Age and Socioeconomic Gradients of Health of Indian Adults: An Assessment of Self-Reported and Biological Measures of Health

Social frailty among older adults in India: Findings from the Longitudinal Ageing Study in India (LASI) - Wave 1

BACKGROUND

From an individual's perspective, social frailty may act as a key determinant of social capital, which is essential for meeting social needs and improvement of overall wellbeing. The present study aimed to understand the social frailty and its determining factors among Indian older adults.

METHODS

Data from the Longitudinal Ageing Study in India (LASI)-wave 1 was used. For the assessment of social frailty the study proposed a multidimensional Social Frailty Index (SFI) score ranging between 0 and 100 using 17 indicators. Bivariate analysis and quantile regression models were applied.

RESULTS

The study results indicated that on average female older adults (mean SFI = 63.7) are relatively more socially frail than male older adults (mean SFI = 59.0). Further, the quantile regression analysis revealed that at the 10th, 25th, 50th, and 75th percentiles, female older adults were significantly more likely to be socially frail than male older adults (β = 3.80, p < .01; β = 2.82, p < .01; β = 1.72, p < .01; and β = 2.62, p < .01, respectively). Educational attainment and better economic condition showed a protective effect against social frailty.

CONCLUSIONS

Investment to improve geriatric health status and socioeconomic conditions shall be a key focus to reduce social frailty prevalence among the older adults. A specific consideration is needed for addressing social frailty among female older adults.

An association between multi-morbidity and depressive symptoms among Indian adults based on propensity score matching

Keeping in view the cascade of disturbances caused by the co-existence of multi-morbidity and depression among aged population, this study aims to ascertain the independent impact of multi-morbidity as a risk factor for the development of depressive symptoms among adults living in India. The present study utilizes data from the nationally representative survey “Longitudinal Ageing Study in India” (LASI, Wave-1, 2017–2018). The eligible sample size was 62,244 adults aged 45 years and above. Descriptive statistics along with bivariate analysis was used to understand the prevalence of depressive symptoms. Further, binary logistic regression and Propensity Score Matching (PSM) methods were applied to examine the independent effect of multi-morbidity on depressive symptoms while controlling the selected background characteristics. Overall, around one-third respondents had at least one chronic disease and one-fifth had multi-morbidity. The most prevalent chronic disease reported in the sampled population was hypertension followed by diabetes and joint disease. It is observed that older adults with multiple chronic diseases had 77% higher odds of having depressive symptoms as compared to those without a history of chronic disease in the multivariable logistic regression model. Results obtained from PSM indicate that the risk of having depressive symptoms was 3.7% higher for adults with multi- morbidity. Depressive symptom was identified to be associated with a wider range of multiple physical health problems and people with multi-morbidity are at a higher risk of having depressive symptoms. It is imperative that multi-morbidity can be used as a screener for identifying people with depressive symptoms.

Socio-economic inequality in functional disability and impairments with focus on instrumental activity of daily living: a study on older adults in India

Background

Studies have examined functional disability among older adults by combining Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). This study adds another dimension to ADL and IADL by combining various impairments such as hearing, vision, walking, chewing, speaking, and memory loss among older adults. This study examines functional disability among older adults in India as measured by ADL, IADL, along with various impairments.

Methods

This study utilized data from Building a Knowledge Base on Population Aging in India (BKPAI), a national-level survey and conducted across seven states of India. The study utilized three outcome variables, namely, ADL, IADL, and Impairments. Descriptive and bivariate analyses were used along with multivariate analysis to fulfil the objectives of the study. The concentration index was calculated for ADL, IADL, and impairments, and further, decomposition analysis was carried out for IADL.

Results

The results observed that nearly 7.5% of older adults were not fully independent for ADL. More than half (56.8%) were not fully independent for IADL, and nearly three-fourths (72.6%) reported impairments. Overall, ADL, IADL, and impairments were higher among older adult’s aged 80+ years, older adults with poor self-rated health, and those suffering from chronic diseases. The likelihood of ADL (AOR = 6.42, 95% CI: 5.1–8.08), IADL (AOR = 5.08, 95% CI: 4.16–6.21), and impairment (AOR = 3.50, 95% CI: 2.73–4.48) were significantly higher among older adults aged 80+ years compared to 60–69 years. Furthermore, older adults who had poor self-rated health and suffered from chronic diseases were more likely to report ADL (AOR = 2.95, 95% CI: 2.37–3.67 and AOR = 2.70, 95% CI: 2.13–3.43), IADL (AOR = 1.74, 95% CI: 1.57–1.92 and AOR = 1.15, 95% CI: 1.04–1.15), and impairment (AOR = 2.36, 95% CI: 2.11–2.63 and AOR = 2.95, 95% CI: 2.65–3.30), respectively compared to their counterparts. Educational status and wealth explained most of the socio-economic inequality in the prevalence of IADL among older adults.

Conclusion

It is recommended that the government advise older adults to adopt health-promoting approaches, which may be helpful. Further, there is a pressing need to deliver quality care to older adults suffering from chronic conditions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11591-1.

Feeling about living arrangements and associated health outcomes among older adults in India: a cross-sectional study

INTRODUCTION

Advancement in the field of gerontology has been concerned with the well-being of older adults in a family setup that is associated with caregiving and support. While family life and well-being are defined by emotion, caregiving, and support activities, dissatisfaction/discontent with living arrangements is a public health concern, which is increasing with a rise in the proportion of the older population in the country. The study examines the association of dissatisfaction with living arrangements with health outcomes among older men and women in India.

METHODS

The present research used data from the 'Building a Knowledge Base on Population Aging in India'. The effective sample size for the analysis was 9181 older adults. Descriptive statistics and bivariate analysis were performed to present the preliminary estimates. For finding the association between various health outcomes over explanatory variables, binary logistic regression model was used separately for men and women.

RESULTS

About 22.8% of men and 30.8% of women who were living alone were dissatisfied with their present living arrangement. It was revealed that both men and women who were dissatisfied with their present living arrangements had significantly higher odds of experiencing poor self-rated health [OR:4.45, 3.25 ~ 6.09 and OR:3.32, 2.54 ~ 4.34], low psychological health [OR: 2.15, 1.61 ~ 2.86 and OR: 1.99, 1.57 ~ 2.53], low subjective well-being [OR: 3.37, 2.54 ~ 4.45 and OR: 3.03, 2.36 ~ 3.38], low ADL [OR: 1.77, 1.2 ~ 2.62 and OR: 1.59, 1.17 ~ 2.18, low IADL] [OR: 1.32, 1.03 ~ 1.69 and OR: 1.57, 1.24 ~ 1.98] and low cognitive ability [OR: 1.26, 0.98 ~ 1.61 and OR:1.44, 1.13 ~ 1.82] in comparison to their counterpart from men and women respectively.

CONCLUSION

It is found that dissatisfaction with the living arrangement of older men and women is negatively associated with major health outcomes. Hence, appropriate policies and programs must be developed to promote increased family care and support and an improved residential environment that would create a feeling of comfort and happiness among older individuals.

Height and quality of life among older adults (50+) in India: a cross-sectional study

Adult height is a summary measure of health and net nutrition in early childhood. This study examines the association between height and quality-of-life outcomes in older adults (50+) in India. Cross-sectional data from Wave 1 of the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) conducted in 2007 were analysed. The association between height and quality of life was assessed using bivariate and multivariate logistic and linear regression models. The mean WHO quality-of-life score (WHO-QoL) increased from 45.2 among the older adults in the lowest height quintile to 53.2 for those in the highest height quintile. However, the prevalence of self-rated poor quality of life declined from 16.4% in the lowest height quintile to 6.1% in the highest height quintile. In the fully adjusted regression model, height was found to be positively associated with quality-of-life outcomes among both men and women, independent of socioeconomic and physical health confounders. The association was particularly strong for women. Women in the highest height quintile had a 2.65 point higher WHO-QoL score than those in the lowest height quintile. Similarly, the likelihood of reporting a poor quality of life was lower among women in the highest height quintile. Furthermore, measures of economic status, handgrip strength, cognitive ability and poor self-rated health were significantly associated with WHO-QoL and self-rated poor quality of life. Overall, this study revealed a significant association between height and quality of life among older adults in India, suggesting a significant role of childhood circumstances in quality of life in later life.

Socio-economic and health determinants of preference for separate living among older adults: A cross-sectional study in India

INTRODUCTION

The living arrangements among the older population form a basic pointer to the care and support of older adults in India, and living with extended kin is clearly differentiated from living separately. This paper attempts to understand the associations between socio-economic and health-related variables with preference for the separate living among older adults in India.

MATERIALS AND METHODS

Using data from Building Knowledge Base on Population Ageing in India (BKPAI), we employed bivariate and probit regressions on a sample of 9540 older adults to fulfil the study objective.

RESULTS

Nearly 21% of older adults were living alone/with a spouse. Additionally, those older adults who lived alone/with spouse had specific reasons, i.e. about 14.6% reported that they had no children, 47.3% of older adults had their children away and 15.9% of older adults reported a family conflict. Availability of children is consistently found to be negatively associated with the preference of separate living. Besides, better self-rated health, independence in daily activities, and facing any type of violence were the strongest predictors of preference for separate living. In addition, the background characteristics, including age, sex, education, religion, and ethnicity, were found as significant predictors of living arrangement preference. Preference for co-residential arrangements emerges among older persons who have a feeling of importance within their family.

CONCLUSION

Physical proximity to kin and health conditions, in addition to economic conditions, substantially determine the swing towards separate living among older adults in India. This suggests that attention has to be paid to the demand for specialized care and health services among older adults living separately.

Socioeconomic inequality in psychological distress among older adults in India: a decomposition analysis

BACKGROUND

Older people coming from a lower wealth gradient are more vulnerable to have stressful life events further adding more risk for common mental health disorders and psychological distress situations. The present study explores the associations between socioeconomic and health-related variables and psychological distress among older adults in India and the contribution of such factors to the inequalities in psychological distress.

METHODS

A cross-sectional survey of 9181 older adults conducted as 'Building a Knowledge Base on Population Ageing in India' was assessed. Logistic regression and decomposition models were used to analyze the data. Psychological distress was measured from General Health Questionnaire (GHQ-12). The value of Cronbach's alpha was 0.90. It was having a scale of 0 to 12 on the basis of experiencing stressful symptoms and was re-coded as 0 (representing 6+ stressful symptoms) and 1 (representing 5 and fewer symptoms).

RESULTS

Older adults from the poored, suffering from multi-morbidity, disabled, with low activities of daily living and low instrumental activities of daily living and poor cognitive ability were suffering from high psychological distress in India. Further, factors such as religion, caste, education, living arrangements, and self-worth in the family were major contributors to the concentration of psychological distress in older adults from poor households (concentration index: - 0.23).

CONCLUSION

The study suggests that among older people, there is a wide disparity of experiencing psychological distress across different socio-economic groups with significant factors being responsible for inequality in psychological distress. There is a need to build a "win-win" circumstance across sectors, including a broad spectrum of health, social and economic benefits to the vulnerable older population.

Violence and associated health outcomes among older adults in India: A gendered perspective

BACKGROUND

Since older population in India continue to rely on family and social networks for care and support, understanding the health outcomes associated with violence within and outside family may direct the development of policies and measures to aid the victims of violence. The present paper examines the health consequences of violence against older adults and its gender differentials in India.

METHODS

Using data from Building Knowledge Base on Population Ageing in India (BKPAI), we employed bivariate and logistic regressions on a sample of 9181 older adults to fulfil the aims and objective of the paper.

RESULTS

About 10.7% and 11.3% of men and women faced violence after turning 60 years respectively. Older adults who ever faced violence after turning age 60 years had 60%, 41% and 33% higher likelihood to have poor-SRH, low ADL and low IADL respectively in comparison to their counterparts. Further, it was found that older adults who ever faced violence after turning age 60 years had 97% and 62% higher likelihood to have lower psychological health and low subjective well-being. Additionally, it was found that women who faced violence had higher odds of having low psychological health [OR: 1.18, CI: 1.06, 1.63], low subjective well-being [OR: 1.70, CI: 1.24, 2.33] and low cognitive ability [OR: 1.32, CI: 1.04, 1.79] in comparison to men who faced violence.

CONCLUSION

Violence against older adults must be recognized as a key public health issue for older adults in India. Study findings indicate the immediate need for assessing victim health outcomes following any type of violence in later years to determine related policies and programs to protect the victims. Reducing violence will have a positive impact on physical and mental health outcomes late in life as well as the functional abilities of older adults, especially older women.

Community involvement, trust, and health-related outcomes among older adults in India: a population-based, multilevel, cross-sectional study

Objectives

this study examined whether individual and contextual measures of structural and cognitive social capital were associated with six health-related outcomes across older adults in India.

Methods

data were collected from a representative sample of adults aged 60 and above across India in 2011-12 (n = 9,174). Personal community involvement and having someone to trust represented individual measures of structural and cognitive social capital. These measures were then aggregated to represent contextual measures of social capital, that is, the mean village level of community involvement and the village proportion having someone to trust. To examine associations between all four social capital indicators and six outcomes including self-rated health, psychological well-being, subjective well-being, memory, activities of daily living (ADL), and instrumental activities of daily living, we fit pooled, sex-stratified, and place-stratified multilevel regression models and adjusted for demographic and socio-economic factors.

Results

personal community involvement was positively associated with all outcomes among the full sample. Adjusted odds ratios ranged from 1.05 (95% CI 1.02; 1.08) for good self-rated health to 1.42 (95% CI 1.33; 1.53) for high-ADL function. Personally having someone to trust was associated with four outcomes. Village-level social capital measures were less frequently associated with outcomes than personal social capital measures. Association strength between six health-related outcomes and individual and contextual measures of structural and cognitive social capital varied, however, among older people in India by sex, place and outcome.

Discussion

interventions to promote healthy ageing by increasing community involvement and trust may need to be tailored to population subgroups.

Secondary prophylaxis to control rheumatic heart disease in developing countries: Put into a cage if can't be killed

A significant socioeconomic inequality is the main barrier to achieve primordial prevention of rheumatic heart disease (RHD) in the developing countries. An effective vaccine with affordable cost against Streptococcus yet to be identified. The subclinical nature of rheumatic fever (RF) is the main hurdle for effective primary prevention of RHD. When RF and RHD are recognized at the earliest, treated adequately and SP with penicillin is strictly followed, then this disease can be kept under control though cannot be eradicated.

Racial or Ethnic Health Disparities among Older Adults in Four Population Groups in South Africa

BACKGROUND

Racial or ethnic health disparities have been evidently apparent during the apartheid era in South Africa. This study aims to assess ethnic health disparities in four elderly population groups.

METHODS

Data for this study emanated from the 2008 study of "Global AGEing and adult health (SAGE) wave 1" (N = 3284) aged 50 years or older in South Africa. Associations between exposure variables and outcome variables (health status variables and chronic conditions) were examined through bivariate analyses and multivariable logistic regression.

RESULTS

Indians or Asians reported the highest prevalence of poor self-rated health (23.7%) and functional disability (11.6% and 29.1%). Coloureds had the lowest grip strength (55.3%) and Whites the highest cognitive functioning (80.1%). Coloureds had the highest prevalence of hypertension (85.0%), stroke and/or angina (15.0%), edentulism (26.8%) and low vision (50.6%); and Indians or Asians had the highest prevalence of arthritis (43.5%) and diabetes (24.4%). In adjusted analysis, Whites (Odds Ratio [OR]: 0.24, Confidence Interval [CI]: 0.11, 0.57) and Coloureds (OR: 0.50, CI: 0.29, 0.87) had lower odds of self-reported health status compared to Black Africans. Coloureds (OR: 0.36, CI: 0.22, 0.61) had lower odds of grip strength than Black Africans. Indians or Asians had higher odds of functional disability (OR: 1.87, CI: 1.03, 3.02) and diabetes (OR: 2.65, CI: 1.45, 4.83) than Black Africans. Whites (OR: 3.92, CI: 1.63, 9.41) and Coloureds (OR: 2.14, CI: 1.21, 3.78) had higher odds of cognitive functioning than Black Africans. Whites had lower odds (OR: 0.54, CI: 0.31, 0.93) and Indians or Asians had higher odds (OR: 1.91, CI: 1.91, 1.01, 3.59) of arthritis than Black Africans. Coloureds had a higher prevalence of hypertension (OR: 1.71, CI: 1.14, 2.58), stroke and/or angina (OR: 1.74, CI = 1.36, 2.22), edentulism (OR: 6.51, CI: 4.07, 10.41) and low vision (OR: 1.68, CI: 1.29, 2.19) than Black Africans.

CONCLUSION

There are still ethnic health disparities in South Africa in the post-apartheid era (i.e., Black Africans [lower cognitive functioning], Whites [poor self-reported health status and edentulism], Coloureds [poor self-reported health status, lower grip strength, arthritis, hypertension, stroke and/or angina, edentulism and low vision], Indians or Asians [poor functional disability, arthritis and diabetes]). Understanding these ethnic health disparities may help in developing better strategies to improve health across population groups.

Socioeconomic patterns of underweight and its association with self-rated health, cognition and quality of life among older adults in India

BACKGROUND

Underweight defined as body mass index (BMI) < 18.5 is associated with negative health and quality of life outcomes including mortality. Yet, little is known about the socioeconomic differentials in underweight and its association with health and well-being among older adults in India. This study examined the socioeconomic differentials in underweight among respondents aged ≥50 in India. Consequently, three outcomes of the association of underweight were studied. These are poor self-rated health, cognition and quality of life.

METHODS

Cross-sectional data on 6,372 older adults derived from the first wave of the WHO's Study on global AGEing and adult health (SAGE), a nationally representative survey conducted in six states of India during 2007-8, were used. Bivariate and multivariate regression analyses were applied to fulfil the objectives.

RESULTS

The overall prevalence of underweight was 38 percent in the study population. Further, socioeconomic status showed a significant and negative association with underweight. The association of underweight with poor self-rated health (OR = 1.60; p < .001), cognition (β = -0.95; p < .001) and quality of life (β = -1.90; p < .001) were remained statistically significant after adjusting for age, sex, place of residence, marital status, years of schooling, wealth quintile, sleep problems, chronic diseases, low back pain and state/province.

CONCLUSION

The results indicated significant socioeconomic differentials in underweight and its association with poor self-rated health, cognition and quality of life outcomes. Interventions focussing on underweight older adults are important to enhance the overall wellbeing of the growing older population in India.

Nutritional risk factors and status of serum 25(OH)D levels in patients with breast cancer: A case control study in India

To study the nutritional risk factors and status of serum 25(OH)D levels in patients with breast cancer. A total of 100 women (cases) with confirmed breast cancer (BC) matched with equal number of healthy females (controls) of similar age and socioeconomic status (SES) were included in study. Controls included were nonbreast cancer patients who accompanied the patients to a tertiary care hospital. All the subjects (cases and controls) were administered a questionnaires to collect data on socioeconomic status, dietary pattern and the frequency of food consumption using a validated food frequency questionnaire. Anthropometric assessment was done for waist and hip circumference to calculate waist to hip ratio (WHR). Non fasting blood samples were collected for serum 25-hydroxyvitamin D [25(OH)D] levels estimation using chemiluminescent immunoassay technique and total serum calcium levels by colorimetric assay technique. Serum 25(OH)D and total calcium levels were expressed in ng/ml and mg/dl. Vitamin D deficiency was defined as per the guidelines set by United States Endocrine Society. The mean age of cases and controls was 45±9 and 46±10 years respectively. On multivariate analysis, an inverse association with BC was found for less frequency of fruits consumption with an adjusted (ORs, 95% CI) (2.7, 0.5-15.7) respectively. Mushroom intake was inversely associated with risk of BC (ORs, 95% CI) (5.6, 1.9-16.6). Saturated fat intake and high WHR were significantly associated with high risk of BC with adjusted ORs, 95% CI of (3.4, 1.4-8.1) and (5, 1.4-17). A significant association (p<0.05) was found between low serum 25(OH)D levels and the risk of BC with adjusted ORs, 95% CI of (2.5, 0.9-7.4). Majority of the patients with BC were suffering from vitamin D deficiency. Dietary intake of mushrooms containing vitamin D naturally was found to be associated with decreased risk of breast cancer. A significant association was found between low serum 25(OH)D levels (<20ng/ml) with the risk of BC. Obesity as a consequence of nutritional risk factors determined by higher WHR was found to be significantly associated with the risk of BC.

Are estimates of socioeconomic inequalities in chronic disease artefactually narrowed by self-reported measures of prevalence in low-income and middle-income countries? Findings from the WHO-SAGE survey

BACKGROUND

The use of self-reported measures of chronic disease may substantially underestimate prevalence in low-income and middle-income country settings, especially in groups with lower socioeconomic status (SES). We sought to determine whether socioeconomic inequalities in the prevalence of non-communicable chronic diseases (NCDs) differ if estimated by using symptom-based or criterion-based measures compared with self-reported physician diagnoses.

METHODS

Using population-representative data sets of the WHO Study of Global Ageing and Adult Health (SAGE), 2007-2010 (n=42 464), we calculated wealth-related and education-related concentration indices of self-reported diagnoses and symptom-based measures of angina, hypertension, asthma/chronic lung disease, visual impairment and depression in three 'low-income and lower middle-income countries'-China, Ghana and India-and three 'upper-middle-income countries'-Mexico, Russia and South Africa.

RESULTS

SES gradients in NCD prevalence tended to be positive for self-reported diagnoses compared with symptom-based/criterion-based measures. In China, Ghana and India, SES gradients were positive for hypertension, angina, visual impairment and depression when using self-reported diagnoses, but were attenuated or became negative when using symptom-based/criterion-based measures. In Mexico, Russia and South Africa, this distinction was not observed consistently. For example, concentration index of self-reported versus symptom-based angina were: in China: 0.07 vs. -0.11, Ghana: 0.04 vs. -0.21, India: 0.02 vs. -0.16, Mexico: 0.19 vs. -0.22, Russia: -0.01 vs. -0.02 and South Africa: 0.37 vs. 0.02.

CONCLUSIONS

Socioeconomic inequalities in NCD prevalence tend to be artefactually positive when using self-report compared with symptom-based or criterion-based diagnostic criteria, with greater bias occurring in low-income countries. Using standardised, symptom-based measures would provide more valid estimates of NCD inequalities.