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Xu KQ, Payne CF. A growing divide: Trends in social inequalities in healthy longevity in Australia, 2001-20. POPULATION STUDIES 2024; 78:231-250. [PMID: 37669002 DOI: 10.1080/00324728.2023.2241429] [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: 09/12/2022] [Accepted: 02/23/2023] [Indexed: 09/06/2023]
Abstract
This study examines two decades of change in social inequalities in life and health expectancy among older adults in Australia, one of the few countries that escaped an economic recession during the global financial crisis. We compare adults aged 45+ across three measures of individual socio-economic position-education, occupation, and household wealth-and use multistate life tables to estimate total life expectancy (TLE) and life expectancy free of limiting long-term illness (LLTI-free LE) based on 20 waves of the Household, Income and Labour Dynamics in Australia Survey (2001-20). Our findings highlight substantial social disparities in both TLE and LLTI-free LE in Australia. Grouping individuals by household wealth shows striking differentials in LLTI-free LE. We observe widening social disparities in healthy longevity over time by all three measures of socio-economic position. This diverging trend in healthy longevity is troubling against the backdrop of widening income and wealth inequalities in Australia.
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Rashmi R, Mohanty SK. Socioeconomic and geographic variations of disabilities in India: evidence from the National Family Health Survey, 2019-21. Int J Health Geogr 2024; 23:4. [PMID: 38369479 PMCID: PMC10874552 DOI: 10.1186/s12942-024-00363-w] [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: 12/09/2023] [Accepted: 02/09/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Increasing disability is of global and national concern. Lack of evidence on disability across socioeconomic groups and geographic levels (especially small areas) impeded interventions for these disadvantaged subgroups. We aimed to examine the socioeconomic and geographic variations in disabilities, namely hearing, speech, visual, mental, and locomotor, in Indian participants using cross-sectional data from the National Family Health Survey 2019-2021. METHODS Using data from 27,93,971 individuals, we estimated age-sex-adjusted disability rates at the national and sub-national levels. The extent of socioeconomic variations in disabilities was explored using the Erreygers Concentration Index and presented graphically through a concentration curve. We adopted a four-level random intercept logit model to compute the variance partitioning coefficient (VPC) to assess the significance of each geographical unit in total variability. We also calculated precision-weighted disability estimates of individuals across 707 districts and showed their correlation with within-district or between-cluster standard deviation. RESULTS We estimated the prevalence of any disability of 10 per 1000 population. The locomotor disability was common, followed by mental, speech, hearing, and visual. The concentration index of each type of disability was highest in the poorest wealth quintile households and illiterate 18 + individuals, confirming higher socioeconomic variations in disability rates. Clusters share the largest source of geographic variation for any disability (6.5%), hearing (5.8%), visual (24.3%), and locomotor (17.4%). However, States/Union Territories (UTs) account for the highest variation in speech (3.7%) and mental (6.5%) disabilities, where the variation at the cluster level becomes negligible. Districts with the highest disability rates were clustered in Madhya Pradesh, Maharashtra, Karnataka, Tamil Nadu, Telangana, and Punjab. Further, we found positive correlations between the district rates and cluster standard deviations (SDs) for disabilities. CONCLUSIONS Though the growing disability condition in India is itself a concerning issue, wide variations across socioeconomic groups and geographic locations indicate the implementation of several policy-relevant implications focusing on these vulnerable chunks of the population. Further, the critical importance of small-area variations within districts suggests the design of strategies targeting these high-burden areas of disabilities.
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Affiliation(s)
- Rashmi Rashmi
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, India.
| | - Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088, India
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Merrick R, Brayne C. Sex Differences in Dementia, Cognition, and Health in the Cognitive Function and Ageing Studies (CFAS). J Alzheimers Dis 2024; 100:S3-S12. [PMID: 39121118 DOI: 10.3233/jad-240358] [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] [Indexed: 08/11/2024]
Abstract
Background There is renewed interest in whether sex differences in dementia risk exist, and what influence social and biological factors have. Objective To review evidence from the Cognitive Function and Ageing Studies (CFAS), a multi-center population-representative cohort study in the UK; focusing on dementia and cognition, incorporating findings on participants' health and social circumstances. Methods After identifying all CFAS publications, the results of all sex-stratified primary analyses of CFAS data were narratively reviewed. Results Of 337 publications, 94 report results by sex (including null findings), which are summarized by theme: dementia epidemiology, cognition, mental health, health expectancy, social context and biological resource (including neuropathology). Conclusions Where differences are found they most commonly favor men; however, greater mortality in men may confound associations with age-related outcomes. This 'survival bias' may explain findings of greater risk of dementia and faster cognitive decline in women. Age-specific dementia incidence was similar between sexes, although reduced incidence across study generations was more pronounced in men. Mood disorders were more prevalent in women, but adjusting for disability and deprivation attenuated the association. Prominent findings from other cohorts that women have more Alzheimer's disease pathology and greater risk of dementia from the Apolipoprotein E ɛ4 allele were not observed, warranting further investigation. The 'male-female health-survival paradox' is demonstrated whereby women live longer but with more comorbidity and disability. Examining why health expectancies changed differently over two decades for each sex (interacting with deprivation) may inform population interventions to improve cognitive, mental and physical health in later life.
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Affiliation(s)
- Richard Merrick
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
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Phetsitong R, Vapattanawong P. Household Need and Unmet Need for Caregivers of Older Persons in Thailand. J Aging Soc Policy 2023; 35:824-841. [PMID: 36224671 DOI: 10.1080/08959420.2022.2132081] [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: 10/05/2021] [Accepted: 05/03/2022] [Indexed: 10/17/2022]
Abstract
The need for caregivers is a crucial issue in Thailand. This research examined levels and trends of household needs and unmet needs for caregivers of older persons and explored potential factors associated with these needs. The analysis utilized data from the Survey of Older Persons in Thailand 2007, 2011, 2014, and 2017. The household need for a caregiver of older persons was defined as a household with one or more older people who needed a caregiver to help them perform basic activities of daily living. The unmet need for a caregiver referred to households where at least one older person in the household needed care but did not receive it. Findings illustrated the increasing levels and trends of household needs as well as unmet needs over time. In terms of potential determinants, older person households in Bangkok and households with higher socioeconomic status were more likely to be the household need for caregivers. In contrast, those households in the Northeastern, the poorest region, were more likely to be the unmet need household. These findings are indicative of the rising demand for long-term care services in Thailand. However, it is vital to consider unmet household needs, especially in the worse-off area, when designing national policies.
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Affiliation(s)
- Ruttana Phetsitong
- Lecturer, Faculty of Physical Therapy, Mahidol University, Nakhon Pathom, Thailand
| | - Patama Vapattanawong
- Professor, Institute for Population and Social Research, Mahidol University, Nakhon Pathom, Thailand
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Xu E, Nicosia FM, Zamora K, Barrientos M, Spar MJ, Reyes-Farias D, Karliner LS, Potter MB, Brown RT. When Functional Impairment Develops Early: Perspectives from Middle-Aged Adults. J Gen Intern Med 2023; 38:90-97. [PMID: 35391621 PMCID: PMC9849615 DOI: 10.1007/s11606-022-07541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 03/29/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Difficulty performing basic daily activities such as bathing and dressing ("functional impairment") affects more than 15% of middle-aged people, and this proportion is increasing. Little is known about the experiences and needs of individuals who develop functional impairment in middle age. OBJECTIVE To examine the experiences and needs of adults who developed functional impairment in middle age. DESIGN Qualitative study using semi-structured interviews. PARTICIPANTS Forty patients aged 50-64 years who developed functional impairment in middle age, recruited from four primary care clinics in San Francisco. APPROACH Interviews included open-ended questions about participants' daily life, ability to perform activities of daily living (ADLs), and needs related to functional impairment. We analyzed interviews using qualitative thematic analysis. KEY RESULTS Interviews revealed several themes related to the psychosocial and physical impacts of developing functional impairment in middle age. Participants noted that losses associated with functional impairment, such as loss of independence, control, and social roles, caused conflict in their sense of identity. To cope with these losses, participants used strategies including acceptance, social comparison, adjusting standards, and engaging in valued life activities. Participants reflected on the intersection of their functional impairment with the aging process, noting that their impairments seemed premature compared to the more "natural" aging process in older adults. In terms of physical impacts, participants described how a lack of accommodations in the built environment exacerbated their impairments. While participants used behavioral strategies to overcome these challenges, unmet needs remained, resulting in downstream physical and psychological impacts including safety risks, falls, frustration, and fear. CONCLUSIONS Unmet psychosocial and physical needs were common among middle-aged adults with functional impairment and led to negative downstream effects. Eliciting and addressing unmet needs may help mitigate downstream health consequences for this growing population, optimizing function and quality of life.
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Affiliation(s)
- Edison Xu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA.
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.
| | - Francesca M Nicosia
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Kara Zamora
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Maureen Barrientos
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Malena J Spar
- Geriatrics, Palliative, and Extended Care, San Francisco VA Health Care System, San Francisco, CA, USA
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA
| | - David Reyes-Farias
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Leah S Karliner
- Division of General Internal Medicine, Multiethnic Health Equity Research Center, University of California, San Francisco, San Francisco, CA, USA
| | - Michael B Potter
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca T Brown
- Division of Geriatric Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
- Geriatrics and Extended Care Program, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Morkphrom E, Srinonprasert V, Sura-amonrattana U, Siriussawakul A, Sainimnuan S, Preedachitkun R, Aekplakorn W. Severity of frailty using modified Thai frailty index, social factors, and prediction of mortality among community-dwelling older adults in a middle-income country. Front Med (Lausanne) 2022; 9:1060990. [PMID: 36569139 PMCID: PMC9780471 DOI: 10.3389/fmed.2022.1060990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Background Frailty has been increasingly recognized as a public health problem for aging populations with significant social impact, particularly in low- and middle-income countries. We aimed to develop a modified version of the Thai Frailty Index (TFI) and explore the association between different frailty statuses, socioeconomic factors, and mortality in community-dwelling older people from a middle-income country. Methods The data from participants aged ≥60 years in the Fourth Thai National Health Examination Survey were used to construct the 30-item TFI. Cutoff points were created based on stratum-specific likelihood ratio. TFI ≤ 0.10 was categorized as fit, 0.10-0.25 as pre-frail, 0.25-0.45 as mildly frail, and >0.45 as severely frail. The association of frailty status with mortality was examined using Cox proportional hazard models. Findings Among 8,195 older adults with a mean age of 69.2 years, 1,284 died during the 7-year follow-up. The prevalence of frailty was 16.6%. The adjusted hazard ratio (aHR) for mortality in pre-frail was 1.76 (95% CI = 1.50-2.07), mildly frail 2.79 (95% CI = 2.33-3.35), and severely frail 6.34 (95% CI = 4.60-8.73). Having a caretaker in the same household alleviated mortality risk for severely frail participants with an aHR of 2.93 (95% CI = 1.92-4.46) compared with an aHR of 6.89 (95% CI = 3.87-12.26) among those living without a caretaker. Interpretation The severity of frailty classified by the modified TFI can predict long-term mortality risk for community-dwelling older adults. Identification of severely frail older people to provide appropriate care might alleviate mortality risk. Our findings can inform policymakers to appropriately allocate services in a resource-limited setting.
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Affiliation(s)
- Ekkaphop Morkphrom
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Geriatric Internal Medicine Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Varalak Srinonprasert
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Geriatric Internal Medicine Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Unchana Sura-amonrattana
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Geriatric Internal Medicine Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arunotai Siriussawakul
- Integrated Perioperative Geriatric Excellent Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supawadee Sainimnuan
- Siriraj Geriatric Internal Medicine Research Group, Research Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rinrada Preedachitkun
- Siriraj Health Policy Unit, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wichai Aekplakorn
- Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Can Sex Differences in Old Age Disabilities be Attributed to Socioeconomic Conditions? Evidence from a Mapping Review of the Literature. JOURNAL OF POPULATION AGEING 2022. [DOI: 10.1007/s12062-022-09395-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractOld age disabilities are more common among women than men, and adverse socioeconomic conditions are associated with a higher prevalence of disabilities among older adults. The goal of this study was to complete a mapping review of the available evidence assessing the extent to which the observed sex differences in older adults’ disabilities can be attributed to sex differences in socioeconomic status. We searched three databases for articles published between 2009 and 2019, and after screening and looking at eligibility criteria, 6 articles were included in the review. For those studies that did not directly analyse the contribution of socioeconomic conditions, we used the ‘difference method’ to estimate the proportion of the sex gap in disabilities among older adults that could be attributed to socioeconomic conditions. Our review demonstrated that women generally have a higher prevalence of disabilities than men. In several studies, these differences could be partly attributed to sex differences in the distribution of socioeconomic conditions. We also find great elasticity in the magnitude of both the sex gap in disabilities and in the proportion that could be attributed to differences in socioeconomic conditions.
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Romero Starke K, Hegewald J, Schmauder S, Kaboth P, Uhlmann LM, Reissig D, Kaufmann KK, Wegge J, Marquardt G, Seidler A. Health and Care Dependency of Older Adults in Dresden, Germany: Results from the LAB60+ Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11777. [PMID: 36142050 PMCID: PMC9517330 DOI: 10.3390/ijerph191811777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 06/16/2023]
Abstract
As the population in Europe ages, an increased focus on the health of older adults is necessary. The purpose of the population-based LAB60+ study was to examine the current health and care situation of the population of older adults in Dresden, Germany, and to assess the effect of age, gender, and socioeconomic status (SES) on health outcomes. In the first half of 2021, 2399 out of 6004 randomly sampled residents of Dresden aged 60 years or older answered questions on their chronic conditions, care dependency, health-related quality of life (HRQoL), and well-being, among others. Of the participants, 91.6% were afflicted with at least one chronic condition, and 73.1% had multimorbidities. More than one-tenth (11.3%) of participants were care dependent. Lower levels of HRQoL and well-being were observed compared to a published German reference population, perhaps because of the ongoing COVID-19 pandemic. Gender differences were observed for some chronic health conditions, and women had a higher risk for lower HRQoL, well-being, and depressivity compared to men. A low SES was associated with a higher risk of the vast majority of health outcomes. Particularly, socioeconomic factors and gender-related inequalities should be considered for the development of prevention and health-promoting measures during late life.
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Affiliation(s)
- Karla Romero Starke
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Janice Hegewald
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
- Federal Institute for Occupational Safety and Health (BAuA), 10317 Berlin, Germany
| | - Stefanie Schmauder
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Pauline Kaboth
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | - Lena Marie Uhlmann
- Work and Organisational Psychology, Technische Universität Dresden, 01069 Dresden, Germany
| | - David Reissig
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
| | | | - Jürgen Wegge
- Work and Organisational Psychology, Technische Universität Dresden, 01069 Dresden, Germany
| | - Gesine Marquardt
- Social and Health Care Buildings and Design, Technische Universität Dresden, 01069 Dresden, Germany
| | - Andreas Seidler
- Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine, Technische Universität Dresden, 01307 Dresden, Germany
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Lowthian E. The Secondary Harms of Parental Substance Use on Children's Educational Outcomes: A Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:511-522. [PMID: 35958702 PMCID: PMC9360289 DOI: 10.1007/s40653-021-00433-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
Parental substance use, that is alcohol and illicit drugs, can have a deleterious impact on child health and wellbeing. An area that can be affected by parental substance use is the educational outcomes of children. Current reviews of the literature in the field of parental substance use and children's educational outcomes have only identified a small number of studies, and most focus on children's educational attainment. To grasp the available literature, the method from Arksey and O'Malley (2005) was used to identify literature. Studies were included if they were empirical, after 1950, and focused on children's school or educational outcomes. From this, 51 empirical studies were identified which examined the relationship between parental alcohol and illicit drug use on children's educational outcomes. Five main themes emerged which included attainment, behavior and adjustment, attendance, school enjoyment and satisfaction, academic self-concept, along with other miscellaneous outcomes. This paper highlights the main findings of the studies, the gaps in the current literature, and the challenges presented. Recommendations are made for further research and interventions in the areas of parental substance use and child educational outcomes specifically, but also for broader areas of adversity and child wellbeing.
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Affiliation(s)
- Emily Lowthian
- DECIPHer, School of Social Sciences, Cardiff University, 1–3 Museum Place, Cardiff, CF10 3BD Wales, UK
- Population Data Science, Swansea University Medical School, Singleton Park, Swansea, SA2 8PP Wales, UK
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Mishra RS, Mohanty SK, Cordes J, Sahoo U, Singh RR, Subramanian SV. Economic gradient of onset of disability in India. BMC Public Health 2021; 21:769. [PMID: 33882902 PMCID: PMC8061006 DOI: 10.1186/s12889-021-10826-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Background Disability in India is associated with increasing non-communicable diseases, rising longevity, and increasing accidents and injuries. Though studies have examined prevalence, patterns, and socioeconomic correlates of disability, no attempt has been made in estimating age of onset of disability in India. Objective This paper investigates the economic gradient of age of onset of locomotor, visual, hearing, speech, mental retardation, mental illness, and other disabilities in India. Method We use nationally representative data of 106,894 disabled individuals from the 76th round of National Sample Survey (NSS), 2018. Descriptive statistics, kernel density, Kaplan-Meier survival curves, and linear regression models are used in the analysis. Result The disability rate in India was 2184 per 100,000 persons. The disability rate was highest for locomotor (1353) followed by hearing (296), visual (234), speech (228), mental retardation (158), and mental illness (131). Over 85% of mental retardation and 80% of speech disabilities occur at birth, while 82% of locomotor and 81% of visual disabilities occur after birth. Among those who had disability after birth, the median age for mental retardation was 2 years followed by mental illness (28 years), speech (29 years), locomotor (42 years), visual (55 years), and 56 years for hearing disability. Adjusting for socioeconomic covariates, the age of onset of locomotor and speech disabilities among the poorest individuals were 7 and 11 years earlier than the richest, respectively. Conclusion The economic gradient of onset of locomotive and speech disabilities are strong. The age of onset of disability was earliest for mental retardation followed by mental illness and speech disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10826-5.
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Affiliation(s)
- Radhe Shyam Mishra
- International Institute for Population Sciences, Govandi station road Deonar, Mumbai, 400088, India.
| | - Sanjay K Mohanty
- Department of Fertility Studies, International Institute for Population Sciences, Mumbai, India.
| | - Jack Cordes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Umakanta Sahoo
- International Institute for Population Sciences, Govandi station road Deonar, Mumbai, 400088, India
| | - Rajeev R Singh
- International Institute for Population Sciences, Govandi station road Deonar, Mumbai, 400088, India
| | - S V Subramanian
- Harvard Centre for Population and Development Studies, Harvard University, Cambridge, MA, USA
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Zaninotto P, Batty GD, Stenholm S, Kawachi I, Hyde M, Goldberg M, Westerlund H, Vahtera J, Head J. Socioeconomic Inequalities in Disability-free Life Expectancy in Older People from England and the United States: A Cross-national Population-Based Study. J Gerontol A Biol Sci Med Sci 2021; 75:906-913. [PMID: 31940032 PMCID: PMC7164527 DOI: 10.1093/gerona/glz266] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Indexed: 01/01/2023] Open
Abstract
Background We examined socioeconomic inequalities in disability-free life expectancy in older men and women from England and the United States and explored whether people in England can expect to live longer and healthier lives than those in the United States. Methods We used harmonized data from the Gateway to Global Aging Data on 14,803 individuals aged 50+ from the U.S. Health and Retirement Study (HRS) and 10,754 from the English Longitudinal Study of Ageing (ELSA). Disability was measured in terms of impaired activities and instrumental activities of daily living. We used discrete-time multistate life table models to estimate total life expectancy and life expectancy free of disability. Results Socioeconomic inequalities in disability-free life expectancy were of a similar magnitude (in absolute terms) in England and the United States. The socioeconomic disadvantage in disability-free life expectancy was largest for wealth, in both countries: people in the poorest group could expect to live seven to nine fewer years without disability than those in the richest group at the age of 50. Conclusions Inequalities in healthy life expectancy exist in both countries and are of similar magnitude. In both countries, efforts in reducing health inequalities should target people from disadvantaged socioeconomic groups.
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Affiliation(s)
- Paola Zaninotto
- Department of Epidemiology and Public Health, University College London, UK
| | - George David Batty
- Department of Epidemiology and Public Health, University College London, UK
| | - Sari Stenholm
- Department of Public Health, University of Turku and Turku University Hospital, Finland
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard University, Boston, Massachusetts
| | - Martin Hyde
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, UK
| | - Marcel Goldberg
- Inserm, Population-based Epidemiologic Cohorts Unit-UMS 011, Villejuif, France.,Inserm, Aging and Chronic Diseases, Epidemiological and Public Health Approaches, Villejuif, France
| | | | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Finland
| | - Jenny Head
- Department of Epidemiology and Public Health, University College London, UK
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The Influence of Racial Differences in the Demand for Healthcare in South Africa: A Case of Public Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145043. [PMID: 32674256 PMCID: PMC7400579 DOI: 10.3390/ijerph17145043] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 01/19/2023]
Abstract
The study sought to analyse the influence of racial differences in the demand for public healthcare in South Africa, using the 2018 General Household Survey (GHS) data. This was completed to understand if race still plays a role in access to healthcare in post-apartheid South Africa. Logistic regression analysis revealed that race significantly explained the variance in demand for public healthcare, with White populations having the lowest probability of demand for public healthcare compared to other races. Consequently, the study noted that racial differences still play a critical role in affording one access to healthcare after assessing the situation obtaining in public healthcare. Therefore, the study recommends that the government of South Africa should create policies that encourage equal access to basic services in addressing racial inequality in the country.
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Murayama H, Liang J, Shaw BA, Botoseneanu A, Kobayashi E, Fukaya T, Shinkai S. Socioeconomic Differences in Trajectories of Functional Capacity Among Older Japanese: A 25-Year Longitudinal Study. J Am Med Dir Assoc 2020; 21:734-739.e1. [PMID: 32312679 DOI: 10.1016/j.jamda.2020.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/17/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES There is limited research on long-term changes in functional capacity among older Japanese, who differ significantly from their counterparts in Western, developed nations. This study aimed to identify distinct trajectories of functional capacity over a 25-year period and to explore socioeconomic differences in trajectory-group membership probabilities, using a national sample of older Japanese. DESIGN Longitudinal panel study with 8 observation points from 1987 to 2012. SETTING AND PARTICIPANTS The data came from the National Survey of the Japanese Elderly, which consisted of 6193 samples of community-dwelling Japanese aged 60 years and older at baseline. METHODS Functional capacity measure included basic and instrumental activities of daily living. Group-based mixture models were used for data analysis. RESULTS Among participants aged 60 to 74 years at baseline, 4 trajectories were identified: minimal disability (80.3%), late-onset disability (11.6%), early-onset disability (6.2%), and moderate disability (1.9%). Those aged ≥75 years at baseline experienced higher levels of disability but somewhat parallel trajectories, including minimal disability (73.3%), early-onset disability (11.2%), moderate disability (11.3%), and severe and worsening disability (4.2%). Lower socioeconomic status, including education and household income, was associated with a higher risk of experiencing trajectories of poorer functional capacity among those aged 60 to 74 years, but no such association existed among those aged ≥75 years. CONCLUSIONS AND IMPLICATIONS We found that approximately 70% to 80% of older Japanese maintained healthy functional capacity over time. Although we could not follow those who dropped out during the observation period, this study provided useful evidence that socioeconomic disparities in functional health converge with age. Our findings inform the design of health policies and interventions aiming to maintain functional health among older adults with diverse socioeconomic backgrounds. In particular, public policies aiming to reduce socioeconomic disparities should be emphasized to promote healthy aging.
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Affiliation(s)
- Hiroshi Murayama
- Institute of Gerontology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan.
| | - Jersey Liang
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| | - Benjamin A Shaw
- Department of Health Policy, Management and Behavior, School of Public Health, State University of New York at Albany, Rensselaer, NY
| | - Anda Botoseneanu
- Department of Health and Human Services, University of Michigan-Dearborn, Dearborn, MI
| | - Erika Kobayashi
- Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Taro Fukaya
- Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
| | - Shoji Shinkai
- Tokyo Metropolitan Institute of Gerontology, Itabashi-ku, Tokyo, Japan
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Obesity Increases Costs With Productivity Loss Due to Disability Retirements, Independent of Physical Activity: A Cohort Study. J Occup Environ Med 2020; 62:325-330. [PMID: 31895736 DOI: 10.1097/jom.0000000000001808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Investigate whether obesity is responsible for costs due to productivity loss (PL) in adults, during 30 months of follow-up. METHODS Absenteeism and disability retirement were considered as PL. For classification of obesity, body mass index (BMI) and waist circumference (WC) values were considered. The statistical software BioEstat (release 5.0) was used and the significance level was set at P value < 0.05. RESULTS For the men, BMI and WC accounted for ∼60% and ∼30% of retirement due to disability (P = 0.001). For the women, this percentage represented ∼19% for BMI and ∼8% for WC, both P < 0.05. Physical activity was not a significant confounder in any of the analyses (P > 0.05). CONCLUSION Total and abdominal obesity were responsible for increased costs from PL due to early retirement among adults aged 50 years or older.
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Brønnum-Hansen H, Foverskov E, Andersen I. Occupational inequality in health expectancy in Denmark. Scand J Public Health 2019; 48:338-345. [DOI: 10.1177/1403494819882138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: The pension age in Denmark is adjusted in line with projected increasing life expectancy without taking health differentials between occupational groups into account. The purpose was to study occupational disparities in partial life expectancy and health expectancy between the ages of 50 and 75. Methods: Register data on occupation and mortality were combined with data from the Danish part of Survey of Health, Ageing and Retirement in Europe in 2010–2014 ( N=3179). Expected lifetime without and with activity limitations and without and with long-term illness was estimated by Sullivan’s method and comparisons made between four occupational groups. Results: We found clear differences between occupational groups. Expected lifetime without activity limitations between the ages of 50 and 75 was about 4.5 years longer for men and women in high skilled white-collar occupations than for men and women in low skilled blue-collar occupations. Men in high skilled blue-collar and low skilled white-collar occupations could expect 2.3 and 3.8 years shorter lifetimes without activity limitations, respectively, than men in high skilled white-collar occupations. For women in low skilled white-collar occupations, lifetime without activity limitations was 2.6 years shorter than for women in high skilled white-collar occupations. Due to few observations, no results were obtained for women in the high skilled blue-collar group. The social gradient was also significant when health was measured by years without long-term illness. Conclusions: The results support implementation of a flexible pension scheme to take into account the health differentials between occupational groups.
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Affiliation(s)
- Henrik Brønnum-Hansen
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Denmark
| | - Else Foverskov
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Denmark
| | - Ingelise Andersen
- Faculty of Health Sciences, Department of Public Health, University of Copenhagen, Denmark
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Grossi CM, Richardson K, Fox C, Maidment I, Steel N, Loke YK, Arthur A, Myint PK, Campbell N, Boustani M, Robinson L, Brayne C, Matthews FE, Savva GM. Anticholinergic and benzodiazepine medication use and risk of incident dementia: a UK cohort study. BMC Geriatr 2019; 19:276. [PMID: 31638906 PMCID: PMC6802337 DOI: 10.1186/s12877-019-1280-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 09/13/2019] [Indexed: 11/22/2022] Open
Abstract
Background Studies suggest that anticholinergic medication or benzodiazepine use could increase dementia risk. We tested this hypothesis using data from a UK cohort study. Methods We used data from the baseline (Y0), 2-year (Y2) and 10-year (Y10) waves of the Medical Research Council Cognitive Function and Ageing Study. Participants without dementia at Y2 were included (n = 8216). Use of benzodiazepines (including nonbenzodiazepine Z-drugs), anticholinergics with score 3 (ACB3) and anticholinergics with score 1 or 2 (ACB12) according to the Anticholinergic Cognitive Burden scale were coded as ever use (use at Y0 or Y2), recurrent use (Y0 and Y2), new use (Y2, but not Y0) or discontinued use (Y0, but not Y2). The outcome was incident dementia by Y10. Incidence rate ratios (IRR) were estimated using Poisson regression adjusted for potential confounders. Pre-planned subgroup analyses were conducted by age, sex and Y2 Mini-Mental State Examination (MMSE) score. Results Dementia incidence was 9.3% (N = 220 cases) between Y2 and Y10. The adjusted IRRs (95%CI) of developing dementia were 1.06 (0.72, 1.60), 1.28 (0.82, 2.00) and 0.89 (0.68, 1.17) for benzodiazepines, ACB3 and ACB12 ever-users compared with non-users. For recurrent users the respective IRRs were 1.30 (0.79, 2.14), 1.68 (1.00, 2.82) and 0.95 (0.71, 1.28). ACB3 ever-use was associated with dementia among those with Y2 MMSE> 25 (IRR = 2.28 [1.32–3.92]), but not if Y2 MMSE≤25 (IRR = 0.94 [0.51–1.73]). Conclusions Neither benzodiazepines nor ACB12 medications were associated with dementia. Recurrent use of ACB3 anticholinergics was associated with dementia, particularly in those with good baseline cognitive function. The long-term prescribing of anticholinergics should be avoided in older people.
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Affiliation(s)
- Carlota M Grossi
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Kathryn Richardson
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.
| | - Chris Fox
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Yoon K Loke
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Antony Arthur
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Phyo Kyaw Myint
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, UK
| | - Noll Campbell
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, USA
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Louise Robinson
- Institute of Health and Society/Institute for Ageing, Newcastle University, Newcastle, NE4 5PL, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Fiona E Matthews
- Institute of Health and Society/Institute for Ageing, Newcastle University, Newcastle, NE4 5PL, UK
| | - George M Savva
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK.,Quadram Institute Bioscience, Norwich, Norfolk, UK
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Kelfve S. Underestimated Health Inequalities Among Older People-A Consequence of Excluding the Most Disabled and Disadvantaged. J Gerontol B Psychol Sci Soc Sci 2019; 74:e125-e134. [PMID: 28369563 DOI: 10.1093/geronb/gbx032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 03/09/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The present study analyzed whether estimates of health inequalities in old age are sensitive to the exclusion of people living in institutions and nonuse of proxy interviews. METHOD Pooled data from the 2004 wave (n = 1,180, aged 69-100, primarily interviewed over the phone) and the 2011 wave (n = 931, aged 76-101, primarily interviewed face-to-face) of the Swedish Panel Study of Living Conditions of the Oldest Old were used to compare absolute and relative differences in disability and mortality between people with compulsory education and people with more than compulsory education. RESULTS Both absolute and relative health inequalities would have been underestimated in a survey that excluded institutionalized people and proxy-interviewed community dwellers. The same patterns were found in men and women and regardless of the mode of data collection (telephone or face-to-face interview). The degree of underestimation was lower in those 85 years and older than in those 69 to 84 years. DISCUSSION A survey that only includes people who live in the community and can participate without the help of a proxy might give the impression that those with low levels of education have less extensive health disadvantages than they actually have.
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Affiliation(s)
- Susanne Kelfve
- Aging Research Center (ARC), Karolinska Institutet & Stockholm University, Sweden.,National Institute for the Study of Ageing and Later Life (NISAL), Linköping University, Norrköping, Sweden
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Yeung P, Breheny M. Quality of life among older people with a disability: the role of purpose in life and capabilities. Disabil Rehabil 2019; 43:181-191. [PMID: 31335217 DOI: 10.1080/09638288.2019.1620875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Purpose in life and capabilities are two significant individual elements that enhance quality of life among older people. Capabilities refers to the extent to which older people are free to make choices that are important to them. At present, it is not known how purpose in life interacts with capabilities to influence quality of life for those living with a disability. This study examined the extent to which purpose in life and capabilities interacts with health status to affect quality of life, particularly for older people with a disability.Methods: Self-report data from participants in a longitudinal cohort study of older New Zealanders were analyzed. Responses from 452 older people with a disability were compared with 3299 age- and gender-matched older people without a disability on indicators related to health and aging. The associations were tested using hierarchical regression. Mediational impact of purpose in life and capabilities were tested via path analysis.Results: Mental health, physical health, purpose in life, and capabilities accounted for a significant amount of variance in quality of life for older people with a disability. Purpose in life and capabilities were significant unique mediators for older people with a disability.Conclusions: Purpose in life may help older people with a disability to deal with early onset stressors or changes in mental and physical health to maintain overall quality of life. The role of capabilities suggests that the social environment and access to resources and choices are important in ensuring that older people aging with or into a disability achieve quality of life in a socially just environment.Implications for rehabilitationsPurpose in life and capability are unique mediators of the relationship between health status and quality of life.Purpose in life may act as an effective buffering mechanism to deal with disability in later life while capability can empower older people with a disability to achieve quality of life in a just environment.The notion of successful aging with disability should be re-defined as using psychological, social support, and healthcare resources to live a life consistent with personal values in the context of disabilityRather than emphasizing structural factors and physical functioning in activity participation, older people with disability should be supported to decide and pursue their own preferences.Rehabilitation professionals can work flexibly with older people with disability to maximize their resilience, dignity, autonomy and choice, and positive connection to others.
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Affiliation(s)
- Polly Yeung
- School of Social Work, Massey University, Palmerston North, New Zealand
| | - Mary Breheny
- School of Health Sciences, Massey University, Palmerston North, New Zealand
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Uccheddu D, Gauthier AH, Steverink N, Emery T. Gender and Socioeconomic Inequalities in Health at Older Ages Across Different European Welfare Clusters: Evidence from SHARE Data, 2004-2015. EUROPEAN SOCIOLOGICAL REVIEW 2019; 35:346-362. [PMID: 31205378 PMCID: PMC6561324 DOI: 10.1093/esr/jcz007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Indexed: 06/09/2023]
Abstract
This study takes a comparative approach to assess whether the association between socioeconomic status (SES) and health in later life differs by gender in a sample of individuals aged 50 and above living in nine European countries (Austria, Belgium, Denmark, France, Germany, Italy, Spain, Sweden, and Switzerland). We apply linear hybrid (between-within) regression models using panel data (50,459 observations from 13,955 respondents) from five waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) between the years 2004-2015. SES measures included education, income, and wealth. A 40- item Frailty Index (FI) of accumulated deficits, an important indicator of health in older populations, was used as dependent variable. Considering between-effects estimates, our results show that the positive impact of education and wealth on health is stronger for women living in countries where the welfare arrangements are less decommodifying and defamilializing. No such interaction is found for income and for fixed-effects estimates. This study could advance the understanding of gender inequalities in health. Also, such findings can guide future policies devoted at reducing gender and socioeconomic inequalities in health in later life.
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Affiliation(s)
- Damiano Uccheddu
- Netherlands Interdisciplinary Demographic Institute (NIDI-KNAW), Lange Houtstraat 19, 2511 CV, The Hague, The Netherlands
- Department of Sociology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Rozenstraat 31, 9712 TG, Groningen, The Netherlands
| | - Anne H Gauthier
- Netherlands Interdisciplinary Demographic Institute (NIDI-KNAW), Lange Houtstraat 19, 2511 CV, The Hague, The Netherlands
- Department of Sociology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Rozenstraat 31, 9712 TG, Groningen, The Netherlands
| | - Nardi Steverink
- Department of Sociology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Rozenstraat 31, 9712 TG, Groningen, The Netherlands
- Department of Health Psychology, Faculty of Medical Sciences, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Tom Emery
- Netherlands Interdisciplinary Demographic Institute (NIDI-KNAW), Lange Houtstraat 19, 2511 CV, The Hague, The Netherlands
- Department of Sociology, Faculty of Behavioural and Social Sciences, University of Groningen, Grote Rozenstraat 31, 9712 TG, Groningen, The Netherlands
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Mosquera I, González-Rábago Y, Martín U, Bacigalupe A. Socio-Economic Inequalities in Life Expectancy and Health Expectancy at Age 50 and over in European Countries. ACTA ACUST UNITED AC 2019. [DOI: 10.3790/sfo.68.4.255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract
Based on the demographic ageing, many European governments have modified the statutory retirement age. However, in general, life expectancy (LE) and health expectancy (HE) are not uniformly distributed, being both lower among the least advantaged groups. Thus, a systematic search and review of the literature has been conducted to identify socioeconomic inequalities in LE and HE at age 50 and over in European countries. Twenty-nine studies were included in the review. Across Europe, people in a more advantaged position can expect to live longer, more years in good health and less in bad health, and therefore a lower percentage of their lives in bad health.
Zusammenfassung: Sozioökonomische Ungleichheiten in der Lebens- und Gesundheitserwartung im Alter von 50 und älter in Europäischen Ländern. Erkenntnisse für die Debatte der Rentenpolitik
Vor dem Hintergrund der demographischen Alterung haben viele europäische Regierungen das Renteneintrittsalter modifiziert. Allerdings sind Lebensund Gesundheitserwartungen nicht gleichmäßig verteilt, sondern sind in benachteiligten Bevölkerungsgruppen niedriger. Um sozioökonomische Ungleichheiten in der Lebens- und Gesundheitserwartung von Individuen im Alter von 50 Jahren und älter zu betrachten, wurde eine systematische Suche und Begutachtung der Literatur in den europäischen Ländern durchgeführt. Es wurden 29 Studien in der Begutachtung miteinbezogen. Es zeigt sich, dass Individuen in vorteilhaften Positionen erwarten können länger zu leben, länger gesund zu sein und weniger häufig einen schlechten Gesundheitszustand aufweisen, was der Grund dafür ist, dass sie auch einen geringeren Anteil ihrer Lebenszeit in schlechter Gesundheit verbringen.
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Burholt V, Windle G, Morgan DJ. A Social Model of Loneliness: The Roles of Disability, Social Resources, and Cognitive Impairment. THE GERONTOLOGIST 2017; 57:1020-1030. [PMID: 27831482 PMCID: PMC5881780 DOI: 10.1093/geront/gnw125] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Accepted: 06/21/2016] [Indexed: 11/17/2022] Open
Abstract
Purpose of the study We consider the points at which cognitive impairment may impact on the pathway to loneliness for older people, through impeding social interaction with family and friends, or by interfering with judgments concerning satisfaction with relationships. Design and methods We conceptualize a mediation model anticipating that social resources (LSNS-6) will mediate the pathway between disability (Townsend Disability Scale) and loneliness (De Jong Gierveld 6-item scale) and a moderated-mediation model in which we hypothesize that cognitive impairment (MMSE) will moderate the association between disability and social resources and between social resources and loneliness. To validate the hypothesized pathways, we draw on the CFAS Wales data set (N = 3,593) which is a nationally representative study of community-dwelling people aged 65 and older in Wales. Results Disability had a significant indirect effect on loneliness through the mediating variable social resources. Cognitive impairment was significantly associated with social resources, but did not moderate the relationship between disability and social resources. Cognitive impairment had a significant impact on loneliness, and moderated the effect of social resources on loneliness. Implications Social structures can (dis)empower people with cognitive impairment and lead to exclusion from social resources or impact on the social construction of aging, cognitive impairment, and dementia. The sense of self for an older person with cognitive impairment may be influenced by social norms and stereotypes, or through a temporal social comparison with an "earlier" sense of self. We conclude that loneliness interventions should be theoretically informed to identify key areas for modification.
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Affiliation(s)
- Vanessa Burholt
- Centre for Innovative Ageing, College of Human and Health Science, Swansea University, UK
| | - Gill Windle
- Dementia Services Development Centre, Bangor Institute of Health & Medical Research, Bangor University, UK
| | - Deborah J Morgan
- Centre for Innovative Ageing, College of Human and Health Science, Swansea University, UK
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Read S, Grundy E, Foverskov E. Socio-economic position and subjective health and well-being among older people in Europe: a systematic narrative review. Aging Ment Health 2016; 20:529-42. [PMID: 25806655 PMCID: PMC4784497 DOI: 10.1080/13607863.2015.1023766] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe. METHOD Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and International Bibliography of the Social Sciences (IBSS). We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population-based samples of older people in Europe and published 1995-2013. RESULTS A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health-related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances. CONCLUSION The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors.
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Affiliation(s)
- Sanna Read
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom,Corresponding author.
| | - Emily Grundy
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
| | - Else Foverskov
- Department of Social Policy, London School of Economics and Political Science, London, United Kingdom
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Anstey KJ, Kingston A, Kiely KM, Luszcz MA, Mitchell P, Jagger C. The influence of smoking, sedentary lifestyle and obesity on cognitive impairment-free life expectancy. Int J Epidemiol 2015; 43:1874-83. [PMID: 25150976 DOI: 10.1093/ije/dyu170] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking, sedentary lifestyle and obesity are risk factors for mortality and dementia. However, their impact on cognitive impairment-free life expectancy (CIFLE)has not previously been estimated. METHODS Data were drawn from the DYNOPTA dataset which was derived by harmonizing and pooling common measures from five longitudinal ageing studies. Participants for whom the Mini-Mental State Examination was available were included (N¼8111,48.6% men). Data on education, sex, body mass index, smoking and sedentary lifestyle were collected and mortality data were obtained from Government Records via data linkage.Total life expectancy (LE), CIFLE and years spent with cognitive impairment (CILE)were estimated for each risk factor and total burden of risk factors. RESULTS CILE was approximately 2 years for men and 3 years for women, regardless of age. For men and women respectively, reduced LE associated with smoking was 3.82and 5.88 years, associated with obesity was 0.62 and 1.72 years and associated with being sedentary was 2.50 and 2.89 years. Absence of each risk factor was associated with longer LE and CIFLE, but also longer CILE for smoking in women and being sedentary in both sexes. Compared with participants with no risk factors, those with 2þ had shorter CIFLE of up to 3.5 years depending on gender and education level. CONCLUSIONS Population level reductions in smoking, sedentary lifestyle and obesity increase longevity and number of years lived without cognitive impairment. Years lived with cognitive impairment may also increase.
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Pongiglione B, De Stavola BL, Ploubidis GB. A Systematic Literature Review of Studies Analyzing Inequalities in Health Expectancy among the Older Population. PLoS One 2015; 10:e0130747. [PMID: 26115099 PMCID: PMC4482630 DOI: 10.1371/journal.pone.0130747] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/23/2015] [Indexed: 11/21/2022] Open
Abstract
Aim To collect, organize and appraise evidence of socioeconomic and demographic inequalities in health and mortality among the older population using a summary measure of population health: Health Expectancy. Methods A systematic literature review was conducted. Literature published in English before November 2014 was searched via two possible sources: three electronic databases (Web of Science, Medline and Embase), and references in selected articles. The search was developed combining terms referring to outcome, exposure and participants, consisting in health expectancy, socioeconomic and demographic groups, and older population, respectively. Results Of 256 references identified, 90 met the inclusion criteria. Six references were added after searching reference lists of included articles. Thirty-three studies were focused only on gender-based inequalities; the remaining sixty-three considered gender along with other exposures. Findings were organized according to two leading perspectives: the type of inequalities considered and the health indicators chosen to measure health expectancy. Evidence of gender-based differentials and a socioeconomic gradient were found in all studies. A remarkable heterogeneity in the choice of health indicators used to compute health expectancy emerged as well as a non-uniform way of defining same health conditions. Conclusions Health expectancy is a useful and convenient measure to monitor and assess the quality of ageing and compare different groups and populations. This review showed a general agreement of results obtained in different studies with regard to the existence of inequalities associated with several factors, such as gender, education, behaviors, and race. However, the lack of a standardized definition of health expectancy limits its comparability across studies. The need of conceiving health expectancy as a comparable and repeatable measure was highlighted as fundamental to make it an informative instrument for policy makers.
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Affiliation(s)
- Benedetta Pongiglione
- Medical Statistics Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Bianca L De Stavola
- Medical Statistics Department, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - George B Ploubidis
- Centre for Longitudinal Studies, Institute of Education, London, United Kingdom
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Almeida OP, Yeap BB, Hankey GJ, Golledge J, Flicker L. Association of depression with sexual and daily activities: a community study of octogenarian men. Am J Geriatr Psychiatry 2015; 23:234-42. [PMID: 24200595 DOI: 10.1016/j.jagp.2013.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 09/10/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To determine the association between clinically significant depressive symptoms, routine function, and sexual interest and practice in a community-derived sample of octogenarian men. METHODS Cross-sectional study of 1,649 community-dwelling men aged 80 years or over with no history of terminal illnesses or neurodegenerative diseases. Men with Patient Health Questionnaire (PHQ-9) scores greater than or equal to 10 were deemed to be clinically depressed. Scores between 5 and 9 were considered indicative of subthreshold depression. We used standard procedures to collect self-reported sociodemographic, lifestyle, and clinical data, as well as basic and instrumental activities of daily living, and a structured questionnaire to ask men about their 12-month interest in sex, frequency, past experiences, and current sexual problems. RESULTS 121 men (7.3%) had clinically significant depression and 239 (14.5%) had subthreshold depression. Depressive symptoms were associated with difficulties in basic and instrumental activities of daily living, but not with sexual practice. Decreased interest in sex and anxiety before sex were associated with subthreshold depression. Clinically significant depressive symptoms were independently and positively associated with past history of diabetes (odds ratio [OR]: 2.1, 95% confidence interval [CI]: 1.1-4.0), depression (OR: 9.0; 95% CI: 4.6-17.3), impaired ability to groom (OR: 3.7, 95% CI: 1.2-11.0), carry out heavy housework duties (OR: 2.4, 95% CI: 1.1-5.1), manage finances (OR: 2.5, 95% CI: 1.1-5.7), or engage in leisure activities (OR: 4.1, 95% CI: 2.0-8.2). CONCLUSIONS Ability to function effectively at home, financial autonomy, and leisure are associated with clinically significant depression in octogenarian men. Maintaining daily function and autonomy may be a suitable target for interventions that aim to reduce the prevalence and incidence of depression in older age.
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Affiliation(s)
- Osvaldo P Almeida
- School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Western Australia, Australia; Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia; Department of Psychiatry, Royal Perth Hospital, Perth, Western Australia, Australia.
| | - Bu B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Department of Endocrinology and Diabetes, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Graeme J Hankey
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Department of Neurology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
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Siordia C. Disability Prevalence According to a Class, Race, and Sex (CSR) Hypothesis. J Racial Ethn Health Disparities 2014; 2:303-10. [PMID: 26539340 DOI: 10.1007/s40615-014-0073-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Disability has been shown to be related in definite ways to social class. In modern industrial societies, disability is influenced by and has the potential to contribute to the production and reproduction of social inequality. However, markers of social stratification processes are sometimes ignored determinants of health. A Class, Race, Sex (CRS) hypothesis is presented to argue that a "low-education disadvantage"; "racial-minority disadvantage"; and "female disadvantage" will compound to affect the risks for being disable. In particular, the CRS hypothesis posits that class is more important than race and the latter more than sex when predicting presence or severity of disability. The cross-sectional study of community-dwelling adults between the ages of 45 and 64 uses data from the American Community Survey (ACS) Public Use Microdata Sample (PUMS) 2008-2012 file. By using 3,429,523 individuals-which weighted equal to 61,726,420-the results of the study suggest the CRS hypothesis applies to both Non-Latino-Blacks and Non-Latino-Whites. There is a "male disadvantage" exception for Non-Latino-Whites. Decreasing between-group differences in health may be achieved by making the age-health association at lower socioeconomic stratum similar to that of the upper socioeconomic strata.
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Affiliation(s)
- Carlos Siordia
- PhD, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
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Clark SD, Birkin M, Heppenstall A. Sub regional estimates of morbidities in the English elderly population. Health Place 2014; 27:176-85. [PMID: 24631924 DOI: 10.1016/j.healthplace.2014.02.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 02/14/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
Abstract
This study focuses on identifying the future trends and spatial concentrations of morbidities in the English elderly population. The morbidities to be estimated are: coronary heart disease; strokes; diabetes; cancer; respiratory illnesses and arthritis in the 60 year and older household residential population. The technique used is a spatial microsimulation of the elderly population of local authorities in England using data from the 2001 Census and the English Longitudinal Study of Ageing. The longitudinal nature of the microsimulated population is then used to estimate the morbidity prevalences for local authorities in 2010/2011. With this knowledge, planners will be able to focus the available health and care resources in those areas with greatest need. For most of these morbidities, there is evidence of a strong correlation between the type of authority and the estimated prevalence rates.
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Affiliation(s)
- Stephen D Clark
- School of Geography, University of Leeds, Leeds LS2 9JT, United Kingdom.
| | - Mark Birkin
- School of Geography, University of Leeds, Leeds LS2 9JT, United Kingdom
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Wahrendorf M, Reinhardt JD, Siegrist J. Relationships of disability with age among adults aged 50 to 85: evidence from the United States, England and continental europe. PLoS One 2013; 8:e71893. [PMID: 23977172 PMCID: PMC3743762 DOI: 10.1371/journal.pone.0071893] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 07/04/2013] [Indexed: 11/19/2022] Open
Abstract
Objectives To extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions. Methods We used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity). Results Findings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA. Conclusions This paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability.
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Affiliation(s)
- Morten Wahrendorf
- International Centre for Life Course Studies in Society and Health (ICLS), Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
- * E-mail:
| | - Jan D. Reinhardt
- Swiss Paraplegic Research, Nottwil, Switzerland
- University of Lucerne, Department of Health Sciences & Health Policy, Lucerne, Switzerland
| | - Johannes Siegrist
- Senior Professorship on Work Stress Research, Faculty of Medicine, University of Duesseldorf, Duesseldorf, Germany
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Martin LG, Schoeni RF, Andreski PM, Jagger C. Trends and inequalities in late-life health and functioning in England. J Epidemiol Community Health 2011; 66:874-80. [PMID: 22147749 DOI: 10.1136/jech-2011-200251] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Recently, late-life disability rates have declined in several countries of the Organisation for Economic Co-operation, but no national-level trend analysis for England has been available. The authors provide such analysis, including measures both early and late in the disablement process, and the authors investigate the extent to which temporal trends are associated with population changes in socioeconomic position (SEP). METHODS The authors fit logistic models of trends in self-reports and nurse measures of 16 health indicators, based on cross-sectional data from those aged 65 years and older from the 1992 to 2007 Health Survey for England. RESULTS Overall, prevalence rates of limitations in seeing, hearing and usual activities declined (p<0.05); ever smoking, measured high blood pressure, high cholesterol, and high C reactive protein decreased (p<0.05); and the proportion with limitations in self-care activities remained stable. But obesity and limitations in walking 200 yards and climbing stairs increased (p<0.05). Increases over time in education and non-manual social class membership were associated with declines in smoking, C reactive protein and problems with usual activities. Had the changes in SEP not occurred, the increases in problems walking and climbing would have been greater. People with less education or of manual social classes experienced relatively worse trends for hearing, mobility functions and usual activities. The opposite was true for seeing. CONCLUSIONS Recent trends in late-life health and functioning in England have been mixed. A better understanding of which specific activities pose challenges, how the environment in which activities are conducted influences functioning and the causes of relatively worse trends for some SEP groups is needed.
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Schafer MH, Ferraro KF. Distal and variably proximal causes: education, obesity, and health. Soc Sci Med 2011; 73:1340-8. [PMID: 21920651 DOI: 10.1016/j.socscimed.2011.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 04/18/2011] [Accepted: 08/06/2011] [Indexed: 11/26/2022]
Abstract
Medical sociologists hold that social conditions generate disparities across a host of health conditions through exposure to a variety of more proximate risk factors. Though distal and proximal causes jointly influence disease, the nature of risk accumulation may differ appreciably by the link of a proximal cause to the outcome in question. This paper employs a representative sample of over 3000 American older adults to examine whether position in the educational gradient amplifies the effect of obesity on two health outcomes. Results indicate that educational inequalities amplify the effect of high body mass index on disability (unstandardized coefficients across education groups range from -.05 [ns] to .26 [p < .01] among overweight respondents yet reach .17 [ns] to .73 [p < .001] among severely obese adults), but fail to amplify the consequences of severe obesity in the case of C-reactive protein (CRP) levels. Instead, educational gradients in CRP are most pronounced at lower levels of body mass. Sex-specific analyses further clarify these patterns, as the connections between CRP and body mass are particularly strong among women. We conclude that risk accumulation processes differ based on the proximity of causes to the health outcome under examination.
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Affiliation(s)
- Markus H Schafer
- University of Toronto, Department of Sociology, 725 Spadina Ave, Toronto, ON Canada.
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Occupational inequalities in health expectancies in France in the early 2000s: Unequal chances of reaching and living retirement in good health. DEMOGRAPHIC RESEARCH 2011. [DOI: 10.4054/demres.2011.25.12] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Szwarcwald CL, da Mota JC, Damacena GN, Pereira TGS. Health inequalities in Rio de Janeiro, Brazil: lower healthy life expectancy in socioeconomically disadvantaged areas. Am J Public Health 2011; 101:517-23. [PMID: 21233437 DOI: 10.2105/ajph.2010.195453] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We investigated deprivation and inequalities in life expectancy and healthy life expectancy by location in Rio de Janeiro, Brazil. METHODS We conducted a health survey of 576 adults in 2006. Census tracts were stratified by income level and categorization as a slum. We determined health status by degree of functional limitation, according to the approach proposed by the World Health Organization. We calculated healthy life expectancies by Sullivan's method with abridged life table. RESULTS We found the worst indicators in the slum stratum. The life expectancy at birth of men living in the richest parts of the city was 12.8 years longer than that of men living in deprived areas. For both men and women older than age 65 years, healthy life expectancy was more than twice as high in the richest sector as in the slum sector. CONCLUSIONS Our analysis detailed the excess burden of poor health experienced by disadvantaged populations of Rio de Janeiro. Policy efforts are needed to reduce social inequalities in health in this city, especially among the elderly.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Laboratório de Informações em Saúde, Institute of Communication and Scientific and Technologic Information in Health, Rio de Janeiro, Brazil.
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Muangpaisan W, Assantachai P, Intalapaporn S, Richardson K, Brayne C. Health expectancies in the older Thai population. Arch Gerontol Geriatr 2010; 53:3-7. [PMID: 20570376 DOI: 10.1016/j.archger.2010.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Revised: 03/30/2010] [Accepted: 04/01/2010] [Indexed: 11/30/2022]
Abstract
This study aims to investigate health expectancies in five domains: cognitive health, psychological health, physical health, functional ability and self-perceived global health (SPGH) in the older Thai population. There are few studies reporting health expectancies in multidimensional health domains, most of which reported only one health dimension. The dataset used was from the Bangkok Longitudinal Study by Siriraj Hospital for the Older Men and Women (BLOSSOM), which is a community cohort study in Bangkok, Thailand. This analysis is based on the cross-sectional data in the year 2005-2006 and includes 5936 participants aged 50 years and over from community settings within six suburban areas in Bangkok. The study found that women had a longer total life expectancy (LE), but had shorter cognitive impairment-free (CIFLE), physical illness-free (PHILE) and disability-free (DIFLE) LEs, than men. However, there was no difference between the life expectancies for living with good SPGH in men and in women. Differences in health expectations might explain this finding. Health promotion and disease prevention should be initiated at a younger age and should target all health domains.
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Affiliation(s)
- Weerasak Muangpaisan
- Department of Preventive and Social Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
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Impact of socioeconomic status on the prevalence of dementia in an inner city memory disorders clinic. Int Psychogeriatr 2009; 21:1096-104. [PMID: 19712540 DOI: 10.1017/s1041610209990846] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Socioeconomic status (SES) has been identified as a possible risk factor for the development of dementia, with low SES shown to be associated with a higher prevalence of dementia, increased psychiatric comorbidity and worse baseline cognitive functioning. Few studies have actually looked at the impact of SES within a clinical population using multiple measures of SES and cognition. METHODS Data on 217 patients seen in an Inner City Memory Disorders Clinic were analyzed with respect to demographic status, clinical status and SES. Correlations were then examined looking at the relationship of SES to clinical variables and neurocognitive status. Regression analysis was undertaken to examine the relative contribution of individual sociodemographic factors to a diagnosis of dementia. RESULTS In general, there was wide variation in the sample examined with respect to most measures of SES. Approximately one third (36%) of the sample had a diagnosis of dementia, the mean age was 66.1 years and the mean Mini-mental State Examination score was relatively high (25.4). There was a strong association between age, individual annual income range, education, medical comorbidity and a diagnosis of dementia, with increased age and medical comorbidity being the strongest predictors. CONCLUSION Increased age, low education, high medical comorbidity and low annual income are all associated with a diagnosis of dementia in an inner city setting. Age and medical comorbidity appear to be more strongly associated with a diagnosis of dementia than SES in an inner city setting.
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Batljan I, Lagergren M, Thorslund M. Population ageing in Sweden: the effect of change in educational composition on the future number of older people suffering severe ill-health. Eur J Ageing 2009; 6:201-211. [PMID: 28798604 DOI: 10.1007/s10433-009-0120-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We investigate how expected changes in the educational level composition of the older population may affect future prevalence of severe ill-health among older people in Sweden. Previous research has indicated that the number of older people, given educational differentials in mortality and expected changes in educational composition during the next decades, may increase more than expected following official population projections in Sweden. Eight alternative scenario projections for the possible development in the number of people with severe ill-health in Sweden between 2000 and 2035 are presented. Scenario projections, where both morbidity and mortality inequalities by educational level are taken into account, are compared with scenarios in which only age and gender are modelled. The projections are made with both constant and decreasing mortality. The calculations show that the expected increases in severe ill-health as a result from the ageing of the population in the period 2000-2035 might, to a large extent, be counteracted by the increase in the educational level of the Swedish population. We recommend therefore that in projections of the prevalence of ill-health, in addition to the ageing of the population, also changes in educational level should be taken into account.
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Affiliation(s)
- Ilija Batljan
- Aging Research Center, Karolinska Institute and Stockholm University, Stockholm, Sweden.,Municipality of Nynäshamn, 149 81 Nynäshamn, Sweden
| | | | - Mats Thorslund
- Aging Research Center, Karolinska Institute and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
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Syddall H, Evandrou M, Cooper C, Sayer AA. Social inequalities in grip strength, physical function, and falls among community dwelling older men and women: findings from the Hertfordshire Cohort Study. J Aging Health 2009; 21:913-39. [PMID: 19597159 DOI: 10.1177/0898264309340793] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. To explore social inequalities in grip strength, SF-36 physical functioning (PF), and falls among older people. Methods. We analyzed data from 3,225 men and women (age 59-73 years) who participated in the Hertfordshire Cohort Study, United Kingdom. Car availability and home ownership were used as markers of material deprivation. Results. A total of 6.4% of men (17.7% women) had no car and 19.3% of men (23.1% women) did not own their home. Having fewer cars was associated with lower grip and poorer PF among men and women (p < .001), and increased falls among men (p < .001). Not owning one's home was associated with lower grip in men and women (p < .001) and poorer PF in men (p < .001). Lower social class was associated with falls among women only (p = .01). Discussion. There are social inequalities in grip strength, PF, and falls among older people. Interventions should consider the contribution of social inequalities to the problem.
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Affiliation(s)
- Holly Syddall
- Epidemiology Resource Centre, University of Southampton, Southhampton General Hospital, Southhampton SO16 6YD, UK.
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Reproductive history, socioeconomic status and disability in the women aged 65 years or older in Turkey. Arch Gerontol Geriatr 2009; 50:11-5. [PMID: 19230990 DOI: 10.1016/j.archger.2009.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 12/28/2008] [Accepted: 01/07/2009] [Indexed: 11/22/2022]
Abstract
Pregnancy and childbirth are an important physiological and emotional phenomenon in their lives for most women and studies have shown that this process may have a significant impact on their health at later ages. The objective of the study is to examine the relationship between functional disabilities in women over the age of 65 and their reproductive history and socioeconomic status. This is a cross-sectional study. The study group consisted of 543 women aged 65 or over. A general questionnaire and the Brief Disability Questionnaire (BDQ) were used to collect data with face-to-face interview in home visits. Of the women 79.2% have disability. First childbirth was experienced at the average age of 19.6+/-3.3 and the average age at which the women experienced their last delivery was 32.5+/-6.3. Parity was 4.1+/-1.7. Advanced age, being widowed and illiterate, less income, being outside of the middle class and having more than four children are important determinants for later life disability. The study highlights the importance of focusing not just on the short-term effects of childbearing and socioeconomic factors, but also of taking into account the possibility of long-term effects on disability in older women.
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Jagger C, Gillies C, Moscone F, Cambois E, Van Oyen H, Nusselder W, Robine JM. Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis. Lancet 2008; 372:2124-31. [PMID: 19010526 DOI: 10.1016/s0140-6736(08)61594-9] [Citation(s) in RCA: 197] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although life expectancy in the European Union (EU) is increasing, whether most of these extra years are spent in good health is unclear. This information would be crucial to both contain health-care costs and increase labour-force participation for older people. We investigated inequalities in life expectancies and healthy life years (HLYs) at 50 years of age for the 25 countries in the EU in 2005 and the potential for increasing the proportion of older people in the labour force. METHODS We calculated life expectancies and HLYs at 50 years of age by sex and country by the Sullivan method, which was applied to Eurostat life tables and age-specific prevalence of activity limitation from the 2005 statistics of living and income conditions survey. We investigated differences between countries through meta-regression techniques, with structural and sustainable indicators for every country. FINDINGS In 2005, an average 50-year-old man in the 25 EU countries could expect to live until 67.3 years free of activity limitation, and a woman to 68.1 years. HLYs at 50 years for both men and women varied more between countries than did life expectancy (HLY range for men: from 9.1 years in Estonia to 23.6 years in Denmark; for women: from 10.4 years in Estonia to 24.1 years in Denmark). Gross domestic product and expenditure on elderly care were both positively associated with HLYs at 50 years in men and women (p<0.039 for both indicators and sexes); however, in men alone, long-term unemployment was negatively associated (p=0.023) and life-long learning positively associated (p=0.021) with HLYs at 50 years of age. INTERPRETATION Substantial inequalities in HLYs at 50 years exist within EU countries. Our findings suggest that, without major improvements in population health, the target of increasing participation of older people into the labour force will be difficult to meet in all 25 EU countries. FUNDING EU Public Health Programme.
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Affiliation(s)
- Carol Jagger
- Department of Health Sciences, University of Leicester, Leicester, UK.
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Parahyba MI, Stevens K, Henley W, Lang IA, Melzer D. Reductions in disability prevalence among the highest income groups of older Brazilians. Am J Public Health 2008; 99:81-6. [PMID: 19008509 DOI: 10.2105/ajph.2007.130708] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to identify the income-disability prevalence relationship among older Brazilians. METHODS Data were from 63,985 individuals 60 years and older from the 1998 and 2003 Brazilian National Household Surveys. Generalized additive logistic models with cubic regression splines were used to estimate the disability-income relationships. RESULTS There was a strong linear relationship between increased income and reduced disability prevalence for most of the income distribution. Benefits were still present above the 90th percentile of income but were more modest. Because incomes among the wealthiest few are disproportionately large, odds ratios of disability nevertheless showed marked improvements, even across the very highest income groups. CONCLUSIONS Among older Brazilians, reduced disability is associated with higher income, and these associations are present even above the 90th percentile of income. In addition to understanding mechanisms of disability reduction among impoverished individuals, work is needed to understand these mechanisms in middle- and high-income groups.
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Affiliation(s)
- Maria Isabel Parahyba
- Instituto Brasileiro de Geografia e Estatística, Coordenação de População e Indicadores Sociais, Av. República do Chile, 500/8 degrees andar, Centro, Rio de Janeiro, 20031-170, Brazil.
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Mwachofi AK, Broyles R. Is Minority Status a More Consistent Predictor of Disability Than Socioeconomic Status? JOURNAL OF DISABILITY POLICY STUDIES 2008. [DOI: 10.1177/1044207308315275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Applying the social and capabilities models of disability and using individuals as the unit of analysis, the authors examined the consistency of socioeconomic status and membership in a minority group as covariates of four dimensions of disability. Using the responses of 260,062 individuals to the 2003 Behavioral Risk Factor Surveillance System, the authors examined three binary variables identifying individuals who required assistive devices or experienced at least 1 day of limited activity because of physical, emotional, or mental problems or because of only physical problems. Among 55,026 respondents who experienced at least 1 day of limited activity, the authors examined variation in the number of disability days. After health needs, lifestyle risks, demographic attributes, and access to care were controlled, the results indicated that socioeconomic status is a more consistent predictor of disability than membership in a minority group.
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Wood R, Sutton M, Clark D, McKeon A, Bain M. Measuring inequalities in health: the case for healthy life expectancy. J Epidemiol Community Health 2007; 60:1089-92. [PMID: 17108308 PMCID: PMC2465513 DOI: 10.1136/jech.2005.044941] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate healthy life expectancy (HLE) as a measure of health inequalities by comparing geographical and area-based deprivation-related inequalities in healthy and total life expectancy (TLE). DESIGN Life table analysis based on ecological cross-sectional data. SETTING AND POPULATION Council area quarters and postcode sector-based deprivation fifths in Scotland. MAIN OUTCOME MEASURES Expectation of life in good self-assessed general health, or free from limiting long-term illness, and TLE, for females and males at birth. RESULTS Women in Scotland have a life expectation of 70.3 years in good health, 61.6 years free from limiting long-term illness, and a TLE of 78.9 years. Comparable figures for men are 66.3, 58.6 and 73.5 years. TLE and HLE decrease with increasing area deprivation. Differences are substantially wider for HLE. A 4.7-year difference is seen in TLE between women living in the most and least deprived fifth of areas. The difference in HLE is 10.7 years in good health and 11.6 years free from limiting long-term illness. The degree of deprivation-related inequality in HLE is 2.5 times wider for women and 1.8 times wider for men than in TLE. CONCLUSIONS Differences in TLE underestimate health inequalities substantially. By including morbidity and mortality, HLE reflects the excess burden of ill health experienced by disadvantaged populations better. Inequalities in length of life and health status during life should be taken into account while monitoring inequalities in population health.
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Affiliation(s)
- Rachael Wood
- Centre for International Public Health Policy, School of Health in Social Science, University of Edinburgh, Medical Quad, Teviot Place, Edinburgh EH8 9AG, Scotland, UK.
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Basta NE, Matthews FE, Chatfield MD, Brayne C. Community-level socio-economic status and cognitive and functional impairment in the older population. Eur J Public Health 2007; 18:48-54. [PMID: 17631489 DOI: 10.1093/eurpub/ckm076] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study aimed to determine if people living in communities with higher socio-economic deprivation are at an increased risk of cognitive and functional impairment even after controlling for the effects of individual socio-economic status. METHODS We analysed cross-sectional data from the Medical Research Council Cognitive Function and Ageing Study which consists of a community-based sample of Cambridgeshire, Gwynedd, Newcastle, Nottingham and Oxford. The study included 13 004 men and women aged 65 years and over who were randomly selected from Family Health Services Authority computerized records after being stratified to ensure equal numbers of those aged 75 years and over and those under 75 years. The outcome measures were cognitive impairment (Mini-Mental State Exam 0-21) and functional impairment (Instrumental Activities of Daily Living and/or Activities of Daily Living disability). RESULTS Individuals living in more deprived areas, as measured by the Townsend deprivation score, were found to have a higher prevalence of cognitive impairment [odds ratio (OR) (most deprived versus least deprived quintile) = 2.3; 95% confidence interval (CI)1.8-3.0; P < 0.001] and functional impairment [OR (most deprived versus least) = 1.6; 95% CI 1.4-1.9; P < 0.001] after controlling for age, sex, centre effects, education and social class. CONCLUSIONS There is a significantly higher prevalence of cognitive impairment and functional impairment in elderly individuals living in socio-economically deprived areas regardless of their own socio-economic status. This evidence is of relevance for informing public health policy and those allocating resources for the long-term care of the elderly.
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Affiliation(s)
- Nicole E Basta
- Florida Epidemic Intelligence Service, Florida Department of Health, Naples, FL, USA
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Jagger C, Matthews R, Melzer D, Matthews F, Brayne C. Educational differences in the dynamics of disability incidence, recovery and mortality: Findings from the MRC Cognitive Function and Ageing Study (MRC CFAS). Int J Epidemiol 2007; 36:358-65. [PMID: 17255347 DOI: 10.1093/ije/dyl307] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aims to establish the extent of educational differences in the disability transitions of incidence, recovery and mortality in people aged 65 years and over, whether these can be explained by differentials in disease burden and their relative contribution to educational differences in prevalence and disability-free life expectancy (DFLE). METHODS A stratified random sample of 13 004 participants in five areas in England and Wales were interviewed in 1991-94 and followed up at 2, 6 (one centre only) and 10 years. Two levels of disability were analysed: mobility difficulty and activities of daily living (ADL) disability. We fitted logistic regression models to model educational differences in disability prevalence, incidence, recovery and mortality transitions. DFLE was calculated to assess the combined effect of the dynamic transitions. RESULTS Those with < or =9 years education had higher ADL and mobility disability prevalence and higher incidence and lower recovery of mobility disability. Differences in disability incidence remained after adjustment for comorbidity. Women with the lowest education had shorter life expectancies (1.7 years less at the age of 65 years) than the most educated and had even shorter DFLE (1.9 years free of ADL disability and 2.8 years free of mobility difficulty at the age of 65 years). CONCLUSIONS Differentials in education continue to contribute to prevalence of disability at ages beyond 65 years in both men and women and independently of diseases. These appear to be driven predominantly by differentials in disability incidence that also compound to produce greater differentials in DFLE between education groups than in total years lived.
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Affiliation(s)
- Carol Jagger
- Leicester Nuffield Research Unit, Department of Health Sciences, University of Leicester, Leicester, UK.
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Gardener EA, Huppert FA, Guralnik JM, Melzer D. Middle-aged and mobility-limited: prevalence of disability and symptom attributions in a national survey. J Gen Intern Med 2006; 21:1091-6. [PMID: 16970558 PMCID: PMC1831629 DOI: 10.1111/j.1525-1497.2006.00564.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Lower limb mobility disabilities are well understood in older people, but the causes in middle age have attracted little attention. OBJECTIVES To estimate the prevalence of mobility disabilities among noninstitutionalized adults in England and to compare the disabling symptoms reported by middle-aged and older people. DESIGN Cross-sectional data from the 2002 English Longitudinal Study of Ageing (ELSA). Mobility disability was identified by level of reported difficulty walking a quarter mile. PARTICIPANTS Eleven thousand two hundred sixteen respondents aged 50 years and older living in private households in 2002. RESULTS The prevalence of difficulty walking a quarter mile increases sharply with age, but even in the middle-aged (50 to 64 years age-group) 18% (95% confidence interval [CI]: 16% to 19%) of men and 19% (95% CI: 17% to 20%) of women reported some degree of difficulty. Of the 16 main symptoms reported as causing mobility disability in middle age, 2 dominated: pain in the leg or the foot (43%; 95% CI: 40% to 46%) and shortness of breath/dyspnea (21%; 95% CI: 18% to 23%). Fatigue or tiredness, and stability problems were cited by only 5% and 6%, respectively. These proportions were slightly different from those in the 65 to 79-year age group: 40%, 23%, 6%, and 8%, respectively. CONCLUSIONS Mobility (walking) disabilities in the middle-aged are relatively common. The symptoms reported as causes in this age group differ little from those reported by older groups, and are dominated by lower limb pain and shortness of breath. More clinical attention paid to disabling symptoms may lead to disability reductions in later life.
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Affiliation(s)
- Elizabeth A Gardener
- Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Cambridge, UK
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Brayne C, McCracken C, Matthews FE. Cohort profile: the Medical Research Council Cognitive Function and Ageing Study (CFAS). Int J Epidemiol 2006; 35:1140-5. [PMID: 16980700 DOI: 10.1093/ije/dyl199] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Carol Brayne
- Department of Public Health and Primary Care, Institute of Public Health, Cambridge University, Forvie Site, Robinson Way, Cambridge CB2 2SR, UK.
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Abstract
Most studies on health trends in the elderly population focus on specific conditions, studied one at a time. However, health problems are often interrelated and exist simultaneously in late life. Individuals with health problems in several domains present special challenges to care services. To estimate future needs for care it may be relevant to study trends of complex health problems as well as single health items. This study identified serious problems in three domains (diseases/symptoms, mobility, cognition/communication) in two representative samples of the Swedish population aged 77 and older (1992: n=537; 2002: n=561). People with serious problems in two or three domains were considered to have complex health problems. Changes between 1992 and 2002 in the prevalence of persons having serious problems in no, one and two/three domains were analyzed with logistic regressions. When examining each domain separately all three showed a significant increase of serious problems. For diseases/symptoms the increase remained significant after controlling for different age and gender distributions in the two surveys. Results showed a significant increase in the prevalence of having problems in one domain, as well as having problems in two or three domains (complex problems). Results persisted when adjusting for different distributions in age, gender and education between 1992 and 2002. Results suggest a worsening of health during the 10-year period and an increase of complex problems. This emphasizes the necessity of cooperation and collaboration between different kinds of medical and social services for elderly people.
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Matthews RJ, Jagger C, Hancock RM. Does socio-economic advantage lead to a longer, healthier old age? Soc Sci Med 2006; 62:2489-99. [PMID: 16364526 DOI: 10.1016/j.socscimed.2005.11.019] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Indexed: 11/24/2022]
Abstract
The effect of socio-economic disadvantage on mortality is well documented and differences exist even at older ages. However, whether this translates into differences in the quality of life lived at older ages is less well studied, and in particular in the proportion of remaining life spent without ill health (healthy life expectancy), a key UK Government target. Although there have been studies exploring socio-economic differences in disability-free life expectancy (DFLE) worldwide, these have tended to focus on a single measure of socio-economic advantage, for example, education, race, social class or income, with the majority based on cross-sectional data from younger populations. In this prospective study we examine differences in DFLE and total life expectancy (TLE) at older ages using a range of measures of socio-economic advantage. We use a longitudinal study of 1480 participants aged 75 years or over in 1988 registered with a UK primary care practice, who were followed up until 2003 with measurements at up to seven time points. Disability was defined as difficulty with any one of five activities of daily living. The largest differences in DFLE for both men and women were found for housing tenure. Women aged 75 years living in owned or mortgaged property could expect to live 1 year extra without disability compared with those living in rented accommodation, while for men the difference was almost 1.5 years. The effect of socio-economic advantage on disability-free and total life expectancies appeared to be larger for men than women. In women, socio-economic advantage had more effect on DFLE than total life expectancy for all indicators considered, thus the socio-economically advantaged experienced a compression of disability.
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Rautio N, Adamson J, Heikkinen E, Ebrahim S. Associations of socio-economic position and disability among older women in Britain and Jyväskylä, Finland. Arch Gerontol Geriatr 2006; 42:141-55. [PMID: 16125807 DOI: 10.1016/j.archger.2005.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Revised: 06/17/2005] [Accepted: 06/21/2005] [Indexed: 11/30/2022]
Abstract
The aim was to compare the pattern of associations in measures of socio-economic position and disability among British and Finnish older women. In Britain data from the British Women's Heart and Health Study was used. Women from 23 towns took part in a nurse-assessed medical examination and postal questionnaire (n = 4286). In Finland, data from the Evergreen study was used. Eight hundred and four women from the city of Jyväskylä were interviewed at home. Socio-economic position was measured according to social class in childhood, education, use of a car, home ownership and previous occupation. Disability measures included questions on difficulties in washing/dressing and climbing stairs. Logistic regression analyses were conducted to examine the relationship between disability and socio-economic position. In the age-adjusted analysis of both samples increasing disability in washing/dressing and climbing stairs was associated with at least one of the measures of deprivation. The relationship between socio-economic position and disability was more distinct in the British than Finnish women. Despite adjustment for a range of confounders, the relationship between socio-economic position and disability was not much attenuated, particularly in the British women. The associations in the measures of socio-economic position and disability showed a slightly different pattern between the British and Finnish women.
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Affiliation(s)
- Nina Rautio
- The Finnish Center for Interdisciplinary Gerontology, P.O. Box 35 (Viveca), FIN-40014 University of Jyväskylä, Finland.
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Nusselder WJ, Looman CWN, Mackenbach JP, Huisman M, van Oyen H, Deboosere P, Gadeyne S, Kunst AE. The contribution of specific diseases to educational disparities in disability-free life expectancy. Am J Public Health 2005; 95:2035-41. [PMID: 16195519 PMCID: PMC1449480 DOI: 10.2105/ajph.2004.054700] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2005] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the contribution that specific diseases, as causes of both death and disability, make to educational disparities in disability-free life expectancy (DFLE). METHODS We used disability data from the Belgian Health Interview Survey (1997) and mortality data from the National Mortality Follow-Up Study (1991-1996) to assess education-related disparities in DFLE and to partition these differences into additive contributions of specific diseases. RESULTS The DFLE advantage of higher-educated compared with lower-educated persons was 8.0 years for men and 5.9 years for women. Arthritis (men, 1.3 years; women, 2.2 years), back complaints (men, 2.1 years), heart disease/stroke (men, 1.5 years; women, 1.6 years), asthma/chronic obstructive pulmonary disease (COPD) (men, 1.2 years; women, 1.5 years), and "other diseases" (men, 2.4 years) contributed the most to this difference. CONCLUSIONS Disabling diseases, such as arthritis, back complaints, and asthma/COPD, contribute substantially to differences in DFLE by education. Public health policy aiming to reduce existing disparities in the DFLE and to improve population health should not only focus on fatal diseases but also on these nonfatal diseases.
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Affiliation(s)
- Wilma J Nusselder
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
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