertainty on the part of the
physicians handling hypertension rather than any-
thing else.

The comparison between 50- and 60-year-old
men shows that the younger age group more often
report a high BP in their parents than the older men.
This might reflect the fewer opportunities of the
older men’s parents to be examined by a physician.

The prevalence of chest pain as revealed in the
questionnaire seems somewhat higher than the cor-
responding figures in a study of men aged 55-59 in
Finland (30), but is comparable to that reported for
60- to 64-year-old men in Prague (1 1). The validity
of the diagnosis AP given in a questionnaire has
been discussed by Lundman et al. (25). In this
health examination additional information could be
obtained at the personal interview in the cases with
positive replies to the AP questions. Between 10.9

Table VII. Frequency of some codable ECG abnormalities according to the Minnesota Code in health
surveys of 50- and 60-year-old men in Uppsala
A subject may be included more than once

50 years ( n = 2 322)

Code Number Subjects Code Number Subjects
Item number of men per cent number of men per cent

60 years (n=331)

No codable abnormality I , O 1 608 69.6 1, 0
Q items I , 1-2 22 1 .o I , 1-2
QRS axis deviation 11, 1 70 3.0 11, 1
High QRS amplitude 111, 1 207 9.0 111, 1
S-T depression IV, 1 16 0.7 I V , 2-3
T-wave items v , 1-2 53 2.3 v, 1-2
A-V conduction defects VI, I 4 47 2.0 VI, 1-4
Ventricular conduction defects V I I , 1-2 24 1.0 VII, 1-2
Atrial fibrillation VIII, 3 7 0.3 VIII, 3

222 67. I
6 I .8

28 8.5
39 11.8
12 3.6
14 4.2
9 2.7
4 1.2
6 1.8

160 U . Waern

and 11.8% positive replies were noted to these
questions, which corresponded well with the figure
of 11.5% for subjects in whom AP was confirmed
by a physician. The increased occurrence of
ischaemic heart disease with age found in studies in
Uppsala is in accordance with other reports (2, 10,
21, 26, 32).

The prevalence of diabetes was five times greater
than in the 50-year-old men. This is in accordance
with the findings of other authors (1, 4, 10, 28, 33)
suggesting an age-related increase of prevalence,
but contradicts the studies of Ostrander et al. (29),
who found the most marked increase in prevalence
in the age groups 4 0 4 9 years.

Studies on smoking habits showed that only
39.6% of the 60-year-old men smoked, as against
51.0% of the 50-year-olds. This diminishing fre-
quency has been discussed by several authors (14,
16, 27, 35, 40). A more negative attitude amongst
physicians towards tobacco smoking may have con-
tributed t o this age effect. This is evident, in fact, in
the group of treated 60-year-old hypertensives, who
smoked less than the population in general.

Measurements of haematocrit and ESR have
been performed in many screenings, due to the sim-
plicity of these tests and certainly for psychological
reasons. However, the diagnostic value of these
tests in this screening was not high.

The mean ESR values were 7.8 and 8.1 mm/h in
the younger and older age groups, respectively.
Only 9.4% and 13.0% had values above 15 mm/h in
the respective age groups.

Many authors (3, 6, 22) have discussed the com-
mon finding of higher ESR values in aged popula-
tions, and regard a higher ESR value as normal in
aged persons. Boyd (3), however, proposed that the
probable upper normal limit in persons aged 65
years or more is 40 mm/h. Gibson (12) denies this
age-related increase of ESR. The present study
shows a negligible effect of age on the ESR values.

Choosing an arbitrary limit of 20 mm/h, 5.2 % and
6.1 % of the younger and older age groups, respec-
tively, fell above this value.

Haematocrit was found to have the same propor-
tion of low values in both populations; thus 6.3 % in
the younger and 4.5% in the older age groups had a
haematocrit below 40 %. In the older group none of
the men had a haematocrit below 40% without a
known cause. The mean haematocrit was slightly
higher in the older age group.

The indices used in describing relative weight

showed that the Norwegian based index rqcom-
mended by Lindberg et al. (24) classified relatively
more men as overweight in both the 50- and 60-year
age groups than the other two indices used. This is
probably explained by the relatively lean Nor-
wegian population chosen as a reference for the
former weight index.

The two other indices used, one based on find-
ings in the Build and Blood Pressure study in USA
( 5 ) and the other on findings in 50-year-old men in
Uppsala (15) yielded almost identical results in de-
scribing relative weight. When the latter was used
there seemed to be more young men with an index
of 0.9, and more older men with an index of 1.1.
However, these differences were not significant and
the proportions of subjects in the two populations
with an index between 0.90 and 1.09 were nearly
identical.

A comparison of the ECG findings showed that
almost the same proportion-approximately two-
thirds-in the two studied populations had no
abnormality according to the Minnesota Code (3 1).

No increase in the occurrence of Q-wave items
was found, but proportionately more men in the
older group had QRS axis deviation and T-wave
items than in the younger men. Atrial fibrillation
also showed a higher prevalence in the group of
older men. Among the groups with codable ab-
normalities, there were more men with multiple
findings in the older than in the younger age group.

Most reports on ECG findings are based on
hospitalized patients, which make epidemiological
comparisons difficult. However, in a large material
of 122,043 ECGs performed in the U.S. Air Force,
Hiss et al. (18) described various findings in differ-
ent age groups. Proportionately more abnormali-
ties, especially T-wave changes, were registered
in higher ages. The same has also been found by
Higgins et al. (17) in analysing results from the
Framingham study.

The health examination of 60-year-old men gave
results that, compared with those for 50-year-old
men, may have been influenced by two factors.

Firstly the age factor, which manifested itself as
increased morbidity and thus increased consump-
tion of medical preparations. This tendency is of
general importance, as the proportion of aged peo-
ple is going to increase in Sweden.

Two main diagnostic groups-diseases of the
circulatory system and diabetes mellitus-merit
special interest. Primary preventive activities and

Upsalo J Med S c i 83

Health and disease at sixty 161

early detection of these diseases ought t o be given
priority in future health screenings of younger
groups.

Secondly, factors operating within a changing
society may have influenced the results. Thus the
decrease in t h e number of smokers between t h e
ages of 50 and 60, which is a common feature, might
be explained in many ways. One contributory factor
may b e the increased propaganda in the mass media
against smoking. In the study of 50-year-old men in
the same community (IS), various primary preven-
tive activities were carried out. These included a
smoking withdrawal programme, dietary informa-
tion and treatment of increased BP. Some of these
activities may have influenced t h e attitudes of o t h e r
groups of middle-aged men.

T h e relatively larger number of 60-year-old than
50-year-old men who are retired may t o a certain
extent b e ascribed to age, but the more liberal rules
as regards retirement, especially o n account of med-
ical disablement, probably accounts for s o m e of the
increase.

Finally, t h e expansion of health screening exami-
nations and medical services offered b y employers,
in particular, must b e considered. Thus, it was
noted paradoxically that many 60-year-old men who
participated in this screening also reported frequent
contacts with other medical authorities. Neverthe-
less, the increased number of 60-year-old men
already under t h e care of other physicians may have
been t h e reason f o r part of t h e lack of participation
in this health examination.

A C K N O W L E D G E M E N T
This work was supported by grants from the Swedish
National Association against Heart and Chest Disease and
from the Faculty of Medicine at the University of Uppsa-
la.

R E F E R E N C E S
1 . Andres, R., Pozefsky, T., Swerdloff, R. S. & Tobin,

D. J.: Effect of aging on carbohydrate metabolism. in
Early Diabetes. Academic Press, New York, 1970.

2. Beaglehole, R., Heiss, G., Tyroler, H. A., Cassel, J.
C. & Hames, C. G.: Prevalence and incidence data in
the assessment of the risk of coronary heart diseases.
Amer J Epidemiol102,l: 55, 1975.

3. Boyd, R. V. & Hoffbrand, B. I.: Erytrocyte sedimen-
tation rate in elderly hospital in-patients. Brit Med J
i:901, 1966.

4. Boyns, D. R., Crossley, J. N., Abrams, M. E., Jar-
rett, R. J. & Keen, H.: Oral glucose tolerance and
related factors in a normal population sample. I.

Blood sugar, plasma insulin, glyceride and cholesterol
measurements and the effects of age and sex. Brit
Med J i: 599, 1969.

5 . Build and Blood Pressure Study, vol. I. Society of the
Actuaries, Chicago, 1959.

6. Bottiger, L. E. & Svedberg, C. A.: Normal erytrocyte
sedimentation rate and age. Brit Med J ii: 85, 1967.

7. Collen, M. F., Cutler, J. L., Siegelaub, A. B. & Cella,
R. L.: Reliability of a self-administered medical
questionnaire. Arch Intern Med 123: 664, 1969.

8. Cullhed, I . , Furberg, B., Lidell, C. & Malmstrom, C.:
Erfarenheter av bandspelar-EKG. Lakartidningen
70: 4557, 1973.

9 . Edwards, D. A. W., Hammond, W. H., Healy, M. J.
R., Tanner, J. M. & Whitehouse, R. H.: Design and
accuracy of calipers for measuring subcutaneous tis-
sue thickness. Brit J Nutr 9: 133, 1955.

10. Epstein, F. H., Francis, T., Hayner, N. S . , Johnson,
B. C., Kjelsberg, M. O., Napier, J. A., Ostrander, L.
D., Payne, M. W. & Dodge, H. J.: Prevalence of
chronic diseases and distribution of selected physio-
logic variables in a total community, Tecumseh,
Michigan. Amer J Epidemioldl: 3,307, 1965.

1 1 . FoTor, J., Hejl, Z., Santrucek, M., VavriK M;, Vrbo-
va, D. & Weber, K.: The prevalence of ischemic heart
disease and obliterative atherosclerosis of peripheral
arteries in 60-64 year old males of a city population.
Cor Vasa 10: 41, 1968.

12. Gibson, I. I. M.: The value of the erythrocyte
sedimentation rate in the aged. Gerontol Clin 14: 185,
1972.

1 3 . Goldmann, M. J.: Principles of Electrocardiography.
Lange 5th Ed. Los Altos, 1964.

14. Hammond, E. C. & Garfinkel, L.: Changes in
cigarette smoking 1959-1965. Amer J Public Health
58: 30, 1968.

15. Hedstrand, H.: A study of middle-aged men with
particular reference to risk factors for cardiovascular
disease. Upsala J Med Sci, Suppl. 19, 1075.

16. Hedstrand, H. & Waern, U.: Andringar i rokvanor
hos man i Uppsala efter 50 firs filder. Lakartidningen
70: 32, 2761, 1973.

17. Higgins, I . T. T., Kannel, W. B . & Dawber, T. R.:
The electrocardiogram in epidemiological studies.
Amer J Prev SOC Med 19: 53, 1965.

18. Hiss, R . G. & Lamb, L. E.: Electrocardiographic
findings in 122 043 individuals. Circulation 25: 947,
1%2.

19. h e l l , L.: Personal communication. 1976.
20. Ioskoski, M.: Participants in a general health exami-

nation. Acta Sociomed Scand I : 37, 1970.
21. Keys, A.: Coronary heart disease in seven countries.

Circulation, Suppl. I, 41: 1 , 1970.
22. Kulvin, S. M.: Erythrocyte sedimentation rates in the

elderly. Arch Ophthalmol88: 617, 1972.
23. Lidell, C. & Waern, U.: In manuscript.
24. Lindberg, W . , Natvig, H., Rygh, A. & Svendsen, K.:

Hoyde of vektundersokelser hos voksne menn og
kvinner. Tidsskr Nor Laegeforen 76: 361, 1956.

2 5 . Lundman, T., Liljefors, I., Cederlof, R. & Friberg,
L.: The validity of the questionnaire diagnosis. An-
gina pectoris. Arch Environ Health22: 597, 1971.

Upsala J Med Sci X3

162 U . Waern

26. Margolis, J. R., Gillum, R. F., Feinleib, M., Brasch,
R. C. & Fabsits, R. R.: Community surveillance for
coronary heart disease: The Framingham cardio-
vascular disease survey. Am 3 Epidemiol 100, 6 : 425,
1974.

27. McKennel, A. C. & Thomas, R. K.: Adults’ and Ado-
lescents’ Smoking Habits and Attitudes. Government
Social Survey. H.M.S.O., London, 1967.

28. Metz, R . , Surmaczynska, B., Berger, S. & Sobel, G.:
Glucose tolerance, plasma insulin and free fatty acids
in elderly subjects. Ann Intern Med64: 1042, 1966.

29. Ostrander, L. D., Lamphiear, D. E. & Block, W. D.:
Diabetes among men in a general population. Preval-
ence and associated physiological findings. Arch In-
tern Med 136:415, 1976.

30. Reunanen, A., Pyorala, K., Punsar, S . , Heinonen, 0.
P., Puro, K . & Aromaa, A,: The prevalence of angina
pectoris and other chest pain in nine population
groups in Finland. Diiodecim89: 668, 1973.

31. Rose, G. A. & Blackburn, H.: Cardiovascular Survey
Methods. WHO Monographies, vol. 56. Geneva,
1968.

32. Rosenman, R. H., Brand, R. J . , Jenkins, D.,
Friedman, M., Straus, R. & Wurm, M.: Coronary
heart disease in the Western collaborative group
study. JAMA233: 8 , 8 7 2 , 1975.

33. Streeten, D. H. P., Gerstein, M. M., Marmor, B. M.
& Doisy, R. J.: Reduced glucose tolerance in elderly
subjects. Diabetes 14: 579, 1965.

34. Tibblin, G.: High blood pressure in men aged 50. A
population study of men born in 1913. Acta Med
Scand, Suppl. 470, 1%7.

35. Todd, G. F.: (Ed.) Statistics of Smoking in the United
Kingdom. Tobacco Research Council, London, 1969.

36. Waern, U., Hedstrand, H. & Aberg, H.: What
middle-aged men know of their parents’ cause of
death and age at death. A comparison between history
and death certificate. Scand J SOC Med4: 123, 1976.

37. Waern, U. & Aberg, H.: Blood pressure in 60-year-old
men. Findings in a health survey and some compari-
sons with 50-year-old men in the same community. To
be published.

38. Waern, U. & Boberg, J.: Comparison of glucose toler-
ance, serum insulin, serum lipids, and skinfold thick-
ness between 50- and 60-year-old men. To be
published.

39. Wilhelmsen, L., Tibblin, G. & Werko, L.: A primary
preventive study in Gothenburg, Sweden. Prev Med
1 , 1 5 3 , 1972.

40. World Health Organization. Series of Technical Re-
ports 168: 1 . WHO, Geneva, 1959.

41. Zeiner-Henriksen, T.: Rskevaner i den norske be-
folkning. Tidsskr Nor Laegeforen 11:617, 1976.

Received February 15, 1978

Address for reprints:

Urban Waern, M.D.
Department of Internal Medicine
University Hospital
S-750 14 Uppsala
Sweden

U[)sulu J M e d S c i 83