Aging and Health Status of Elderly in Latin America and the Caribbean: Preliminary Findings

Aging in Latin America and the Caribbean will not proceed along known paths already followed by more developed countries. In particular, the health profile of the future elderly population is less predictable due to factors associated with their demographic past that may haunt them for a long time and make them more vulnerable, even if economic and institutional conditions turn out to be better than what they are likely to be. This paper answers a set of questions regarding the nature and determinants of health status among the elderly in Latin America and the Caribbean using SABE (Survey on Health and Well-Being of Elders), a cross-sectional representative sample of over 10,000 elderly aged 60 and above in private homes in seven major cities in Latin America and the Caribbean. We examine health outcomes such as self-reported health, functional limitations-Activities of Daily Living (ADL's) and Instrumental Activities of Daily Living (IADL's), obesity (ratio of weight in kilograms to the square of height in centimeters), and self-reported chronic conditions (including diabetes). The findings include: (a) Countries differ in self-reported health but exhibit much less differences in terms of functional limitations. The number of chronic conditions increase with age and is higher among females than among males; (b) On average SABE countries display levels of self-reported diabetes (and obesity) that are as high if not higher than those found in the US; (c) There is evidence, albeit weaker than expected, suggesting deteriorated health and functional status in the region; (d) There is important evidence pointing toward rather strong inequalities (by education and income) in selected health outcomes. Preliminary findings from SABE confirm that Latin America and the Caribbean display peculiarities in the health profile of elderly, particularly with regard to diabetes and obesity. It is important that new policy initiatives begin to seriously target the region's elderly, especially with an emphasis on the prevention and treatment of diabetes and obesity.     

Prevalence of self-reported arthritis among elders from Latin America and the Caribbean and among Mexican Americans from the southwestern United States

This study examines the prevalence of self-reported arthritis and arthritis symptoms and their relationship to functional limitations in elders from Latin America and the Caribbean and in Mexican Americans from the southwestern United States. This study includes 8,122 elderly aged 60 and older from seven Latin America and Caribbean countries and 2,580 noninstitutionalized Mexican Americans aged 65 or older residing in the southwestern United States. The estimated prevalence of self-reported arthritis ranged from 23.8% in Mexico City to 55.6% in Havana. The prevalence of self-reported pain among arthritic subjects across all countries ranged from 30.7% in older Mexican Americans to 83.7% in Santiago. Arthritis was independently associated with any Activities of Daily Living and any Instrumental Activities of Daily Living limitation across the eight countries after controlling for relevant factors. Self-reported arthritis and arthritis symptoms are highly prevalent among elders from Latin America and the Caribbean and older Mexican Americans and is a significant cause of disability in all studied populations.     

Controlling hypertension and reducing its associated morbidity and mortality in the Caribbean: implications of race and ethnicity

Cardiovascular diseases and stroke, especially hypertension, represent a significant global disease burden for both morbidity and mortality, with a disproportionately higher impact in vulnerable low‐ to middle‐income countries. International initiatives such as the Centers for Disease and Prevention and the Pan American Health Organization Standardized Hypertension Treatment Project have been developed to address this burden on the Caribbean and Latin America populations. The disparity in disease burden observed in low‐ to middle‐income countries is explained, in part, by differences in disease risks for different racial and ethnic groups with high blood pressure more prevalent and hypertension‐related morbidity significantly higher in men and women of African heritage. In addition to the race and ethnic differences in indicators of socioeconomic status, access to care and health service delivery, the physiologic mechanism of high blood pressure including salt‐sensitivity, may also play a significant role in the disparities in hypertension and hypertension‐related outcomes. This article focuses on potential racial and ethnic differences in influences on the pathophysiology of hypertension in the Caribbean region of the world. The identification of such differences may be used in the development of population hypertension control strategies and treatment approach that address the excess disease burden in these populations. The consideration of strategies, such as salt reduction and hypertension awareness and treatment, are particularly relevant to the high‐risk Caribbean region.     

Clinical differentiation of inflammatory bowel disease (IBD) in Latin America and the Caribbean

The aim of the present study was to describe the epidemiological and clinical characteristics of inflammatory bowel disease (IBD), including medical and surgical treatments, in several countries in Latin America and the Caribbean.IBD is recognized as a global health problem because its incidence and prevalence have increased significantly over the last few years.This multicenter retrospective cohort study included 4714 patients with IBD diagnosed from 9 countries in Latin America and the Caribbean: Colombia, Cuba, Dominican Republic, Ecuador, Mexico, Peru, Puerto Rico, Uruguay, and Venezuela.Crohn disease (CD) was more frequent in Puerto Rico (71.9%), the Dominican Republic (61.0%), and Peru (53.1%). Ulcerative colitis was more frequent in Colombia (78.6%), Venezuela (78.2%), Mexico (75.5%), Cuba (69.9%), Ecuador (64.1%), and Uruguay (60.9%). The following clinical characteristics were more frequent in the Caribbean: penetrating behavior in CD, steroid dependence, steroid resistance, intolerance to thiopurines, extraintestinal manifestations, surgeries, hospitalizations due to IBD, and family history of IBD. The factors associated with the use of biological therapy were pancolitis in ulcerative colitis, penetrating behavior in CD, steroid resistance and dependence, presence of extraintestinal manifestations, and the need for surgery.This study from Latin America and the Caribbean demonstrated the different epidemiological and clinical characteristics of IBD.     

Equity and Prevention of Cardiovascular Diseases in Latin America and the Caribbean

Non-communicable diseases, particularly cardiovascular diseases, are the leading cause of decreased life expectancy and death in Latin America and the Caribbean. Although a lifestyle, which includes no tobacco use, good nutrition, and regular physical activity is touted as key to health, the environmental, racial, social and economic conditions, which underpin lifestyle are often ignored or considered only secondarily. Placing the main responsibility on a patient to change their lifestyle or to simply comply with pharmacological treatment ignores the specific conditions in which the individual lives. Furthermore, there are major disparities in access to both healthy living conditions as well as access to medical care.There is sufficient evidence to support advocating for policies that support healthy living, particularly healthy food choices. Progress is being made to improve the food environment with enactment of front of package nutritional labels. However, policies were enacted only after intense regional research and advocacy supporting their implementation.Government officials must rise above the pressures of commercial interests and support health-promoting policies or be exposed as self-interest groups themselves. Strong advocacy is required to persuade officials that all policies should take health into consideration both to improve lives and economies.     

Hepatocellular carcinoma in Latin America: Diagnosis and treatment challenges

Latin America, a region with a population greater than 600000000 individuals, is well known due to its wide geographic, socio-cultural and economic heterogeneity. Access to health care remains as the main barrier that challenges routine screening, early diagnosis and proper treatment of hepatocellular carcinoma(HCC). Therefore, identification of population at risk, implementation of surveillance programs and access to curative treatments has been poorly obtained in the region. Different retrospective cohort studies from the region have shown flaws in the implementation process of routine surveillance and early HCC diagnosis. Furthermore, adherence to clinical practice guidelines recommendations assessed in two studies from Brazil and Argentina demonstrated that there is also room for improvement in this field, similarly than the one observed in Europe and the United States. In summary, Latin America shares difficulties in HCC decision-making processes similar to those from developed countries. However, a transversal limitation in the region is the poor access to health care with the consequent limitation to standard treatments for overall population. Specifically, universal health care access to the different World Health Organization levels is crucial, including improvement in research, education and continuous medical training in order to expand knowledge and generation of data promoting a continuous improvement in the care of HCC patients.     

Newborn screening in Latin America at the beginning of the 21st century

Summary Newborn screening (NBS) in Latin America took its first steps in the mid-1970s. Nevertheless, many years elapsed before it achieved its integration within the public health care system and its systematic and continuous implementation under a programme structure. Latin American countries can be characterized not only by their great geographic, demographic, ethnic, economic and health system diversity, but also by their heterogeneity in NBS activities, which gives rise to variation in degree of organization: countries with optimal fulfilment (Cuba, Costa Rica, Chile, Uruguay); others rapidly expanding their coverage (Brazil, Mexico, Argentina); some others in a recent implementation phase (Colombia, Paraguay, Venezuela, Nicaragua, Peru); others with minimal, isolated and non-organized activities (Guatemala, Dominican Republic, Bolivia, Panama, Ecuador); and finally others without any NBS activities at all (El Salvador, Honduras, Haiti). Despite this disparity, a sustained and significant growth in NBS activities has become evident during the last decade, highlighted by implementation of new programmes, increase in coverage, expansion of NBS panels, increasing involvement of governmental and public health authorities, and integration of NBS teams through scientific societies and External Quality Assurance Schemes. Currently, congenital hypothyroidism (CH) is the most widely screened disease, followed by phenylketonuria, with organized NBS programmes for CH in 14 countries. Other diseases usually included in NBS programmes are screened in a lower rate. Every year, around 11.2 million infants are born in Latin America. During 2005, 49.3% of newborns were screened for CH, indicating that around 5.7 million newborns still did not have access to the benefits of NBS. Electronic Supplementary Material The online version of this article (doi:) contains supplementary material, which is available to authorized users. Competing interests: None declared     

Gerontology-specific graduate programs in Brazil and Colombia

Every year the proportion of elderly people increases at a greater rate compared with other age groups, changing the population structure of most countries. Latin America has been internationally known for its higher percentage of young compared with elderly persons. The United Nations predicts that the proportion of elderly persons in Latin America and the Caribbean will be more similar to world figures in 2020 and even higher in 2040. The increasing elderly population in Latin America has increased the demand for advanced degree professionals with gerontology training. Nevertheless, in spite of training efforts during the last decade, the number of gerontology professionals is still insufficient. In total, the authors were able to locate only ten gerontology programs in Latin America (four in Brazil, two in Argentina, and one each in Uruguay, Peru, Cuba, and Colombia). The programs currently available in Brazil and Colombia are described in an effort to share information on the common characteristics of Master's and PhD degree programs in gerontology in Latin America. The authors concluded that, in Latin America, programs focused exclusively on gerontology are scarce.     

Gender Differences in Health and Health Expectancies of Older Adults in Singapore: An Examination of Diseases,Impairments, and Functional Disabilities

Using a nationally representative sample of 4,511 Singaporeans aged 55+ from the 2005 National Survey of Senior Citizens (NSSC), this paper examines gender differences in specific diseases, impairments, and disabilities, and computes health expectancies for these health dimensions. Results show that women have higher prevalence for hypertension, bone/joint, eye/vision, and walking problems, while heart diseases and stroke are more common among men, particularly at younger ages. At ages 75+, women have more disabilities related to basic activities of daily living (bathing, dressing, toileting, transferring, and feeding) than men. Health expectancies computations by the Sullivan method reveal that while women live longer than men, they can also expect more years of life both without and with diseases, impairments, and disabilities. At age 65, a larger proportion of women’s remaining life is with hypertension, bone/joint problems, vision impairments, walking difficulties, and functional disabilities compared to same-aged men. The findings largely support the gender health-survival paradox found in Western countries—that women have higher morbidity rates despite longer life expectancy. The morbidity differences between men and women, however, vary depending on the particular health dimension and measure examined. Older women in Singapore tend to be advantaged in prevalence of diseases and disease-free life expectancy, but have more impairments and functional disabilities, and a larger proportion of remaining life with these difficulties compared to older men. Health policies and programs in Singapore will need to cater to these gender differences in specific health dimensions and measures.     

Ciguatera fish poisoning in Brazilian traveler to Caribbean

Ciguatera poisoning is the most common form of non-bacterial food-poisoning from fish worldwide. The incidence among Brazilians returning from high-risk regions is unclear because it is not a mandatory reportable disease. We describe a previously healthy 53-year-old Brazilian woman developed Ciguatera fish poisoning while traveling to Havana, Cuba. Physicians and health care professionals should advise travelers to avoid eating ciguatoxic fish species and potentially toxic fish species in the Caribbean islands. Despite the prognosis for most cases is good with a short duration of self-limited symptoms, early recognition of the identifying clinical features of ciguatera can result in improved patient care.     

Gender gaps in life expectancy and expected years with activity limitations at age 50 in the European Union: associations with macro-level structural indicators

Women generally live longer than men, but women’s longer lives are not necessarily healthy lives. The aim of this article is to describe the pattern of gender differences in expected years with and without activity limitations across 25 EU countries and to explore the association between gender differences and macro-level factors. We applied to the Eurostat life table’s data from the Statistics of Income and Living Conditions Survey to estimate gender differences in life expectancy with and without activity limitations at age 50 for 2005. We studied the relationship between the gender differences and structural indicators using meta-regression techniques. Differences in years with activity limitations between genders were associated with the life expectancy (LE) and the size of the gender difference in LE. Gender difference in years with activity limitations were larger as the gross domestic product, the expenditure on elderly care and the indicator of life-long learning decreased, and as the inequality in income distribution increased. There was evidence of disparity in the associations between the more established EU countries (EU15) and the newer EU10 countries. Among the EU15, gender differences were positively associated with income inequality, the proportion of the population with a low education and the men’s mean exit age from labour force. Among the EU10, inequalities were smaller with increasing expenditure in elderly care, with decreasing poverty risk and with decreasing employment rate of older people. The association between structural indicators and the gender gap in years with activity limitations suggests that gender differences can be reduced.     

Child survival: magnitude of the problem in Latin America

This document summarizes the most relevant epidemiologic characteristics of infant and child mortality in Latin America. The gap in infant mortality rates between Latin America and the developed countries is wide and appears to be increasing. In the developed countries, 980 of each 1000 infants survive to the age of 5, but only 900 did so in Latin America in 1975-80. Infant mortality declined in Latin America between 1950-55 and 1980-85 from 128 to 63/1000 live births, with a slight increase in the rate of decline over the past decade. The great differences in social and economic development within Latin America are reflected in mortality rates before the age of 5 that also vary widely, from 34/1000 in Cuba to 221/1000 in Bolivia in 1975-80. Latin American countries with moderate risk of early childhood mortality are led by Cuba and Costa Rica, with rates of 34-35/1000. The 2 countries are very different politically but both have implemented vigorous social policies that benefitted their entire populations. Both had sustained mortality declines between 1955-80. Argentina, Chile, Uruguay, Venezuela, and Panama had mortality rates of 46-56/1000. Within the region, 16.4% of births and 8% of deaths in children under 5 are estimated to occur in these 7 countries. The countries of very high mortality include the least developed Caribbean, Central American, and Andean countries: Haiti, guatemala, Honduras, Nicaragua, Bolivia, and Peru. 3 of these countries contain large indigenous populations that have largely remained outside the development process. Their average rate of infant mortality is 162/1000. 14.7% of births and 27.0% of deaths in children under 5 in Latin America occur in these 6 countries. The intermediate group contains the 2 most populated countries of the region, Brazil and Mexico. The risk of death under age 5 ranges from 74 to 114/1000 and averages 99/1000. The 7 countries account for 68.9% of births and 68% of deaths in children under 5. The rate of decline in infant mortality in Latin America is on the whole moderate, with no sign of acceleration. Progress is slowest in the countries with the highest rates. Available data clearly demonstrate excess mortality in rural areas, especially when compared to capital cities, but the degree of disparity varies among countries. In countries with high mortality and a large rural population, sustained decline in national mortality rates will require rural populations to be incorporated in the decline. In 1985, about 40% of Latin American children under 5 were believed to be in rural areas, but the proportion rural was 57% in the countries with highest mortality. Statistical information on causes of death in children under 5 is most deficient in exactly the areas where it is most needed. Most deaths are clearly due to infectious diseases and conditions preventable by vaccination. Social inequalities in survival of young children have been extensively described as a function of paternal occupational status, maternal education, and geographic factors. More effective policies are needed to ensure a more equitable distribution of wealth that will make possible a major improvement in child survival.     

Problems and priorities in child survival

This work synthesizes the conclusions and recommendations of the 1985 International Workshop on Child Survival held in Teotihuacan, Mexico. Data are presented which document the extent of the problem of child survival in Latin America and the deficiencies of available data. Malnutrition, diseases preventable through vaccination, diarrheal diseases, acute respiratory infections, perinatal disorders, and shortcomings in quality of care are separately discussed following an assessment of their socioeconomic and cultural determining factors. Recent advances in the preventive component of primary health care programs are discussed. In Latin America, 900 of each 1000 live born babies survive to the 5th year of life compared to 980 in developed countries. Although the mortality rate of children under 5 in Latin America declined from 128 in 1950-55 to 63 in 1980-85, there are wide disparities between countries. Most countries of Latin America were classified as having high or very high infant and child mortality. There are serious differences in child survival between geographic regions and social groups of each country. The mortality decline in Costa Rica, Cuba, and Chile demonstrates that other countries could avoid a large proportion of deaths by ensuring that benefits of current programs have broader coverage. The severe economic crisis in Mexico and other countries threatens the progress already achieved in child survival. The recommendations of the conference are based on the premise that recent efforts to improve survival have been insufficient and a more rational use of the available resources and knowledge is required. In the area of health policy, priority should continue to be given to providing care for mothers and small children. Investments should be reoriented toward extending coverage of primary health care. The proportion of mothers attended during delivery by trained paramedical personnel or physicians should be increased, and family planning programs in rural areas should be strengthened. At least 80% of the target population should be immunized, and the use of oral rehydration therapy should be promoted. Educational programs to promote lactation through the 5th month and introduction of appropriate solids should be reinforced. Programs are needed to control acute respiratory infections by recognizing danger signs and seeking help. Excessive use of obstetrical interventions in urban areas should be curtailed. Quality of primary health care and other services should be assured and community participation in decision making and service delivery encouraged. In the area of research policy, funds for operational research should be included in primary health care budgets. Research by multidisciplinary teams should focus on improvement of service delivery systems and evaluation of quality of care and extent of coverage.     

Survey data for the study of aging in Latin America and the Caribbean: selected studies

The article summarizes three of the data collection studies that can assist researchers in examining population aging processes in the Latin America and Caribbean region with an emphasis on cross-national comparisons, including the population of Mexican immigrants in the United States. These are the Survey on Health and Wellbeing of Elders conducted in seven urban centers of the region, the national Mexican Health and Aging Study, and the Hispanic Established Populations for Epidemiologic Studies of the Elderly in the United States. The article describes the studies and marks them as informative, comprehensive, and still underanalyzed in particular for the purpose of cross-national analyses of aging among Latin American and Caribbean populations.     

Editorial: Transforming global health, global health education, infectious disease, and chronic conditions in the 21st century

Chronic and infectious diseases, including health care-associated infections and tropical diseases, represent a large portion of the global health burden. Solutions need to be found while addressing other health priorities identified by the Millennium Development Goals. A number of organizations and initiatives have been created to meet this need. Developing countries in Latin America and several African countries are taking a larger role in the development of robust health systems, capacity building, and education. Integrated, efficient, and equitable health systems that incorporate primary, secondary, and tertiary care models with a research focus are critically needed to fill this void.     

The sexual and reproductive health of young people in Latin America: evidence from WHO case studies

This original article addresses the sexual and reproductive health needs of young people aged 15 to 24 in Latin America. It introduces five articles from original research projects in three countries: Argentina, Brazil, and Peru. These projects were funded by the World Health Organization. This article explains the importance of studies that address the sexual and reproductive health of young people in developing countries. It provides an overview of sexual and reproductive health issues in Latin America and a discussion these issues in the three study countries. The five articles deal with difficult and challenging issues, including: knowledge of STIs and HIV/AIDS; pregnancy related practices; quality of care; the role of young men in couple formation, pregnancy and adoption of contraceptive practice; and, the role of obstetricians and gynecologists in public policy debate about family planning and abortion. The four articles in this special section help to improve our understanding of the factors that contribute to risky sexual behavior and negative reproductive health outcomes among youth in Latin America. The findings are useful to help inform and improve health care interventions in various contexts.     

Dengue and dengue hemorrhagic fever in Latin America and the Caribbean

Four serotypes of dengue viruses produce dengue fever, dengue hemorrhagic fever, and dengue shock syndrome. They are the most important arbovirus infections of humans, in terms of both morbidity and mortality, constituting one of the most rapidly expanding and re-emerging infectious disease problems in Latin America. In less than 20 years, the region has transformed itself from hypoendemic to hyperendemic, while serotype circulation in most countries has gone from none or single to multiple. Changes in endemicity have coincided with the emergence and increasing incidence of the severer forms of dengue infection. This article reviews the clinical presentations of these diseases. Health care providers who see patients in or returning from areas of Latin America, the Caribbean, and other tropical areas must consider dengue in the differential diagnosis of patients presenting with compatible symptoms, and must be knowledgeable in the current management of this important disease.     

Is everyone treated equally? Management of genital Chlamydia trachomatis infection in New Zealand

Health disparities often reflect inequitable access to appropriate health care. This study aimed to establish if cases of genital chlamydia infection were managed equitably by age, gender and ethnicity in a region of New Zealand with high rates of chlamydia infection (858 per 100,000 population). Clinical records of 415 genital chlamydia cases from 19 different health-care sites, including general practice and community settings, were reviewed. Data were analysed by demographic variables. For those treated, men were treated more quickly than women (median 3 days versus 6 days, P < 0.001), but there was no difference by ethnicity. Cases without documented treatment were more likely to be women (8.2% versus 2.1%, P = 0.037) and more likely to be Māori than non-Māori (13.6% versus 4.8%, P = 0.036). Overall, the most notable issue was the lack of effective partner notification across all demographic variables. Ongoing efforts are required to ensure equitable access to timely treatment and to ensure that more effective partner notification strategies are implemented.     

Ethical challenges in transplant practice in Latin America: the Aguascalientes Document

Organ transplants are currently an alternative treatment for a growing number of diseases, which were previously considered terminal. Bioethics has played an important role since the advent of this surgical technique, mainly in defining death criteria and the optimum transplantation conditions. This issue continues being a universal focal point, mainly concerning the equity of access to transplantation, criteria for assigning deceased-donor organs, living-donor safety, risk of commercial trade, fair access to high-quality immunosuppressive drugs and organ transplant legislation. These problems are characteristic of Latin America and the Caribbean, and were the driving force behind the First Latin American Bioethics and Transplant Forum, sponsored by the Latin American and Caribbean Transplant Society (STALYC), and all the transplant societies from subsidiary countries. The "Document of Aguascalientes" is a collection of all the ideas and opinions that were proposed during round tables and analyses. The document is divided into four sections: 1) living donor; 2) organ trading and transplant tourism; 3) the state role in legislation, transplant distribution and coverage; and 4) access to and quality of immunosuppression. The Bioethics and Transplant Forum was created to analyse and find solutions for this complex issue. The "Document of Aguascalientes" aims to serve as an instrument of expression and a vehicle for the ideas put forward during the Forum, so that they can act as transplant practice guidelines in Latin America.     

HIV and HTLV-I infections in the Americas: a regional perspective

With over 143,000 cases of AIDS reported to the World Health Organization from 145 countries and with an estimated 5 to 10 million people worldwide infected with HIV, AIDS has become firmly established as a global pandemic. In the region of the Americas over 100,862 cases of AIDS have been reported with indigenous transmission documented in 45 to 46 countries. While North America has the highest annual number of AIDS cases per population, with 72 cases/million, the Caribbean subregion has a disproportionately high number of cases, with annual rates as high as 200 to 300 cases/million population for some countries. Despite differences in absolute number of cases, there has been a remarkable similarity in the temporal rate of increase of AIDS in the countries of the Americas, reflecting delayed introduction of the virus to some areas with an early exponential increase similar to that observed initially in the United States. Although the modes of transmission of HIV are the same throughout the region, evidence of increasing bisexual and heterosexual transmission, particularly in the Caribbean subregion, has resulted in a lower male-to-female ratio of AIDS cases and increased perinatal transmission. Clinically, a resurgence of diarrheal diseases, respiratory infections, and tuberculosis has been documented in association with HIV infection in many tropical countries of the Americas. With relatively high rates of HTLV-I infection already established in the Caribbean subregion, the overall public health problems of the Americas will be markedly potentiated by further spread of these 2 human retroviruses. If HIV infection continues to penetrate the poor and less advantaged populations in Latin America and the Caribbean, the potential exists for a massive epidemic in the Americas that may rapidly parallel the situation in Africa.