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Bauldry S, Thomas PA, Sauerteig-Rolston MR, Ferraro KF. Educational Inequalities in Dual-Function Life Expectancy. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae072. [PMID: 38685796 PMCID: PMC11157625 DOI: 10.1093/geronb/gbae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES This study investigates educational inequalities in dual functionality, a new concept that captures a combination of physical and cognitive functioning, both of which are important for independent living and quality of life. METHODS Using data from the Health and Retirement Study and the National Health Interview Survey Linked Mortality Files, we define a measure of dual functionality based on the absence of limitations in activities of daily living and dementia. We estimate age-graded dual-function rates among adults 65+ and age-65 dual-function life expectancy across levels of education stratified by gender. RESULTS In their mid-60s, 67% of women with less than a high school degree manifest dual functionality as compared with over 90% of women with at least a 4-year college degree. A similar pattern holds among men. These education-based gaps in dual functionality remain across later life, even as dual-function rates decline at older ages. Lower dual-function rates among older adults with less education translate into inequalities of 6.7 and 7.3 years in age-65 dual-function life expectancy between men and women, respectively, with at least a 4-year college degree compared to their counterparts with less than a high school degree. DISCUSSION Older adults, particularly women, with less than a high school degree are estimated to live a smaller percentage of their remaining years with dual functionality compared with older adults with at least a college degree. These inequalities have implications for the distribution of caregiving resources of individuals, family members, and the broader healthcare community.
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Affiliation(s)
- Shawn Bauldry
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Patricia A Thomas
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Madison R Sauerteig-Rolston
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
| | - Kenneth F Ferraro
- Center on Aging and the Life Course, Purdue University, West Lafayette, Indiana, USA
- Department of Sociology, Purdue University, West Lafayette, Indiana, USA
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Wang J, Kwan P, Zhang G, Shen M, Piccenna L, O'Brien TJ, Zhang L. A Multidimensional Assessment of Activities of Daily Living, Mental Status, Communication, and Social Abilities Among Older Adults in Shenzhen, China: Cross-Sectional Study. JMIR Public Health Surveill 2023; 9:e43612. [PMID: 37561566 PMCID: PMC10450528 DOI: 10.2196/43612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/09/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND China is facing a rapidly expanding aging population. Insights into the health status of older adults are of great significance for health resource allocation and health care provision to this population. OBJECTIVE With the goal of providing a comprehensive understanding of the health status of older adults and to inform potential interventions, we investigated the level of disability and identified risk factors associated with disability among the older population (aged ≥60 years) living in China. METHODS A total of 8467 older adults living in the Chinese city of Shenzhen were enrolled in this cross-sectional study. We used a multidimensional ability assessment survey, which assessed their activities of daily living (ADL; including eating, bathing, grooming, dressing, defecation control, urination control, using a toilet unaided, transfer, flat-ground walking, stair activity), mental status (including cognitive function, aggressive behavior, depression symptoms), sensory and communication (including consciousness level, vision, hearing, communication), and social participation (including living, working, time/space orientation, distinguish persons, social communication) abilities. The impact of demographic risk factors on ability levels was analyzed using ordinal logistic regression. The correlations between the four dimensions of ability mentioned above were analyzed using Spearman correlation analysis. RESULTS A total of 7766 participants were effectively assessed. The participants' average age was 70.64 (SD 8.46) years comprising 56.53% females. The overall ability level was classified as mildly, moderately, and severely impaired for 27.57% (n=2141), 2.83% (n=220), and 4.28% (n=332) of the 7766 participants, respectively. With increasing age, the proportion of impaired participants increased from 17.62% (365/2071) in the age group 60-64 years to 91.3% (253/277) in the age group above 90 years (P<.001), corresponding to an approximate 10% rise for every 5-year age increment. The odds of having more severe overall ability impairment in females was 1.15 times that in males (odds ratio [OR] 1.15, 95% CI 1.04-1.28). Participants who were divorced or widowed had a higher risk of more severe overall ability impairment than those currently married (OR 1.98, 95% CI 1.68-2.33). Participants living with nonrelatives had an increased risk of more severe overall ability impairment than those living alone (OR 2.38, 95% CI 1.46-3.91). Higher education level was a protective factor of overall ability impairment (college degree or above: OR 0.32, 95% CI 0.24-0.42). The four dimensions of ability assessed were significantly correlated; a low score for ADL was significantly correlated with poorer mental status, sensory and communication, and social participation (all P<.001). CONCLUSIONS The proportion of disability among Chinese older adults increases with age, being female, having lower education levels, being divorced or widowed, and living with nonrelatives. Impairment in ADL ability is significantly correlated with poor mental status, social participation, and sensory and communication abilities. A holistic approach to improving the health of the older population is recommended in China.
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Affiliation(s)
- Jing Wang
- China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China
| | - Patrick Kwan
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Gong Zhang
- Ministry of Education Key Laboratory of Tumour Molecular Biology and Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University, Guangzhou, China
| | - Mingwang Shen
- China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China
- Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province, Xi'an, Shaanxi, China
| | - Loretta Piccenna
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, The Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Departments of Medicine and Neurology, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Lei Zhang
- China-Australia Joint Research Centre for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, Shaanxi, China
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia
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Badache AC, Mäki-Torkko E, Widen S, Fors S. Why Are Old-Age Disabilities Decreasing in Sweden and Denmark? Evidence on the Contribution of Cognition, Education, and Sensory Functions. J Gerontol B Psychol Sci Soc Sci 2023; 78:483-495. [PMID: 36112366 PMCID: PMC9985323 DOI: 10.1093/geronb/gbac118] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Improvements in educational attainment, cognitive and sensory functions, and a decline in the prevalence of disabilities have been observed in older adults in Sweden and Denmark. In the present study, it was investigated whether better cognition, higher educational attainment, and improved sensory function among older adults aged 60 and older in these countries have contributed to decreasing rates of old-age disabilities. METHODS The analyses were based on repeated cross-sectional data from the Survey of Health, Ageing, and Retirement in Europe for the 2004-2017 period. Descriptive data were used to benchmark the declining prevalence of disabilities, improving cognitive and sensory functions, and increased educational level. The association between time and disabilities was analyzed with logistic regression models, and the contribution of the improved cognitive function, education, and sensory function to the declining prevalence of old-age disabilities was estimated using the Karlson-Holm-Breen method for mediation analysis. RESULTS The analysis suggests that the declining prevalence of old-age disabilities in Sweden and Denmark between 2004 and 2017 can largely be attributed to improved cognitive function and vision and to a lesser extent by education and hearing ability. DISCUSSION These findings raise important questions about the causal mechanisms producing the associations between cognition, education, and sensory functions and disability in older age. Future studies should explore the causal nature of the associations between these mediators and old-age disabilities. In addition, they should explore whether these findings differ across regional and cultural contexts and over different time periods.
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Affiliation(s)
- Andreea C Badache
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Swedish Institute for Disability Research, Örebro University, Örebro, Sweden
| | - Elina Mäki-Torkko
- School of Medical Sciences, Örebro University, Sweden.,Audiological Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Stephen Widen
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Stefan Fors
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm, Sweden
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Rahman MM, Jagger C, Leigh L, Holliday E, Princehorn E, Loxton D, Kowal P, Beard J, Byles J. The Impact of Education and Lifestyle Factors on Disability-Free Life Expectancy From Mid-Life to Older Age: A Multi-Cohort Study. Int J Public Health 2022; 67:1605045. [PMID: 36046258 PMCID: PMC9421499 DOI: 10.3389/ijph.2022.1605045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: Low education and unhealthy lifestyle factors such as obesity, smoking, and no exercise are modifiable risk factors for disability and premature mortality. We aimed to estimate the individual and joint impact of these factors on disability-free life expectancy (DFLE) and total life expectancy (TLE). Methods: Data (n = 22,304) were from two birth cohorts (1921–26 and 1946–51) of the Australian Longitudinal Study on Women’s Health and linked National Death Index between 1996 and 2016. Discrete-time multi-state Markov models were used to assess the impact on DFLE and TLE. Results: Compared to the most favourable combination of education and lifestyle factors, the least favourable combination (low education, obesity, current/past smoker, and no exercise) was associated with a loss of 5.0 years TLE, 95% confidence interval (95%CI): 3.2–6.8 and 6.4 years DFLE (95%CI: 4.8–7.8) at age 70 in the 1921–26 cohort. Corresponding losses in the 1946–51 cohort almost doubled (TLE: 11.0 years and DFLE: 13.0 years). Conclusion: Individual or co-ocurrance of lifestyle risk factors were associated with a significant loss of DFLE, with a greater loss in low-educated women and those in the 1946–51 cohort.
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Affiliation(s)
- Md Mijanur Rahman
- The Daffodil Centre, The University of Sydney and Cancer Council NSW, Sydney, NSW, Australia
| | - Carol Jagger
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Lucy Leigh
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Emily Princehorn
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Deb Loxton
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Paul Kowal
- World Health Organization (Switzerland), Geneva, Switzerland
| | - John Beard
- ARC Centre of Excellence in Population Ageing Research, University of New South Wales, Kensington, NSW, Australia
| | - Julie Byles
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
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5
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Han Y, Xue J, Pei W, Fang Y. Hierarchical structure in the activities of daily living and trajectories of disability prior to death in elderly Chinese individuals. BMC Geriatr 2021; 21:522. [PMID: 34600493 PMCID: PMC8487510 DOI: 10.1186/s12877-021-02460-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
Background The global burden of disability continues to increase. Understanding the hierarchical structure of activities of daily living (ADL) and the trajectories of disability of elderly individuals is pivotal to developing early interventions. Purpose To determine the hierarchical structure of the ability of Chinese elderly individuals to perform ADL and further describe the trajectories of disability prior to death. Methods Longitudinal item response theory model (LIRT) was constructed for 28,345 elderly participants in the Chinese Longitudinal Healthy Longevity Survey, in which ADL were measured using the Katz scale from 1998 to 2018, until the participants’ death. Two difficulty parameters (κ−partial and κ−total) were used in the LIRT defining the thresholds for hierarchical structure in ADL (κ−partial: no limitation to partial limitation, κ−total: partial limitation to totally limited). Disability values estimated from the LIRT were fitted to a mixed-effects model to examine the manner in which the trajectories of disability varied with different subject characteristics. Results The findings confirmed the earliest loss in the capability to perform ADL (bathing(κ-partial = − 1.396), toileting(κ-partial = − 0.904)) at the level of partial limitation, with an overlap of partial and totally limited (total bathing, partial dressing, partial transferring, total dressing, partial feeding, partial continence), and finally a total loss of capability for toileting, feeding, transferring, and continence (κ-total = 3.647). Disability trajectories varied with sex (β = 0.041, SE = 0.001), place of residence (β = 0.010, SE = 0.001), and marital status (β = 0.144, SE = 0.001). Females, individuals living in urban areas, and those who lived without a spouse had a poorer disability status. Conclusion The loss in the ability to perform ADL has a hierarchical structure. Subject characteristics affect trajectories of disability in the elderly Chinese population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02460-y.
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Affiliation(s)
- Yaofeng Han
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, China.,Center for Aging and Health Research School of Public Health, Xiamen University, Xiamen, China
| | - Jihui Xue
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, China
| | - Wei Pei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiang'an South Road, Xiamen, 361102, China.
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6
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Cantu PA, Sheehan CM, Sasson I, Hayward MD. Increasing Education-Based Disparities in Healthy Life Expectancy Among U.S. Non-Hispanic Whites, 2000-2010. J Gerontol B Psychol Sci Soc Sci 2021; 76:319-329. [PMID: 31711225 DOI: 10.1093/geronb/gbz145] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To examine changes in Healthy Life Expectancy (HLE) against the backdrop of rising mortality among less-educated white Americans during the first decade of the twenty-first century. METHODS This study documented changes in HLE by education among U.S. non-Hispanic whites, using data from the U.S. Multiple Cause of Death public-use files, the Integrated Public Use Microdata Sample (IPUMS) of the 2000 Census and the 2010 American Community Survey, and the Health and Retirement Study (HRS). Changes in HLE were decomposed into contributions from: (i) change in age-specific mortality rates; and (ii) change in disability prevalence, measured via Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). RESULTS Between 2000 and 2010, HLE significantly decreased for white men and women with less than 12 years of schooling. In contrast, HLE increased among college-educated white men and women. Declines or stagnation in HLE among less-educated whites reflected increases in disability prevalence over the study period, whereas improvements among the college educated reflected decreases in both age-specific mortality rates and disability prevalence at older ages. DISCUSSION Differences in HLE between education groups increased among non-Hispanic whites from 2000 to 2010. In fact, education-based differences in HLE were larger than differences in total life expectancy. Thus, the lives of less-educated whites were not only shorter, on average, compared with their college-educated counterparts, but they were also more burdened with disability.
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Affiliation(s)
- Phillip A Cantu
- Department of Sociology and Population Research Center, University of Texas at Austin.,Preventative Medicine and Population Health, University of Texas Medical Branch, Galveston
| | - Connor M Sheehan
- School of Social and Family Dynamics, Arizona State University, Tempe
| | - Isaac Sasson
- Department of Sociology and Anthropology and the Herczeg Institute on Aging, Tel Aviv University, Israel
| | - Mark D Hayward
- Department of Sociology and Population Research Center, University of Texas at Austin
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7
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Ye L, Elstgeest LEM, Zhang X, Alhambra-Borrás T, Tan SS, Raat H. Factors associated with physical, psychological and social frailty among community-dwelling older persons in Europe: a cross-sectional study of Urban Health Centres Europe (UHCE). BMC Geriatr 2021; 21:422. [PMID: 34247573 PMCID: PMC8274028 DOI: 10.1186/s12877-021-02364-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Frailty is an age-related condition resulting in a state of increased vulnerability regarding functioning across multiple systems. It is a multidimensional concept referring to physical, psychological and social domains. The purpose of this study is to identify factors (demographic characteristics, lifestyle factors and health indicators) associated with overall frailty and physical, psychological and social frailty in community-dwelling older people from five European countries. METHODS This cross-sectional study used baseline data from 2289 participants of the Urban Health Center European project in five European countries. Multivariable logistic regression models were used to assess associations of the factors with overall frailty and the three frailty domains. RESULTS The mean age was 79.7 (SD = 5.7). Participants who were older, were female, had secondary or equivalent education, lived alone, not at risk of alcohol use, were less physically active, had multi-morbidity, were malnourished or with a higher level of medication risk, had higher odds of overall frailty (all P < 0.05). Age was not associated with psychological and social frailty; sex was not associated with social frailty; smoking and migration background was not associated with overall frailty or any of its domains. There existed an interaction effect between sex and household composition regarding social frailty (P < 0.0003). CONCLUSIONS The present study contributed new insights into the risk factors for frailty and its three domains (physical, psychological and social frailty). Nurses, physicians, public health professionals and policymakers should be aware of the risk factors of each type of frailty. Furthermore, examine these risk factors more comprehensively and consider overall frailty as well as its three domains in order to further contribute to decision-making more precisely on the prevention and management of frailty. TRIAL REGISTRATION The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952 . The date of registration is 13/03/2017.
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Affiliation(s)
- Lizhen Ye
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Liset E M Elstgeest
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Xuxi Zhang
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.,Center for Healthy Aging and Development Studies, National School of Development, Peking University, Beijing, 100871, China
| | - Tamara Alhambra-Borrás
- Polibienestar Research Institute - Universitat de València ES, 29 46022, Valencia, Spain
| | - Siok Swan Tan
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000, Rotterdam, CA, The Netherlands.
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Rubio Valverde JR, Mackenbach JP, Nusselder WJ. Trends in inequalities in disability in Europe between 2002 and 2017. J Epidemiol Community Health 2021; 75:712-720. [PMID: 33674458 PMCID: PMC8292565 DOI: 10.1136/jech-2020-216141] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/18/2021] [Accepted: 02/26/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Monitoring socioeconomic inequalities in population health is important in order to reduce them. We aim to determine if educational inequalities in Global Activity Limitation Indicator (GALI) disability have changed between 2002 and 2017 in Europe (26 countries). METHODS We used logistic regression to quantify the annual change in disability prevalence by education, as well as the annual change in prevalence difference and ratio, both for the pooled sample and each country, as reported in the European Union Statistics on Income and Living Conditions (EU-SILC) and the European Social Survey (ESS) for individuals aged 30-79 years. RESULTS In EU-SILC, disability prevalence tended to decrease among the high educated. As a result, both the prevalence difference and the prevalence ratio between the low and high educated increased over time. There were no discernible trends in the ESS. However, there was substantial heterogeneity between countries in the magnitude and direction of these changes, but without clear geographical patterns and without consistency between surveys. CONCLUSIONS Socioeconomic inequalities in disability appear to have increased over time in Europe between 2002 and 2017 as per EU-SILC, and have persisted as measured by the ESS. Efforts to further harmonise disability instruments in international surveys are important, and so are studies to better understand international differences in disability trends and inequalities.
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Affiliation(s)
- Jose R Rubio Valverde
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan P Mackenbach
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Wilma J Nusselder
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Sphingolipids and physical function in the Atherosclerosis Risk in Communities (ARIC) study. Sci Rep 2021; 11:1169. [PMID: 33441925 PMCID: PMC7806657 DOI: 10.1038/s41598-020-80929-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/22/2020] [Indexed: 11/09/2022] Open
Abstract
Long-chain sphingomyelins (SMs) may play an important role in the stability of myelin sheath underlying physical function. The objective of this study was to examine the cross-sectional and longitudinal associations of long-chain SMs [SM (41:1), SM (41:2), SM (43:1)] and ceramides [Cer (41:1) and Cer (43:1)] with physical function in the Atherosclerosis Risk in Communities (ARIC) study. Plasma concentrations of SM (41:1), SM (41:2), SM (43:1), Cer (41:1) and Cer (43:1) were measured in 389 ARIC participants in 2011-13. Physical function was assessed by grip strength, Short Physical Performance Battery (SPPB), 4-m walking speed at both 2011-13 and 2016-17, and the modified Rosow-Breslau questionnaire in 2016-2017. Multivariable linear and logistic regression analyses were performed, controlling for demographic and clinical confounders. In cross-sectional analyses, plasma concentrations of SM 41:1 were positively associated with SPPB score (β-coefficients [95% confidence internal]: 0.33 [0.02, 0.63] per 1 standard deviation [SD] increase in log-transformed concentration, p value 0.04), 4-m walking speed (0.042 m/s [0.01, 0.07], p value 0.003), and negatively with self-reported disability (odds ratio = 0.73 [0.65, 0.82], p value < 0.0001). Plasma concentrations of the five metabolites examined were not significantly associated with longitudinal changes in physical function or incidence of poor mobility. In older adults, plasma concentrations of long-chain SM 41:1 were cross-sectionally positively associated with physical function.
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Fillenbaum GG, Sloane R, Burchett BM, Hall K, Pieper CF, Whitson HE, Colón-Emeric CS. Determinants of Maintenance and Recovery of Function in a Representative Older Community-Resident Biracial Sample. J Am Med Dir Assoc 2020; 21:1141-1147.e1. [PMID: 32037299 DOI: 10.1016/j.jamda.2019.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Focus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, (2) decline, and (3) recovery of personal self-maintenance activities over six years in an older, community representative, African American and white sample. DESIGN Longitudinal study, analyses included descriptive statistics and repeated measures proportional hazards. SETTING/PARTICIPANTS Community-representative participants of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), unimpaired at baseline (n = 3187; 46% white, 54% African American; 64% female, 36% male), followed annually for up to 6 years. MEASURES Data included information on basic activities of daily living (BADL), demographic characteristics, health status, social services provided and received, household size, neighborhood safety, and survival status. RESULTS Over 6 years, ∼75% remained unimpaired, of whom 30% were unimpaired when they dropped out or died. Of ∼25% who became impaired, just under half recovered. Controlled analyses indicated that those who became impaired were in poorer health, younger, and more likely to be African American. Characteristics of recovery included younger age, not hospitalized in the previous year, and larger household size. CONCLUSIONS/IMPLICATIONS Maintenance of health status facilitated continued unimpaired BADL. While decline was associated with poorer health, younger age, and being African American, recovery was also associated with younger age, together with larger household size, and no further deterioration in health as measured here. Maintenance of good health is preferred, but following decline in functioning, increased effort to improve health and avoid further decline, which takes into account not only physical but also personal social conditions, is needed.
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Affiliation(s)
- Gerda G Fillenbaum
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC.
| | - Richard Sloane
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | | | - Katherine Hall
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veteran Affairs Health Care System, Durham, NC
| | - Carl F Pieper
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veteran Affairs Health Care System, Durham, NC; Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Heather E Whitson
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veteran Affairs Health Care System, Durham, NC
| | - Cathleen S Colón-Emeric
- Duke University School of Medicine, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC; Geriatric Research Education and Clinical Center, Durham Veteran Affairs Health Care System, Durham, NC
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Jehn A, Zajacova A. Disability trends in Canada: 2001-2014 population estimates and correlates. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:354-363. [PMID: 30547289 PMCID: PMC6964543 DOI: 10.17269/s41997-018-0158-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/15/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Disability is a major concern for the health of midlife and older Canadians. Understanding disability trends is critical for detecting socio-economic and health precursors that could be amenable to policy interventions. The purpose of this study is to assess trends in rates of disability among Canadian adults age 40-64 and 65+. We also examine the impact of changing socio-demographic and health factors over time on the trends. METHODS Data from the 2001-2014 Canadian Community Health Survey (CCHS), a repeated cross-sectional nationally representative study, are used to estimate age- and gender-stratified logistic regression models of disability as a function of the year of interview to assess trends. Disability is defined as experiencing difficulties with a variety of individual functions, such as seeing, walking, climbing stairs, and bending. RESULTS Among men and women 65 and older, disability has declined since 2001 in most subgroups and regardless of changing socio-economic and health characteristics. Adults 40-64 years of age, in contrast, have experienced stagnating disability over the observation period. If it were not for changes in the distribution of education and household income, the disability rate would be increasing significantly. CONCLUSION Older Canadian adults are experiencing mild but systemic improvements in disability. More worrisome is the stagnating trend among midlife cohorts, which could portend greater disability burden in the future as Canada's population ages. Preventive efforts need to be targeted at vulnerable groups at earlier ages in order to prevent future increases in disability-related financial, caregiving, and medical burden.
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Affiliation(s)
- Anthony Jehn
- Social Science Centre, University of Western Ontario, 1151 Richmond Street, London, ON N6G 2V4 Canada
| | - Anna Zajacova
- Social Science Centre, University of Western Ontario, 1151 Richmond Street, London, ON N6G 2V4 Canada
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Hao Q, Sun X, Yang M, Dong B, Dong B, Wei Y. Prediction of mortality in Chinese very old people through the frailty index based on routine laboratory data. Sci Rep 2019; 9:221. [PMID: 30659252 PMCID: PMC6338748 DOI: 10.1038/s41598-018-36569-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 11/25/2018] [Indexed: 02/05/2023] Open
Abstract
The increased risk of death in older adults can be successfully identified through frailty index (FI), based on comprehensive geriatric assessment data and self-reported data from the accumulated deficit, although the method depending on routine laboratory data (FI-LAB) remains uncertain. In the current study, the capacity of FI-LAB in evaluating the risk of mortality in a very old Chinese community cohort was analyzed. The 90-year- and above old individuals from a Dujiangyan community in Sichuan Province, China, who had completed a health assessment at baseline (in 2005) and whose laboratory data were analyzed (n = 736) from cumulative data from the Project of Longevity and Aging. The FI-LAB data was constructed from routine laboratory data and calculated as the ratio of abnormal factors in 22 variables (including red blood cells, white blood cells, and alanine transaminase) that can be assessed through blood tests. The multivariable Cox regression was used to evaluate the effect of frailty on death. In the four-year follow-up, 53.5% of the 736 participants (age = 93.6 ± 3.4 years; 67.5% women), were reported dead. The FI-LAB mean baseline value was 0.21 (standard deviation = 0.10; range = 0 to 0.55). Frailty (after adjusting for gender, age, and other confounders) could be directly correlated with increased death risk, with a hazard ratio of 1.31 (95% confidence interval (CI): 1.07–1.61) in comparison with those without frailty among the individuals. Frailty as defined by FI-LAB, established only on routine laboratory data, indicates a significant death risk in the very old people.
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Affiliation(s)
- Qiukui Hao
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelian Sun
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Yang
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Biao Dong
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.,Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Birong Dong
- The Center of Gerontology and Geriatrics/National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, China.
| | - Yuquan Wei
- Key Laboratory of Biotherapy and Cancer Center/Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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Zajacova A, Montez JK. Explaining the increasing disability prevalence among mid-life US adults, 2002 to 2016. Soc Sci Med 2018; 211:1-8. [PMID: 29864712 DOI: 10.1016/j.socscimed.2018.05.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/11/2018] [Accepted: 05/24/2018] [Indexed: 12/23/2022]
Abstract
Several recent studies have documented an alarming upward trend in disability and functional limitations among US adults. In this study, we draw on the sociomedical Disablement Process framework to produce up-to-date estimates of the trends and identify key social and medical precursors of the trends. Using data on US adults aged 45-64 in the 2002-2016 National Health Interview Surveys, we estimate parametric and semiparametric models of disability and functional limitations as a function of interview time. We also determine the impact of socioeconomic resources, health behaviors, and health conditions on the trends. Our results show increasing prevalence of disability and functional limitations. These trends reflect the net result of complex countervailing forces, some associated with increases in functioning problems (unfavorable trends in economic well-being, especially income, and psychological distress) while other factors have suppressed the growth of functioning problems (favorable trends in educational attainment and some health behaviors, such as smoking and alcohol use). The results underscore that disability prevention must expand beyond medical interventions to include fundamental social factors and be focused on preventing or delaying the onset of chronic health problems and functional limitations.
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Franse CB, van Grieken A, Qin L, Melis RJF, Rietjens JAC, Raat H. Socioeconomic inequalities in frailty and frailty components among community-dwelling older citizens. PLoS One 2017; 12:e0187946. [PMID: 29121677 PMCID: PMC5679620 DOI: 10.1371/journal.pone.0187946] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 10/27/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND So far, it has not yet been studied whether socioeconomic status is associated with distinct frailty components and for which frailty component this association is the strongest. We aimed to examine the association between socioeconomic status and frailty and frailty components. In addition we assessed the mediating effect of the number of morbidities on the association between socioeconomic status and other frailty components. METHODS This is a cross-sectional study of pooled data of The Older Persons and Informal Caregivers Survey Minimum DataSet in the Netherlands among community-dwelling persons aged 55 years and older (n = 26,014). Frailty was measured with a validated Frailty Index that consisted of 45 items. The Frailty Index contained six components: morbidities, limitations in activities of daily living (ADL), limitations in instrumental ADL (IADL), health-related quality of life, psychosocial health and self-rated health. Socioeconomic indicators used were education level and neighbourhood socioeconomic status. RESULTS Persons with primary or secondary education had higher overall frailty and frailty component scores compared to persons with tertiary education (P < .001). Lower education levels were most consistently associated with higher overall frailty, more morbidities and worse self-rated health (P < .05 in all age groups). The strongest association was found between primary education and low psychosocial health for persons aged 55-69 years and more IADL limitations for persons aged 80+ years. Associations between neighborhood socioeconomic status and frailty (components) also showed inequalities, although less strong. The number of morbidities moderately to strongly mediated the association between socioeconomic indicators and other frailty components. CONCLUSION There are socioeconomic inequalities in frailty and frailty components. Inequalities in frailty, number of morbidities and self-rated health are most consistent across age groups. The number of morbidities a person has play an important role in explaining socioeconomic inequalities in frailty and should be taken into account in the management of frailty.
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Affiliation(s)
- Carmen B. Franse
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
- * E-mail:
| | - Amy van Grieken
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Li Qin
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - René J. F. Melis
- Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Judith A. C. Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Zajacova A, Montez JK. Physical Functioning Trends among US Women and Men Age 45-64 by Education Level. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2017; 63:21-30. [PMID: 28287310 PMCID: PMC5494255 DOI: 10.1080/19485565.2016.1263150] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Functional limitations and disability declined in the US during the 1980s and 1990s, but reports of early 21st century trends are mixed. Whether educational inequalities in functioning increased or decreased is also poorly understood. Given the importance of disability for productivity, independent living, and health care costs, these trends are critical to US social and health policies. We examine recent trends in functional limitations and disability among women and men aged 45-64. Using 2000-2015 National Health Interview Surveys data on over 155,000 respondents, semiparametric and logistic regression models visualize and test functioning trends by education. Among women and men with at least a college degree, there was no change in disability and mild increase in limitations over time. All other education levels experienced significant increases in functioning problems ranging from 18% higher odds of functional limitations in 2015 compared to 2000 among men with some college to about 80% increase in the odds of disability among women and men with less than high school education. The similar trends for both genders suggest common underlying causes, possibly including the worsening economic well-being of middle- and working-class families. The pervasive growth of functioning problems is a cause for concern that necessitates further scholarly investigation.
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Affiliation(s)
- Anna Zajacova
- Department of Sociology, Western University, London, Ontario, Canada
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