Predictors of 10-year mortality in a population of community-dwelling Brazilian elderly: the Bambuí Cohort Study of Aging

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.

Evaluation of the properties of WHODAS-12 measurements in individuals with Chagas disease in Brazil

Numerous tests employed to predict cardiac and functional status are expensive and not widely accessible for a considerable number of patients, particularly those diagnosed with Chagas disease (CD) residing in remote and endemic regions. To date, there is no knowledge of studies that have validated instruments that address functionality in an expanded way, including the biopsychosocial factors in patients with CD. This study aims to evaluate the psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS 2.0), in its 12-item shortened version (WHODAS-12) when applied to patients with CD. This is a cross-sectional study of a prospective cohort that follows individuals with CD (SaMi-Trop). Data collection took place between October 2019 and March 2020. In the interviews, sociodemographic information, life habits, clinical information, and indicators of disability measured by WHODAS-12 were collected. Descriptive analysis, internal consistency and construct validity of the instrument were performed. A total of 628 patients with CD were interviewed, most were women (69.5%), their mean age was of 57 years, and most declared an average self-perception of health (43.4%). The 12 items of WHODAS-12 were distributed into three factors, which together account for 61% of the variance. The Kaiser-Meyer-Olkin (KMO) index was 0.90, indicating adequacy of the sample for factor analysis. The internal consistency of the global scale showed alpha = 0.87. The percentage of incapacity was 16.05%, indicating mild incapacity for the evaluated patients. WHODAS-12 is a valid and reliable measure to assess the disability of the Brazilian population with CD.

An Assessment of Mortality among Elderly Brazilians from Alcohol Abuse Diseases: A Longitudinal Study from 1996 to 2019

Alcohol use disorder (AUD) is a worldwide public health problem, being an important aggravating factor of comorbidities found in the elderly, with the potential to increase mortality indicators for this age group.

OBJECTIVE

To analyze alcohol-induced deaths in elderly people with alcohol-related disorder in Brazil between 1996 and 2019.

METHODS

An ecological study was conducted with secondary data obtained from the Brazilian Unified Health System (SIM) Mortality Information System from 1996 to 2019. TabNet/DATASUS, Excel^® 2016 and SPSS 21^® were used to prepare the results.

RESULTS

Between 1996 and 2019, 85,928 alcohol-induced deaths were recorded among the elderly (>60 years); in 1996, the lowest number of deaths was recorded (n = 1396), and in 2018, there were the highest number of deaths (n = 5667). In the profile of the elderly, there was a predominance of men (88%). Mortality from AUD was due to alcoholic liver disease (62.2%), followed by mental disorders due to alcohol use (37.3%).

CONCLUSIONS

Coping with AUD is a public health problem that aims to reduce the number of deaths from diseases, conditions and injuries in which alcohol consumption is the causative agent, in addition to preventing deaths to which alcohol contributes.

Relationship between physical activity and functional capacity change in aged cohort in São Paulo, Brazil

OBJECTIVES

to evaluate the relationship between leisure-time physical activity and functional capacity change among aged people.

METHODS

we analyzed data of an aged cohort looking for determinants of functional capacity at follow-up. Baseline data were collected between 2007 and 2008 - average follow-up of 3,5 years. A full multivariate linear regression model was built to evaluate functional capacity at the end of the follow-up, controlling for functional capacity at baseline, sociodemographic, health and behavioral characteristics and amount of leisure-time physical activity in the period.

RESULTS

final model showed functional capacity independently correlated with age (p<0.001), body mass (p=0.013) and the number of activities of daily living compromised at baseline (p<0.001). Functional capacity improved with increased physical activity but loss statistical significance after adjustments (p=0.384).

CONCLUSIONS

functional capacity decreases with increased age, increased loss of functional capacity at baseline and increased body mass. Albeit a non-significant association, leisure-time physical activity appears as an important modifiable factor.

Association between "a body shape index" and mortality: Bambuí Cohort Study of Aging, Brazil

This article aims to evaluate the joint and separate association between abdominal and general adiposity indicators and mortality. Data was collected from 1,366 older adults in the Bambuí Cohort Study of Aging with complete information for all variables of interest. The outcome variable was all-cause time until death; exposure variables were a body shape index (ABSI), waist circumference (WC), waist-to-height ratio (WHtR) and body mass index (BMI), assessed at the beginning of the study, and at the 3rd, 5th and 11th year of follow-up. Association between the quartiles of anthropometric indicators and mortality was calculated using an extended Cox proportional hazards model and adjusted for socioeconomic and behavioral confounding factors. Older adults in the 4th ABSI quartile had a higher risk of mortality regardless of BMI (1.27; 95%CI: 1.01-1.58), but this association was not observed in sensitivity analyses. Older adults in the 2nd, 3rd and 4th BMI quartiles had a lower risk of mortality, even when adjusted for WC or ABSI. WC and WHtR showed no association consistent with all-cause mortality after adjustment for confounding factors. Considering the loss of significance in the sensitivity analyses, ABSI's predictive capacity for mortality is still weak. Thus, adopting ABSI in clinical practice or in epidemiological surveys, in conjunction or replacing BMI and WC, requires more in-depth studies.

Prevalence of sarcopenia and 9-year mortality in nursing home residents

BACKGROUND

Sarcopenia is a progressive loss of muscle mass, strength, and function. It is linked to functional decline, and secondary to this, to nursing home admission.

AIMS

To look into the prevalence of sarcopenia in a nursing home population and to gain insight into the relation of sarcopenia with mortality in this cohort.

METHODS

A longitudinal cohort follow-up started in October 2007 in 52 nursing homes in Belgium. Following data were procured: anthropometrics (weight/length), body composition (muscle mass through bio-impedance absorptiometry, BIA), functional status (Katz), nutritional status (mini-nutritional assessment-short form, MNA), and a number of laboratory parameters.

RESULTS

In total, 745 residents were included. Mean age was 84.6 ± 7.2 years. Mean follow-up time was 1632 ± 1026 days. In total, 17% had severe sarcopenia, 45% had moderate sarcopenia, and 38% had no sarcopenia. Following items were significant (p < 0.05) on univariate analysis with mortality as outcome: sarcopenia, gender, BMI, skeletal muscle mass, age, MNA, and functional level. In multivariate analysis, only MNA, skeletal muscle mass, and age were still significant. Odds ratio for skeletal muscle mass was 1.171 for the highest percentile group, 2.277 for the middle percentile group, and 4.842 for the lowest percentile group.

DISCUSSION

The prevalence of sarcopenia was higher than in comparative literature, for which there are a few hypotheses. Cut-off values for sarcopenia using BIA for specific cohorts need to be re-evaluated.

CONCLUSIONS

It seems to remain useful to screen for muscle mass in institutionalized elderly, because there is a clear and significant correlation with long-term mortality.

Depressive symptoms, emotional support and activities of daily living disability onset: 15-year follow-up of the Bambuí (Brazil) Cohort Study of Aging

Psychosocial factors appear to be associated with increased risk of disability in later life. However, there is a lack of evidence based on long-term longitudinal data from Western low-middle income countries. We investigated whether psychosocial factors at baseline predict new-onset disability in long term in a population-based cohort of older Brazilians adults. We used 15-year follow-up data from 1,014 participants aged 60 years and older of the Bambuí (Brazil) Cohort Study of Aging. Limitations on activities of daily living (ADL) were measured annually, comprising 9,252 measures. Psychosocial factors included depressive symptoms, social support and social network. Potential covariates included sociodemographic characteristics, lifestyle, cognitive function and a physical health score based on 10 self-reported and objectively measured medical conditions. Statistical analysis was based on competitive-risk framework, having death as the competing risk event. Baseline depressive symptoms and emotional support from the closest person were both associated with future ADL disability, independently of potential covariates wide range. The findings showed a clear graded association, in that the risk gradually increased from low emotional support alone (sub-hazard ratio - SHR = 1.11; 95%CI: 1.01; 1.45) to depressive symptoms alone (SHR = 1.52; 95%CI: 1.13; 2.01) and then to both factors combined (SHR = 1.61; 95%CI: 1.18; 2.18). Marital status and social network size were not associated with incident disability. In a population of older Brazilian adults, lower emotional support and depressive symptoms have independent predictive value for subsequent disability in very long term.

Sociodemographic and health factors associated with mortality in community-dwelling elderly

OBJECTIVE

The objective of this study is to identify factors associated with mortality, with emphasis on gender and age differences.

METHODS

This is a cross-sectional study, which uses data from the FIBRA-2008-2009 network in Campinas, State of São Paulo, Brazil, with information on non-institutionalized residents of the urban area and the Mortality Information System. The dependent variable has been death, in 2013. The associations have been tested by odds ratio (OR) and their 95% confidence intervals, and the analyses have been conducted using the program Stata 12.0.

RESULTS

Average age has been 72.3 years, 69.3% have been women, and 8.9% have died. We have found greater OR for mortality in individuals aged ≥ 75 years, classified as pre-frail or frail, and in those who have reported heart disease.

CONCLUSIONS

In this study, the analysis of specific subgroups has allowed us to better understand the relationship between the factors associated with death in the elderly. With the exception of age, strategies based on primary and secondary care, focused on priority groups, can have a positive impact on the reduction of mortality among the elderly.

OBJETIVO

Identificar fatores associados à mortalidade, com ênfase nas diferenças de gênero e idade.

MÉTODOS

Trata-se de estudo transversal, utilizando dados provenientes da rede FIBRA-2008-2009 em Campinas, SP, com informações de pessoas não institucionalizadas residentes na área urbana e pelo Sistema de Informações de Mortalidade. A variável dependente foi a ocorrência de óbito, verificada em 2013. As associações foram testadas pelas razões de chances (OR) e respectivos intervalos de confiança de 95%, e as análises conduzidas no programa Stata 12.0.

RESULTADOS

A média de idade foi 72,3 anos, 69,3% eram mulheres e 8,9% foram a óbito. Encontrou-se maior OR para mortalidade nos indivíduos com idade ≥ 75 anos, nos classificados como pré-frágil ou frágil e naqueles que referiram doença do coração.

CONCLUSÕES

Neste estudo, a análise para os subgrupos específicos permitiu melhor compreender a relação entre fatores que se associam ao óbito no idoso. Com exceção da idade, estratégias baseadas no cuidado específico de atenção primária e secundária, direcionadas a grupos prioritários, podem ter um impacto positivo na redução da mortalidade entre os idosos.

The Effects of Weight and Waist Change on the Risk of Long-Term Mortality in Older Adults- The Bambuí (Brazil) Cohort Study of Aging

OBJECTIVE

We aimed to investigate the risk of long-term mortality associated with weight and waist circumference (WC) change among older adults, particularly the overweight and obese ones.

DESIGN

Cohort Study.

SETTING

The Bambuí (Brazil) Cohort Study of Aging.

PARTICIPANTS

Community-dwelling elderly (n=1138).

MEASUREMENTS

Weight and WC were reassessed three years after baseline. Mortality risk associated with a 5% weight/WC loss and gain was compared to that of weight/WC stability by Cox models adjusted for clinical, behavioral and social known risk factors for death (age, gender, BMI, smoking, diabetes, total cholesterol, hypertension, Chagas disease, major electrocardiographic changes, physical activity, B-type natriuretic peptide, C-reactive protein, creatinine, education and household income).

RESULTS

Female sex was predominant (718; 63.1%). Mean age was 68 (6.7) years. Weight stability (696; 61.1%) was more common than weight loss (251; 22.1%) or gain (191; 16.8%). WC remained stable in 422 (37.3%), decreased in 418 (37.0%) and increased in 291 (25.7%) participants. There were 334 (29.3%) deaths over a median follow-up time of 8.0 (6.4-8.0) years from weight/WC reassessment. Weight loss (HR 1.69; 95% CI 1.30-2.21) and gain (HR 1.37; 95% CI 1.01-1.85) were associated with increased mortality, except in those who were physically active in which weight gain was associated with decreased mortality. Results were similar for participants who were overweight/obese or with abdominal obesity at baseline (HR 1.41; 95%CI 1.02-1.97 and HR 2.01; 95%CI 1.29-3.12, for weight loss and gain, respectively). WC change was not significantly associated with mortality.

CONCLUSION

Although weight loss has been recommended for adults with excessive weight regardless of age, weight change might be detrimental in older adults. Rather than weight loss, clinical interventions should target healthy lifestyle behaviors that contribute to weight stability, particularly physical activity in overweight and obese older adults.

Predictors of 49-month mortality in Chinese nonagenarians and centenarians in PLAD study

OBJECTIVE

To examine whether a set of well-known predictors of mortality in younger elderly also maintain their importance in Chinese oldest old group.

DESIGN

A cross-sectional study of 1401 inhabitants aged 90 and older were conducted in the area of Dujiangyan, China. 825 subjects participated and were followed up for vital status after 49 months. Professional interviewers collected baseline data concerning socio-demographic characteristics, lifestyle habits, physical factors and geriatric assessment. Bivariate analysis was conducted between survivors and deceased. Cox regression models were used to evaluate predictors of mortality.

RESULTS

Four hundred and thirty-six (52.8%) of 825 participants eligible for the analysis died during the 49 months of follow-up period. Older age, comorbidity, lower MMSE score, lower ADL and IADL scores increased the risk of mortality in the study group. Multivariate analyses showed older age (HR = 1.03, 95% CI 1.01-1.07) and comorbidity (HR = 1.09, 95% CI 1.02-1.17) were associated with mortality while female gender (HR = 0.61, 95% CI 0.43-0.86), taking exercise (HR = 0.80, 95% CI 0.64-1.01) and higher MMSE scores (HR = 0.96, 95% CI 0.94-0.99) showed a positive effect on survival.

CONCLUSION

In Chinese nonagenarians and centenarians, age, gender, taking exercise, cognitive impairment and comorbidity at baseline show predictive power of oldest old mortality.

Clinical and epidemiological profile of elderly patients with Chagas disease followed between 2005-2013 by pharmaceutical care service in Ceará State, Northeastern Brazil

By controlling the transmission of Chagas disease, the challenge of providing assistance to millions of infected patients that reach old age arises. In this study, the socioeconomic, demographic and comorbidity records of all elderly chagasic patients followed at the Pharmaceutical Care Service of the Chagas Disease Research Laboratory were assessed. The information related to the clinical form of the disease was obtained from medical records provided by the Walter Cantídio University Hospital. The profile of the studied population was: women (50.5%); mean age of 67 years; retired (54.6%); married (51.6 %); high illiteracy rate (40.2%); and family income equal to the minimum wage (51.5%). The predominant clinical forms of Chagas disease were cardiac (65.3%) and indeterminate (14.7%). The main electrocardiographic changes were the right bundle branch block (41.0%), associated or not with the anterosuperior left bundle branch block (27.4%). The average number of comorbidities per patient was 2.23 ± 1.54, with systemic arterial hypertension being the main one found (67.0%). It was found that the elderly comprise a vulnerable group of patients that associate aging with cardiac and/or digestive disorders resulting from the evolution of Chagas disease and other comorbidities, which requires special attention from health services to ensure more appropriate medical and social care.

Social determinants of death among the elderly: a systematic literature review

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.

C-reactive protein and B-type natriuretic peptide yield either a non-significant or a modest incremental value to traditional risk factors in predicting long-term overall mortality in older adults

Background

New biomarkers may aid in preventive and end-of-life decisions in older adults if they enhance the prognostic ability of traditional risk factors. We investigated whether C-reactive protein (CRP) and/or B-type natriuretic peptide (BNP) improve the ability to predict overall mortality among the elderly of the Bambuí, Brazil Study of Aging when added to traditional risk factors.

Methods

From 1997 to 2007, 1,470 community-dwelling individuals (≥60 years) were followed-up. Death was ascertained by continuous verification of death certificates. We calculated hazard ratios per 1 standard deviation change (HR) of death for traditional risk factors only (old model), and traditional risk factors plus CRP and/or BNP (new models) and assessed calibration of the models. Subsequently, we compared c-statistic of each of the new models to the old one, and calculated integrated discriminative improvement (IDI) and net reclassification improvement (NRI).

Results

544 (37.0%) participants died in a mean follow-up time of 9.0 years. CRP (HR 1.28, 95% CI 1.17-1.40), BNP (HR 1.31 95% CI 1.19-1.45), and CRP plus BNP (HR 1.26, 95% CI 1.15-1.38, and HR 1.29, 95% CI 1.16-1.42, respectively) were independent determinants of mortality. All models were well-calibrated. Discrimination was similar among the old (c-statistic 0.78 [0.78-0.81]) and new models (p=0.43 for CRP; p=0.57 for BNP; and p=0.31 for CRP plus BNP). Compared to the old model, CRP, BNP, and CRP plus BNP models led to an IDI of 0.009 (p<0.001), -0.005 (p<0.001) and -0.003 (p=0.84), and a NRI of 0.04 (p=0.24), 0.07 (p=0.08) and 0.06 (p=0.10), respectively.

Conclusions

Despite being independent predictors of long-term risk of death, compared to traditional risk factors CRP and/or BNP led to either a modest or non-significant improvement in the ability of predicting all-cause mortality in older adults.

The impact of body mass index and weight changes on disability transitions and mortality in brazilian older adults

The aim of this study was to examine the association between body mass index and weight changes on disability transitions and mortality among Brazilian older adults. Longitudinal data from the Health, Well-Being, and Aging in Latin America and the Caribbean Study conducted in São Paulo, Brazil (2000 and 2006), were used to examine the impact of obesity on disability and mortality and of weight changes on health transitions related to disability. Logistic and multinomial regression models were used in the analyses. Individuals who were obese were more likely than those of normal weight to have limitations on activities of daily living (ADL), instrumental activity of daily living (IADL), and Nagi's limitations. Obesity was associated with higher incidence of ADL and IADL limitations and with lower recovery from Nagi's limitations. Compared to those who maintained their weight, those who gained weight experienced higher incidence of ADL and Nagi's limitations, even after controlling for initial body mass index. Higher mortality among overweight individuals was only found when the reference category was "remaining free of Nagi limitations." The findings of the study underline the importance of maintaining normal weight for preventing disability at older ages.

Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study

BACKGROUND

Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking.

METHODS AND FINDINGS

The vital status of 12,373 people aged 65 y and over was determined 3-5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89-0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites.

CONCLUSIONS

Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in preventing and treating chronic disease, may be as important as economic and human development.

Birth cohort differences in physical functioning levels among elderly Brazilians: findings from the Bambuí cohort study of aging (1997-2008)

The aim of this study was to investigate the cohort differences in physical functioning levels among the older (cohort members born in 1916-1926 and in 1927-1937) participants of the Bambuí Cohort Study of Aging. The data came from participants aged 71-81 who took part at baseline in 1997 (n = 491) and in the 11th wave in 2008 (n = 620). The physical functioning variables included the following self-reported measures: activities of daily living, the instrumental activities of daily living and mobility. Poisson regression analyses were used to investigate the cohort year differences in physical functioning levels. Overall, the young cohort (2008) showed better levels of physical functioning compared to the older cohort (1997) across all three measures of physical functioning used.