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Terra e Souza LH, Diaz-Quijano FA, de Azevedo Barros MB, Lima MG. Race (black-white) and sex inequalities in tooth loss: A population-based study. PLoS One 2022; 17:e0276103. [PMID: 36228031 PMCID: PMC9560604 DOI: 10.1371/journal.pone.0276103] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 09/05/2022] [Indexed: 11/07/2022] Open
Abstract
The effect of health inequalities is determined by different socioeconomic, sex, and race conditions. This study aimed to analyze the association of tooth loss with race (defined by self-reported skin color) and sex. Based on the hypothesis that the association between tooth loss and race may be modified by sex, we also aimed to evaluate possible interactions between race and sex in association with this event, in a population-based study in the city of Campinas, Brazil. A directed acyclic graph was used to select covariates. The prevalence, of tooth loss was 19% higher in black women compared to white men (Prevalence ratio [PR]: 1.19; 95%CI: 1.05–1.34). Moreover, the prevalence of tooth loss in black women was 26% higher than in white women (PR: 1.26; 95%CI: 1.13–1.42); and, within the strata of black people, black women had 14% higher dental loss (PR: 1.14; 95%CI: 1.02–1.27) compared to black men. This study found a significant interaction between race and sex in tooth loss, with a disadvantage for black women. In addition, this work contributes to the discussion of health inequities and can support policies for the provision of universal dental care.
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Affiliation(s)
- Lívia Helena Terra e Souza
- Department of Collective Health, Collaborating Center for Health Situation Analysis (CCAS), School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
- * E-mail:
| | - Fredi Alexander Diaz-Quijano
- Department of Epidemiology, Laboratory of Causal Inference in Epidemiology [Laboratório de Inferência Causal em Epidemiologia], School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Marilisa Berti de Azevedo Barros
- Department of Collective Health, Collaborating Center for Health Situation Analysis (CCAS), School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
| | - Margareth Guimarães Lima
- Department of Collective Health, Collaborating Center for Health Situation Analysis (CCAS), School of Medical Science, University of Campinas, Campinas, São Paulo, Brazil
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Andrade FCD, Chen XS. A biopsychosocial examination of chronic back pain, limitations on usual activities, and treatment in Brazil, 2019. PLoS One 2022; 17:e0269627. [PMID: 35657984 PMCID: PMC9165836 DOI: 10.1371/journal.pone.0269627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Chronic back pain is prevalent in Brazil, leading to enormous healthcare costs and social burdens. It also disproportionately affects low-income and less-healthy people.
Objectives
This study examines the associations of chronic back pain with biological, psychological, and social factors; how it limits usual activities; and how chronic back pain influences the use of treatment services.
Methods
Using Brazil’s National Health Survey (PNS-2019), multivariate logistic regressions were conducted to examine how biological, psychological, and social factors correlate with chronic back pain, limitations on usual activities, and pain treatment.
Results
PNS-2019 data showed that 23.4% (95% CI 22.8–24.0) of Brazilian adults aged over 20 reported back pain. A higher prevalence of chronic back pain was associated with biological factors (older age, being female, overweight or obese, current smoking, and having more chronic conditions), lower social conditions (low education, low per capita household income, non-married, and living in rural areas), and poor psychological health (more depressive symptoms). Chronic back pain is more likely to limit usual activities among those with low social conditions (lower education, lower income), poor physical and behavioral health (obese, current smokers, and those with a greater number of chronic conditions), and worse psychological health (more depressive symptoms). However, married people and those who do not consume alcohol were also more likely to report limited activities. Among those with back pain, 68% received at least one form of treatment. Those with intense limitations on their usual activities were 2.2 times as likely to report treatment. People with higher social conditions (higher income, college education, and private health insurance) were more likely to receive treatment.
Conclusion
The results show significant biological, psychological, and social disparities in the prevalence of chronic back pain in Brazil. The findings point to the need for tailored policies and prevention programs with attention to vulnerable groups. Even though Brazil has universal health care, those with better socioeconomic conditions are more likely to receive treatment.
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Affiliation(s)
| | - Xiayu Summer Chen
- School of Social Work, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
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Sato EM, Magalhães MO, Jenkins BC, da Silva Ferreira L, da Silva HAR, Farias Furtado PR, Soares Ferreira EG, dos Santos ECS, Callegari B, Pasqual Marques A. Low Back Pain in Elderly from Belém-Pa, Brazil: Prevalence and Association with Functional Disability. Healthcare (Basel) 2021; 9:1658. [PMID: 34946384 PMCID: PMC8702051 DOI: 10.3390/healthcare9121658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND This cross-sectional study aimed to determine the prevalence of low back pain (LBP) in the elderly population living in Belém-Pará and to assess the spectrum of problems related to these diseases including the demographic, socioeconomic, occupational characteristics and disability in this population. METHODS Three structured questionnaires were applied in a randomly selected representative sample of 512 elderly people aged ≥60 years. RESULTS LBP prevalence in the elderly population was 55.7%. Among then, 56.1% had pain at the time of the interview (punctual prevalence), 91.7% had LBP in the last 365 days (prevalence in the last year), and 85.3% at some point in life (prevalence at some point in life). Overall, most studies are above average. LBP was positively associated with hypertension and the influence of the physical and mental health on their social activities ranged from slightly to extreme. LBP was negatively associated with characteristics, such as education (over 11 years), class A or B income, physical activity, high satisfaction with previous work, and excellent self-perceived health, corroborating to the literature. CONCLUSIONS Greater intensity of pain and functional disability were associated with the presence of comorbidities, smoking habits, and low physical activity. LBP prevalence was high, above the national average, mainly affecting the underprivileged classes related to several modifiable factors, highlighting the importance of preventive and interventionist actions for healthy aging.
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Affiliation(s)
- Elaine Miyuka Sato
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
- Laboratory of Human Motricity Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil;
| | - Mauricio Oliveira Magalhães
- Master’s Program in Human Movement Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil; (M.O.M.); (L.d.S.F.)
| | - Beatriz Coelho Jenkins
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Lays da Silva Ferreira
- Master’s Program in Human Movement Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil; (M.O.M.); (L.d.S.F.)
| | - Hallyson Andrey Raposo da Silva
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Paulo Renan Farias Furtado
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Eder Gabriel Soares Ferreira
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Emmanuele Celina Souza dos Santos
- Faculty of Physical and Occupational Therapy, Institute of Health Sciences, Federal University of Pará, Belém-Pará 66075-110, Brazil; (B.C.J.); (H.A.R.d.S.); (P.R.F.F.); (E.G.S.F.); (E.C.S.d.S.)
| | - Bianca Callegari
- Laboratory of Human Motricity Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil;
- Master’s Program in Human Movement Sciences, Federal University of Pará, Belém-Pará 66050-160, Brazil; (M.O.M.); (L.d.S.F.)
| | - Amélia Pasqual Marques
- Department of Physiotherapy, Speech Therapy and Occupational Therapy, Faculty of Medicine, University of São Paulo, São Paulo 05508-060, Brazil;
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Santos CESD, Rech CR, Antes DL, Schneider IJC, d’Orsi E, Benedetti TRB. Incidence and prevalence of diabetes self-reported on elderly in south of Brazil: results of EpiFloripa Ageing Study. CIENCIA & SAUDE COLETIVA 2019; 24:4191-4200. [DOI: 10.1590/1413-812320182411.31092017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 04/17/2018] [Indexed: 11/22/2022] Open
Abstract
Abstract This study investigated the prevalence and incidence of diabetes self-referred in the elderly. Longitudinal population-based study (EpiFloripa Ageing Study), with 1.702 elderly in 2009/10 and 1.197 in 2013/14 of Florianópolis, SC. Self-reported and anthropometric data were collected at home. The prevalence of diabetes self-referred in 2009/10 was 22.1% (95%CI 20.1-24.1). The characteristics were: no formal schooling (2.30; CI95% 1.32-4.00); 5 to 8 years of schooling (OR = 1.70, CI95% 1.07-2.69); increased waist circumference (OR = 3.31, CI95% 2.05-5.34) and hypertension (OR = 2.38, CI95%: 1.68-3.36). The incidence of diabetes self-reported after four years of follow-up was 8.3% (95% CI, 6.7-10.3). After adjustment: increased waist circumference (OR= 2.23, CI95% 1.09-4.57) at baseline was associated with the incidence of diabetes. The prevalence and incidence of diabetes were high among the elderly. Interventions must be performed especially with elderly with low and without formal schooling, with increased waist circumference and hypertension, thus they were the subgroups with higher odds ratio of reporting and developing diabetes.
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de Souza IMB, Sakaguchi TF, Yuan SLK, Matsutani LA, do Espírito-Santo ADS, Pereira CADB, Marques AP. Prevalence of low back pain in the elderly population: a systematic review. Clinics (Sao Paulo) 2019; 74:e789. [PMID: 31664424 PMCID: PMC6807687 DOI: 10.6061/clinics/2019/e789] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/14/2019] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to estimate the prevalence of low-back pain (LBP) and to identify the level of functional disability in elderly individuals in different populations. From January 1985 to October 2018, a search was performed using the following databases: Embase, LILACS, SciELO, Scopus, Medline, and the Web of Science. The descriptors were low-back pain, back pain, lower-back pain, prevalence, and elderly in Portuguese and English. Two independent reviewers conducted a search for studies and evaluated their methodological quality. The search strategy returned 2186 titles, and 35 were included in this review. The studies evaluated 135,059 elderly individuals aged between 60 and 102 years, and the prevalence of LBP ranged from 21% to 75%. The levels of functional disability, as well as functional difficulties, activities of daily living, and physical capacity, were identified in 60% of the studies. This review indicated a high prevalence of LBP in elderly individuals and functional disability that affects factors important for independence. However, the studies used different methodologies, suggesting that more studies be conducted with scientific accuracy, methodological quality, and low risk of bias to contribute to the proposal of preventive actions for elderly populations.
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Affiliation(s)
- Ingred Merllin Batista de Souza
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Tina Fujii Sakaguchi
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Susan Lee King Yuan
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Luciana Akemi Matsutani
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | | | | | - Amélia Pasqual Marques
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
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Francisco PMSB, Segri NJ, Borim FSA, Malta DC. Prevalência simultânea de hipertensão e diabetes em idosos brasileiros: desigualdades individuais e contextuais. CIENCIA & SAUDE COLETIVA 2018; 23:3829-3840. [DOI: 10.1590/1413-812320182311.29662016] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/09/2016] [Indexed: 11/22/2022] Open
Abstract
Resumo A prevalência da simultaneidade de doenças específicas nos idosos ainda é pouco descrita na literatura. O objetivo do estudo foi estimar a prevalência simultânea de hipertensão arterial e diabetes mellitus em idosos brasileiros, e os fatores contextuais e individuais a ela associados. Estudo transversal de base populacional com idosos (≥ 60 anos) entrevistados pelo Vigitel em 2012 (n = 10.991). As análises foram realizadas por meio de regressão de Poisson multinível no Stata 12. A média de idade dos idosos foi de 69,4 anos e a prevalência simultânea das doenças foi de 16,2% com variação nas capitais brasileiras. Em São Paulo e Curitiba as prevalências foram mais elevadas do que em Boa Vista e Manaus. Maiores prevalências foram observadas nas capitais das regiões Sul/Sudeste/Centro-Oeste, nos idosos de cor preta e parda, naqueles com escolaridade ≤ 8 anos de estudo, nos não fumantes e ex-fumantes, e com excesso de peso. Verificou-se o efeito da região geográfica na prevalência simultânea pela elevação de 23,5% na magnitude da razão de prevalencia, após ajuste para todas as variáveis individuais. Por meio do estudo, foi possível dimensionar o efeito do contexto onde estão inseridos os idosos (região de residência) sobre a prevalência das principais doenças que acometem e relacionam-se à mortalidade na população idosa na atualidade.
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Jesus-Moraleida FRD, Ferreira PH, Ferreira ML, Silva JPD, Assis MG, Pereira LSM. The Brazilian Back Complaints in the Elders (Brazilian BACE) study: characteristics of Brazilian older adults with a new episode of low back pain. Braz J Phys Ther 2017; 22:55-63. [PMID: 28870602 PMCID: PMC5816084 DOI: 10.1016/j.bjpt.2017.06.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/08/2017] [Accepted: 02/13/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Low back pain (LBP) is little explored in the aging population especially when considering age-relevant and culturally dependent outcomes. We aimed to describe socio-demographic and clinical characteristics of Brazilian older people with a new episode of LBP presenting to primary care. METHODS We sourced baseline information on socio-demographic, pain-related and clinical characteristics from 602 older adults from the Brazilian Back Complaints in the Elders (Brazilian BACE) study. We analyzed differences in pain, disability, functional capacity and psychosocial factors between sub-groups based on age (i.e. participants aged 55-74 or ≥75 years), education (i.e. those with four years or less of schooling or those with more than four years of schooling) and income (i.e. participants who reported earning two or less minimal wages or three and more). RESULTS Participants presented severe LBP (7.18/10, SD: 2.59). Younger participants were slightly more disabled (mean difference 1.29 points, 95% confidence interval [CI]: 0.03/5.56), reporting poorer physical health, and less fall-related self-efficacy (mean difference of 2.41, 95% CI 0.35/4.46). Those less educated, and those with income equal or less than two minimum wages had more disability, pain catastrophizing and worse functional capacity. CONCLUSIONS This was the first study showing that Brazilian older adults with LBP present high levels of functional disability and psychological distress, especially those with low socioeconomic status.
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Affiliation(s)
- Fabianna Resende De Jesus-Moraleida
- Universidade Federal do Ceará, Faculdade de Medicina, Departmento de Fisioterapia, Fortaleza, CE, Brazil; Universidade Federal de Minas Gerais (UFMG), Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Departamento de Fisioterapia, Belo Horizonte, Brazil.
| | | | - Manuela Loureiro Ferreira
- The University of Sydney, Sydney Medical School, Institute of Bone and Joint Research, Sydney, New South Wales, Australia
| | - Juscelio Pereira Da Silva
- Universidade Federal do Ceará, Faculdade de Medicina, Departmento de Fisioterapia, Fortaleza, CE, Brazil
| | - Marcella Guimarães Assis
- Universidade Federal de Minas Gerais (UFMG), Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Departamento de Fisioterapia, Belo Horizonte, Brazil
| | - Leani Souza Máximo Pereira
- Universidade Federal de Minas Gerais (UFMG), Escola de Educação Física, Fisioterapia e Terapia Ocupacional, Departamento de Fisioterapia, Belo Horizonte, Brazil
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Penger M, Strobl R, Grill E. Country-specific and individual determinants of dizziness in Europe: results from the Survey of Health Ageing and Retirement in Europe (SHARE). Public Health 2017; 149:1-10. [DOI: 10.1016/j.puhe.2017.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 02/23/2017] [Accepted: 04/04/2017] [Indexed: 10/19/2022]
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Almeida APSC, Nunes BP, Duro SMS, Facchini LA. Socioeconomic determinants of access to health services among older adults: a systematic review. Rev Saude Publica 2017; 51:50. [PMID: 28513761 PMCID: PMC5779074 DOI: 10.1590/s1518-8787.2017051006661] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 10/25/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to analyze the association between the socioeconomic characteristics and the access to or use of health services among older adults. METHODS This is a systematic review of the literature. The search has been carried out in the databases PubMed, LILACS and Web of Science, without restriction of dates and languages; however we have included only articles published in Portuguese, English, and Spanish. The inclusion criteria were: observational design, socioeconomic factors as variables of interest in the analysis of the access to or use of health services among older adults, representative sample of the target population, adjustment for confounding factors, and no selection bias. RESULTS We have found 5,096 articles after deleting duplicates and 36 of them have been selected for review after the process of reading and evaluating the inclusion criteria. Higher income and education have been associated with the use and access to medical appointments in developing countries and some developed countries. The same association has been observed in dental appointments in all countries. Most studies have shown no association between socioeconomic characteristics and the use of inpatient and emergency services. We have identified greater use of home visits in lower-income individuals, with the exception of the United States. CONCLUSIONS We have observed an unequal access to or use of health services in most countries, varying according to the type of service used. The expansion of the health care coverage is necessary to reduce this unequal access generated by social inequities.
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Affiliation(s)
- Ana Paula Santana Coelho Almeida
- Departamento de Ciências da Saúde. Universidade Federal do Espírito Santo. São Mateus, ES, Brasil.,Programa de Pós-Graduação em Epidemiologia. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Bruno Pereira Nunes
- Departamento de Enfermagem. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | | | - Luiz Augusto Facchini
- Departamento de Medicina Social. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
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Pernambuco L, Espelt A, Góis ACB, de Lima KC. Voice Disorders in Older Adults Living in Nursing Homes: Prevalence and Associated Factors. J Voice 2017; 31:510.e15-510.e21. [PMID: 28069466 DOI: 10.1016/j.jvoice.2016.11.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 11/16/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To estimate the prevalence and the associated factors with voice disorders (VDs) in older adults living in nursing homes. STUDY DESIGN Cross-sectional. METHODS A sample of 117 Brazilian individuals of both sexes and preserved cognitive function, aged >59 years, living in 10 nursing homes, was studied. VDs were screened using the validated tool "Rastreamento de Alterações Vocais em Idosos" (RAVI-Screening for Voice Disorders in Older Adults). Associated factors included variables related to socioeconomic and demographic profile; nursing home; general health; ear, nose, and throat conditions; lifestyle; functionality; and psychosocial status. Bivariate analysis was performed by Pearson's chi-square or Fisher's exact test. Multivariate analysis was performed by multiple binomial regression. The significance level was 5%. RESULTS The prevalence of VDs was 39.3% (95% confidence interval [CI] = 30.4-48.1). There was no significant difference in prevalence according to age and sex. Multivariate analysis revealed that the prevalence of VDs were independently associated with anxiety symptoms (prevalence ratio [PR] = 1.97, 95% CI = 1.17-3.29), smoking (PR = 1.56, CI = 1.02-2.38), general daily inactivity (PR = 1.62, CI = 1.10-2.38), temporomandibular disorder (PR = 1.68, CI = 1.11-2.54), choking (PR = 1.53, CI = 1.06-2.20), and self-reported hearing loss (PR = 1.52, CI = 1.04-2.21). CONCLUSION VDs are common among older adults with preserved cognitive function living in nursing homes. The associated factors with VDs in this population can be prevented, diagnosed, controlled, or treated. Screening procedures and early intervention should be considered.
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Affiliation(s)
- Leandro Pernambuco
- Department of Speech, Language and Hearing Sciences, Federal University of Paraíba (UFPB), Paraíba, Brazil.
| | - Albert Espelt
- Customer Service and Drug Addiction Prevention, Public Health Agency of Barcelona (ASPB), Barcelona, Spain; School of Psychology, Department of Psychobiology and Methodology of Health Sciences, Autonomous University of Barcelona (UAB), Bellaterra, Spain; Carlos III Health Institute, CIBER in Epidemiology and Public Health, Madrid, Spain
| | - Amanda C B Góis
- Post-Graduate Program in Public Health (PPGSCol-UFRN), Federal University of Rio Grande do Norte (UFRN), Rio Grande do Norte, Brazil
| | - Kenio Costa de Lima
- Post-Graduate Program in Public Health (PPGSCol-UFRN), Federal University of Rio Grande do Norte (UFRN), Rio Grande do Norte, Brazil
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de Azevedo Barros MB, Lima MG, Medina LDPB, Szwarcwald CL, Malta DC. Social inequalities in health behaviors among Brazilian adults: National Health Survey, 2013. Int J Equity Health 2016; 15:148. [PMID: 27852275 PMCID: PMC5112654 DOI: 10.1186/s12939-016-0439-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/08/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Considering the high socioeconomic inequalities prevailing in Brazil and lifestyle as a strong determinant of morbidity and premature mortality, our purpose was to evaluate the degree of socioeconomic disparities in the prevalence of health behaviors among Brazilian adult population using data from the 2013 Brazilian National Health Survey. METHOD Based on a sample of 49,025 individuals aged 20 to 59 years, we estimated the prevalence of several health behaviors and a score of unhealthy behaviors according to gender, education, race/color and possession of private health insurance. The prevalence ratios adjusted by age and gender were estimated by means of multiple Poisson regression and the analyses took into account the sampling design. RESULTS Significant social inequalities were identified in the Brazilian adults. Higher prevalence of current smoking, leisure-time physical inactivity, sedentary lifestyle, whole milk consumption and low ingestion of greens, vegetables, and fruits were observed among the less educated, in the non-white population, and among those without private health insurance. Higher prevalence of heavy episodic drinking was found in the non-white population, but no difference in the consumption of fatty meat was found according to skin color. Score of unhealthy behavior higher than 6 was more frequent in lower educational strata (PR = 3.74) in the non-white population (PR = 1.39) and among those without private health insurance (PR = 1.78). Compared to women, men had higher prevalence rates of smoking, hazardous alcohol consumption, and fatty meat consumption and lower consumption of greens, vegetables and fruits. CONCLUSION The results of the study emphasize the importance of monitoring social inequalities in health as part of national health policies and the urgent need to prioritize actions to promote healthy behaviors, especially among the most socially vulnerable segments of society.
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Affiliation(s)
| | - Margareth Guimarães Lima
- State University of Campinas – UNICAMP, Campinas, Brazil
- Department of Public Health – UNICAMP - Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz, 13083-887 Campinas, SP Brazil
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Borim FSA, Neri AL, Francisco PMSB, Barros MBDA. Dimensions of self-rated health in older adults. Rev Saude Publica 2015; 48:714-22. [PMID: 25372161 PMCID: PMC4211567 DOI: 10.1590/s0034-8910.2014048005243] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/23/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze the association between negative self-rated health and indicators of health, wellbeing and sociodemographic variables in older adults. METHODS Cross-sectional study that used data from a population-based health survey with a probability cluster sample that was carried out in Campinas, SP, Southeastern Brazil,, in 2008 and 2009. The participants were older adults (≥ 60 years) and the dependent variable was self-rated health, categorized as: excellent, very good, good, bad and very bad. The adjusted prevalence ratios were estimated by means of Poisson multiple regression. RESULTS The highest prevalences of bad/very bad self-rated health were observed in the individuals who never attended school, in those with lower level of schooling, with monthly per capita family income lower than one minimum salary. Individuals who scored five or more in the physical health indicator also had bad self-rated health, as well as those who scored five or more in the Self-Reporting Questionnaire 20 and those who did not refer feeling happiness all the time. CONCLUSIONS The independent effects of material life conditions, physical and mental health and subjective wellbeing, observed in self-rated health, suggest that older adults can benefit by health policies supported by a global and integrative view of old age.
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Cardosoa JDC, Azevedo RCDS, Reiners AAO, Louzadad CV, Espinosae MM. [Poor self-rated health and associated factors among elderly urban residents]. Rev Gaucha Enferm 2015; 35:35-41. [PMID: 25842778 DOI: 10.1590/1983-1447.2014.04.46916] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to examine the prevalence of bad self-rated health in the elderly and associated demographic and socioeconomic factors. This was an epidemiological, cross-sectional study. Data were collected through interviews using the BOAS (Brazil Old Age Schedule) questionnaire. The study included 573 elderly residents in the urban area of Cuiabá-MT, Brazil.The adopted measure of association was the prevalence ratio. For multivariate analysis, multiple Poisson regression was used. The prevalence of poor/very poor self-rated health was 30.9% and the associated factors were income, number of morbidities and urinary incontinence. The association of demographic and socioeconomic factors with poor/very poor self-rated health among the elderly in this study shows the need for assistance and policies that minimize the impact of these factors on the lives and health of the elderly.
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Brinda EM, Kowal P, Attermann J, Enemark U. Health service use, out-of-pocket payments and catastrophic health expenditure among older people in India: the WHO Study on global AGEing and adult health (SAGE). J Epidemiol Community Health 2015; 69:489-94. [PMID: 25576563 DOI: 10.1136/jech-2014-204960] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 12/22/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Healthcare financing through out-of-pocket payments and inequities in healthcare utilisation are common in low and middle income countries (LMICs). Given the dearth of pertinent studies on these issues among older people in LMICs, we investigated the determinants of health service use, out-of-pocket and catastrophic health expenditures among older people in one LMIC, India. METHODS We accessed data from a nationally representative, multistage sample of 2414 people aged 65 years and older from the WHO's Study on global AGEing and adult health in India. Sociodemographic characteristics, health profiles, health service utilisation and out-of-pocket health expenditure were assessed using standard instruments. Multivariate zero-inflated negative binomial regression models were used to evaluate the determinants of health service visits. Multivariate Heckman sample selection regression models were used to assess the determinants of out-of-pocket and catastrophic health expenditures. RESULTS Out-of-pocket health expenditures were higher among participants with disability and lower income. Diabetes, hypertension, chronic pulmonary disease, heart disease and tuberculosis increased the number of health visits and out-of-pocket health expenditures. The prevalence of catastrophic health expenditure among older people in India was 7% (95% CI 6% to 8%). Older men and individuals with chronic diseases were at higher risk of catastrophic health expenditure, while access to health insurance lowered the risk. CONCLUSIONS Reducing out-of-pocket health expenditure among older people is an important public health issue, in which social as well as medical determinants should be prioritised. Enhanced public health sector performance and provision of publicly funded insurance may protect against catastrophic health expenses and healthcare inequities in India.
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Affiliation(s)
- Ethel Mary Brinda
- Section for Health Promotion and Health Services Research, Department of Public health, Aarhus University, Aarhus, Denmark
| | - Paul Kowal
- Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland Research Centre for Gender, Health and Ageing, University of Newcastle, New South Wales, Australia
| | - Jørn Attermann
- Section of Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ulrika Enemark
- Section for Health Promotion and Health Services Research, Department of Public health, Aarhus University, Aarhus, Denmark
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Mendes GS, Moraes CF, Gomes L. Prevalência de hipertensão arterial sistêmica em idosos no Brasil entre 2006 e 2010. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2014. [DOI: 10.5712/rbmfc9(32)795] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objetivo: observar a evolução da prevalência de hipertensão arterial sistêmica (HAS) em idosos entre 2006 e 2010 no Brasil. Métodos: estudo descritivo, ecológico, quantitativo, de um período entre 2006 e 2010, com dados coletados do Departamento de Informática do Sistema Único de Saúde (DATASUS) relacionados ao sexo, região e escolaridade na faixa etária de 65 anos ou mais. Resultados: na análise entre regiões brasileiras, não houve diferença significativa nos anos analisados. Na comparação entre os sexos, a prevalência de HAS acima de 65 anos nas mulheres foi maior que nos homens. Com relação ao nível de escolaridade, foi encontrado que a prevalência no ano de 2006 foi significativamente menor do que nos anos de 2008 e 2009 entre pessoas com 9 a 11 anos de educação formal. Entre as regiões, quanto menor o nível de escolaridade, maior a prevalência de hipertensão. Conclusão: a prevalência da HAS acima dos 65 anos não seguiu uma tendência linear, mas manteve-se elevada, com predomínio em idosos do sexo feminino e em idosos com baixa escolaridade, chamando a atenção para a necessidade de ações de prevenção dos fatores de risco e acompanhamento em longo prazo dos idosos hipertensos.
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Silva VDL, Cesse EÂP, Albuquerque MDFPMD. Social determinants of death among the elderly: a systematic literature review. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 17 Suppl 2:178-93. [DOI: 10.1590/1809-4503201400060015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 06/12/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: This study aims at working on a systematic review of articles published on social determinants associated with the elderly mortality. METHODS: We searched articles published in Portuguese, English and Spanish language periodicals from January 1st 2007 to December 31st 2009, by means of Lilacs and Pubmed databases. Twenty cohort studies were identified, having most of them been developed in European, North-American and Asian countries. RESULTS: The articles analysed provided determinant social factors significantly associated with the elderly mortality: urban/rural and intercontinental variation, be part of ethnic minorities, financial stress, living conditions, schooling, social participation, gender and race discrimination, smoking, alcoholism, physical activities, instrumental activities of daily living, leisure, marital status, equality and healthy lifestyle. CONCLUSION: Mortality amongst the elderly is influenced by social determinants in many levels of reach, from determinants linked to lifestyle to socioeconomic macro-determinants. The actions on these determinants must be guided by the intersectorial perspective and regarded as a priority in the health sector, seeking to provide extended longevity with good quality of life for the population.
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Bastos TF, Alves MCGP, Barros MBDA, Cesar CLG. Men's health: a population-based study on social inequalities. CAD SAUDE PUBLICA 2012; 28:2133-42. [PMID: 23147955 DOI: 10.1590/s0102-311x2012001100013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/17/2012] [Indexed: 11/22/2022] Open
Abstract
This study evaluates social inequalities in health according to level of schooling in the male population. This was a cross-sectional, population-based study with a sample of 449 men ranging from 20 to 59 years of age and living in Campinas, São Paulo State, Brazil. The chi-square test was used to verify associations, and a Poisson regression model was used to estimate crude and adjusted prevalence ratios. Men with less schooling showed higher rates of alcohol consumption and dependence, smoking, sedentary lifestyle during leisure time, and less healthy eating habits, in addition to higher prevalence of bad or very bad self-rated health, at least one chronic disease, hypertension, and other health problems. No differences were detected between the two schooling strata in terms of use of health services, except for dental services. The findings point to social inequality in health-related behaviors and in some health status indicators. However, possible equity was observed in the use of nearly all types of health services.
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Affiliation(s)
- Tássia Fraga Bastos
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, Brasil.
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de Oliveira MA, Francisco PMSB, Costa KS, Barros MBDA. [Self-medication in the elderly population of Campinas, São Paulo State, Brazil: prevalence and associated factors]. CAD SAUDE PUBLICA 2012; 28:335-45. [PMID: 22331159 DOI: 10.1590/s0102-311x2012000200012] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Accepted: 10/03/2011] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the prevalence and causative factors associated with self-medication in the elderly and identify the main drugs consumed without prescription. A cross-sectional population-based study with stratified clustered two-stage sampling was performed in Campinas, São Paulo, Brazil in 2008 and 2009. Of the 1,515 elderly studied, 80.4% reported using at least one drug during the three days preceding the survey. Of these, 91.1% reported the use of prescription drugs only and the remainder (8.9%) reported simultaneous use of prescribed and non prescribed drugs. After adjustment, a negative association between age ≥ 80 years, hypertension, chronic diseases, use of health services, dental consultations and adherence to a medical plan,and self-medication was found, whereas a positive association was found with per capita income. Dipyrone, acetylsalicylic acid, diclofenac, Ginkgo biloba, paracetamol and homeopathic medicines were among the most used non-prescribed drugs. Pharmaceutical assistance should be provided as a priority to the elderly, to avoid the misuse of medicines and ensure access to the correct drugs.
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