All-cause mortality over a three-year period among community-dwelling older adults in Southern Brazil

The association between disability and all-cause mortality in low-income and middle-income countries: a systematic review and meta-analysis

BACKGROUND

There are 1·3 billion people with disabilities globally. On average, they have poorer health than their non-disabled peers, but the extent of increased risk of premature mortality is unknown. We aimed to systematically review the association between disability and mortality in low-income and middle-income countries (LMICs).

METHODS

We searched MEDLINE, Global Health, PsycINFO, and EMBASE from Jan 1, 1990 to Nov 14, 2022. Longitudinal epidemiological studies in any language with a comparator group that measured the association between disability and all-cause mortality in people of any age were eligible for inclusion. Two reviewers independently assessed study eligibility, extracted data, and assessed risk of bias. We used a random-effects meta-analysis to calculate the pooled hazard ratio (HR) for all-cause mortality by disability status. We then conducted meta-analyses separately for different impairment and age groups.

FINDINGS

We identified 6146 unique articles, of which 70 studies (81 cohorts) were included in the systematic review, from 22 countries. There was variability in the methods used to assess and report disability and mortality. The meta-analysis included 54 studies, representing 62 cohorts (comprising 270 571 people with disabilities). Pooled HRs for all-cause mortality were 2·02 (95% CI 1·77-2·30) for people with disabilities versus those without disabilities, with high heterogeneity between studies (τ2=0·23, I2=98%). This association varied by impairment type: from 1·36 (1·17-1·57) for visual impairment to 3·95 (1·60-9·74) for multiple impairments. The association was highest for children younger than 18 years (4·46, [3·01-6·59]) and lower in people aged 15-49 years (2·45 [1·21-4·97]) and people older than 60 years (1·97 [1·65-2·36]).

INTERPRETATION

People with disabilities had a two-fold higher mortality rate than people without disabilities in LMICs. Interventions are needed to improve the health of people with disabilities and reduce their higher mortality rate.

FUNDING

UK National Institute for Health and Care Research; and UK Foreign, Commonwealth and Development Office.

The association between disability and mortality: a mixed-methods study

BACKGROUND

Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities.

METHODS

We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374.

FINDINGS

Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ2=0·28, I2=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types.

INTERPRETATION

Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health.

FUNDING

National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.

Functional dentition and edentulism associated with mortality: A cohort study of older adults in Southern Brazil

OBJECTIVE

The aim of this study was to evaluate the association between the lack of a functional dentition and edentulism with mortality in a cohort of older adults in a Southern Brazilian city.

MATERIALS AND METHODS

This is a longitudinal study carried out with community-dwelling older adults (≥60 years old) from Pelotas, Brazil, using data from the baseline (2014) and the first follow-up (2017). Main exposures were functional dentition (20+ teeth present) and edentulism (absence of all teeth), derived from self-reported number of teeth. All-causes mortality was evaluated according to the city's Epidemiological Surveillance Department. Potential confounders were age, sex, socioeconomic position, smoking, diabetes, hypertension, and body mass index (BMI). To test the association between functional dentition and edentulism with mortality, Poisson regression models with robust variance were used, to estimate Relative Risks and 95% confidence intervals.

RESULTS

A total of 1289 older adults had information on all variables of interest and comprise the analytical sample (from 1451 at baseline). When analysing the presence of functional dentition, only 222 individuals (17.2%) had 20 or more teeth in their mouth, while 490 older adults were edentulous (38.0%). Crude analysis showed an association between tooth loss indicators and mortality. Models adjusted for sociodemographic variables and health conditions and behaviours revelled no association between the exposures and mortality.

CONCLUSIONS

With the findings of this study, we did not identify an association between edentulism and functional dentition with mortality, after considering important shared risk factors.

Mortality risk factors in community-dwelling, subjectively healthy, Swiss older adults: update after 8-years follow-up

BACKGROUND

Worldwide population is ageing, but little is known regarding risk factors associated with increased mortality in subjectively healthy, community-dwelling older adults. We present the updated results of the longest follow-up carried out on Swiss pensioners and we provide results on potential risk factors associated with mortality before the onset of the COVID-19 pandemic.

MATERIALS AND METHODS

Within the SENIORLAB study, we collected demographic data, anthropometric measures, medical history, and laboratory parameters of 1467 subjectively healthy, community-dwelling, Swiss adults aged ≥ 60 years over a median follow-up of 8.79 years. The variables considered in the multivariable Cox-proportional hazard model for mortality during follow-up were selected based on prior knowledge. Two separate models for males and females were calculated; moreover, we fitted the old model obtained in 2018 to the complete follow-up data to highlight differences and similarities.

RESULTS

The population sample included 680 males and 787 females. Age of participants ranged between 60 and 99 years. We experienced 208 deaths throughout the entire follow-up period; no patients were lost at follow-up. The Cox-proportional hazard regression model included female gender, age, albumin levels, smoking status, hypertension, osteoporosis and history of cancer within predictors of mortality over the follow-up period. Consistent findings were obtained also after gender stratification. After fitting the old model, female gender, hypertension, and osteoporosis still showed statistically significant independent associations with all-cause mortality.

CONCLUSIONS

Understanding the predictors of a healthy survival can improve the overall quality of life of the ageing population and simultaneously reduce their global economic burden.

TRIAL REGISTRATION

The present study was registered in the International Standard Randomized Controlled Trial Number registry: https://www.isrctn.com/ISRCTN53778569 (registration date: 27/05/2015).

Age is the most important factor for change in body mass index and waist circumference in older people in southern Brazil

OBJECTIVES

The aim of this study is to assess the changes in body mass index and waist circumference (WC) and their associations with sociodemographic, behavioral, and health characteristics in non-institutionalized older people in southern Brazil over a period of ≤6 y.

METHODS

This is a prospective study, with interviews conducted in 2014 and in 2019 to 2020. Of the 1451 individuals from Pelotas, Brazil, aged >60 y and interviewed in 2014, 537 were reevaluated in 2019 to 2020. An increase or decrease was defined as a variation of ≥5% in body mass index and WC in the second visit compared with the first. The association with changes in outcomes was assessed according to sociodemographic, behavioral, and health characteristics using multinomial logistic regression.

RESULTS

Approximately 29% of the older participants lost body mass. Regarding WC, there was an increase in 25.6% in the older participants. The older participants ages ≥80 y had greater odds of losing body mass (odds ratio [OR] = 4.73; 95% confidence interval [CI], 2.29-9.76) and of reducing WC (OR = 2.84; 95% CI, 1.59-6.94). Former smokers had, on average, 41% and 64% lower odds of losing and gaining body mass (95% CI, 0.37-0.95 and 95% CI, 0.19-0.68, respectively), and those who were on ≥5 medications had greater odds of gaining body mass (OR = 1.92; 95% CI, 1.12-3.28) and WC (OR = 1.79; 95% CI, 1.18-2.74).

CONCLUSIONS

Despite the high proportion of older people who kept their body mass index and WC stable during this period, many of them lost body mass and gained WC. The findings also highlighted the importance of age in the nutritional changes observed in the population.

Sintomatologia depressiva e mortalidade em idosos da América Latina: uma revisão sistemática com metanálise

Objetivo.

Averiguar a associação entre sintomatologia depressiva e mortalidade em idosos da América Latina.

Métodos.

Realizou-se uma revisão sistemática com metanálise de estudos indexados nas bases PubMed, Scientific Electronic Library Online (SciELO), Web of Science, Cochrane Library, Scopus e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). O estudo foi registrado na base PROSPERO (International Prospective Register of Systematic Reviews) e estruturado de acordo com o referencial metodológico PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). A metanálise foi realizada usando modelos de efeitos aleatórios, e os dados analisados incluíram as medidas de risco relativo (RR) bruto e heterogeneidade, com estimativas pontuais e intervalos de confiança de 95% (IC95%).

Resultados.

Cinco estudos, realizados no Brasil e no México, foram incluídos na metanálise, abrangendo 8 954 idosos. O RR para mortalidade na presença de sintomatologia depressiva foi de 1,44 (IC95%: 1,16; 1,78). A heterogeneidade encontrada foi de 80,87%. As metarregressões mostraram que quanto maior a proporção de mulheres nas amostras dos estudos, maior o risco de mortalidade associada à sintomatologia depressiva, e quanto maior o tempo de acompanhamento do estudo, menor o risco de mortalidade associada à sintomatologia depressiva.

Conclusão.

A presença de sintomatologia depressiva associou-se positivamente à mortalidade em idosos latino-americanos, com RR de óbito 44% maior em relação aos idosos sem sintomatologia depressiva. As principais limitações do estudo foram o pequeno número de trabalhos encontrados na revisão sistemática e a variação entre as escalas utilizadas para determinar a presença de sintomatologia depressiva.

Employment in old age and all-cause mortality: A systematic review

Social participation promotes and maintains the health of older adults. Working is a type of social participation; however, the effect of employment in old age on health outcomes has not been established. This study aimed to review the relationship between employment in old age (≥60 years) and all-cause mortality. For this systematic review, a computerized search was performed using PubMed, CINAHL and PsycINFO for prospective studies published through June 2020. The observational studies were extracted according to the study participants, indicators, follow-up period, statistical approach and main results. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Of the 37 832 records identified, 14 studies were included in the systematic review based on the inclusion and exclusion criteria. Eight studies were derived from Asian countries (four from Japan, two from Taiwan and one from Thailand and South Korea), three were from the United States, two were from Israel and one was from Brazil. The baseline data of 13 studies were collected before 2000. Thirteen of the 14 studies reported any association between employment in later life and a lower risk of mortality. Four studies examined the sex-related differences in the effect of later-life employment on all-cause mortality, but the association was controversial. Overall, we revealed that working in old age would lower mortality risk. Although more findings based on recent data are required, this study indicates that working later in life is beneficial for promoting and maintaining health. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2022; ••: ••-••.