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Sandoval MH, Portaccio MEA, Albala C. Ethnic differences in disability-free life expectancy and disabled life expectancy in older adults in Chile. BMC Geriatr 2024; 24:116. [PMID: 38297194 PMCID: PMC10829324 DOI: 10.1186/s12877-024-04728-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/19/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Although about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown. OBJECTIVE To estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile. METHOD Disability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan's method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile. RESULTS Non-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively). CONCLUSIONS This is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.
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Affiliation(s)
- Moisés H Sandoval
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile.
| | | | - Cecilia Albala
- Institute of Nutrition and Food Technology (INTA), University of Chile, Santiago, Chile
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Sandoval MH, Alvear Portaccio ME, Albala C. Life expectancy by ethnic origin in Chile. Front Public Health 2023; 11:1147542. [PMID: 37397745 PMCID: PMC10309032 DOI: 10.3389/fpubh.2023.1147542] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/25/2023] [Indexed: 07/04/2023] Open
Abstract
Background Ethnic and racial differences in life expectancy have been well established in different societies. However, even though an important part of the population of Latin America is Indigenous, there is little knowledge about them. Objective Determine if there are ethnic differences in life expectancy at birth and at 60 years in Chile, and if the Mapuche (largest Indigenous ethnic group) have similar life expectancy to other Indigenous peoples. Method Life tables for the Mapuche and other Indigenous groups and non-Indigenous people were built using the 2017 census. Specifically, we used the questions of the number of live children born and the number of surviving children. With this information, using the indirect method of own children we determined infantile mortality. Then, using the relational logit model and the model life table (west), we estimated the survival function for all ages. Results Indigenous Chileans have seven years lower life expectancy at birth than the non-Indigenous population (76.2 vs. 83.2 years). The differential at age 60 is 6 years (20.3 vs. 26.4 years). We also found that Mapuche have an even greater disadvantage in survival than other ethnic groups. This is reflected in 2 years less life expectancy, both at birth and at 60 years. Discussion Our results ratify the existence of marked ethnic-racial inequality in the extension of life in Chile and demonstrate a greater disadvantage in terms of survival of the Mapuche compared to other Indigenous and non-Indigenous groups. It is thus of great relevance to design policies that would decrease the existing inequalities in lifespan.
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Affiliation(s)
- Moisés H. Sandoval
- Unidad de Nutrición Pública, Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
| | | | - Cecilia Albala
- Unidad de Nutrición Pública, Instituto de Nutrición y Tecnología de los Alimentos, Universidad de Chile, Santiago, Chile
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Ross S, Armas Rojas N, Sawatzky J, Varona-Pérez P, Burrett JA, Calderón Martínez M, Lorenzo-Vázquez E, Bess Constantén S, Sherliker P, Morales Rigau JM, Hernández López OJ, Martínez Morales MÁ, Alonso Alomá I, Achiong Estupiñan F, Díaz González M, Rosquete Muñoz N, Cendra Asencio M, Emberson J, Peto R, Lewington S, Lacey B. Educational inequalities and premature mortality: the Cuba Prospective Study. Lancet Public Health 2022; 7:e923-e931. [PMID: 36334608 DOI: 10.1016/s2468-2667(22)00237-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although socioeconomic status is a major determinant of premature mortality in many populations, the impact of social inequalities on premature mortality in Cuba, a country with universal education and health care, remains unclear. We aimed to assess the association between educational level and premature adult mortality in Cuba. METHODS The Cuba Prospective Study (a cohort study) enrolled 146 556 adults aged 30 years and older from the general population in five provinces from Jan 1, 1996, to Nov 24, 2002. Participants were followed up until Jan 1, 2017, for cause-specific mortality. Deaths were identified through linkage to the Cuban Public Health Ministry's national mortality records. Cox regression models yielded rate ratios (RRs) for the effect of educational level (a commonly used measure for social status) on mortality at ages 35-74 years, with assessment for the mediating effects of smoking, alcohol consumption, and BMI. FINDINGS A total of 127 273 participants aged 35-74 years were included in the analyses. There was a strong inverse association between educational level and premature mortality. Compared with a university education, men who did not complete primary education had an approximately 60% higher risk of premature mortality (RR 1·55, 95% CI 1·40-1·72), while the risk was approximately doubled in women (1·96, 1·81-2·13). Overall, 28% of premature deaths could be attributed to lower education levels. Excess mortality in women was primarily due to vascular disease, while vascular disease and cancer were equally important in men. 31% of the association with education in men and 18% in women could be explained by common modifiable risk factors, with smoking having the largest effect. INTERPRETATION This study highlights the value of understanding the determinants of health inequalities in different populations. Although many major determinants lie outside the health system in Cuba, this study has identified the diseases and risk factors that require targeted public health interventions, particularly smoking. FUNDING UK Medical Research Council, British Heart Foundation, Cancer Research UK, CDC Foundation (with support from Amgen).
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Affiliation(s)
- Stephanie Ross
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Nurys Armas Rojas
- National Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
| | - Julia Sawatzky
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Patricia Varona-Pérez
- Institute of Hygiene, Epidemiology and Microbiology, Ministry of Public Health, Havana, Cuba
| | - Julie Ann Burrett
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Marcy Calderón Martínez
- Institute of Hygiene, Epidemiology and Microbiology, Ministry of Public Health, Havana, Cuba
| | | | - Sonia Bess Constantén
- Directorate of Medical Records and Health Statistics, Ministry of Public Health, Havana, Cuba
| | - Paul Sherliker
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK; MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK
| | | | | | | | - Ismell Alonso Alomá
- Directorate of Medical Records and Health Statistics, Ministry of Public Health, Havana, Cuba
| | | | - Mayda Díaz González
- Municipal Center of Hygiene, Epidemiology and Microbiology, Colón, Matanzas, Cuba
| | | | | | - Jonathan Emberson
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK; MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK
| | - Richard Peto
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
| | - Sarah Lewington
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK; MRC Population Health Research Unit, NDPH, University of Oxford, Oxford, UK.
| | - Ben Lacey
- Nuffield Department of Population Health (NDPH), University of Oxford, Oxford, UK
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Sandoval MH, Portaccio MA, Albala C. Social participation and 5-year all-cause mortality in older Chilean people. CAD SAUDE PUBLICA 2022; 38:e00124921. [DOI: 10.1590/0102-311x00124921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022] Open
Abstract
We aimed to examine the degree to which social participation is associated with mortality risk in older adults in Chile. We used the Chilean National Survey on Elderly Dependency, which is linked to vital statistics, in order to obtain death records. Four proportional risk regression models were estimated. Even with controlled sociodemographic, economic, family, and health variables, older adults who participate in social activities had a 22% lower risk of death than those who do not participate. We concluded that social participation is a strong and significant protective factor for mortality in Chilean older adults. Social participation should thus be promoted from a life course perspective considering its effect on mortality in older adults who maintained an active social life.
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