中国65岁及以上老年人日常生活活动能力与死亡的关系

  目的  探讨老年人日常生活活动能力(activities of daily living, ADL)与中短期死亡之间的关系。  方法  本研究使用了来自中国老年健康影响因素跟踪调查(Chinese Longitudinal Healthy Longevity Survey, CLHLS)的数据。分析样本包括37 173名CLHLS项目历次调查中的新人群,生存结局来自研究对象2~4年后首次跟踪随访调查结果。失能情况是通过ADL能力量表进行测量。计算ADL总分并进行分组之后,本研究通过多种统计建模策略,探讨不同失能水平对老年人死亡的影响。  结果  调整人口学、健康行为、膳食摄入特征等混杂因素后,ADL总分人群死亡风险存在着统计学关联(RR=1.09, 95% CI:1.08~1.09, P < 0.001)。以6分组作对照,得分高于6分组的人群发生死亡的风险增加69%(RR=1.69, 95% CI:1.65~1.74, P < 0.001)。以正常组作为对照组,低级失能组和高级失能组的人群发生死亡的风险分别增加52%和92%(RR=1.52, 95% CI:1.47~1.56, P < 0.001; RR=1.92, 95% CI: 1.86~1.97, P < 0.001)。  结论  基于CLHLS样本发现,失能会增加老年人发生死亡的风险,短期随访、低年龄段的失能老年人发生死亡的风险更大。     

社区老年人身体活动与罹患肌少症的关联

  目的  探讨日常身体活动水平和体育锻炼习惯对社区老年人肌少症的影响。  方法  于2019年5月―8月招募≥65岁的老年人,通过亚洲肌少症诊断标准调查社区老年人肌少症患病率。采用自制问卷收集老年人一般人口学资料和生活习惯资料。采用国际体力活动量表（international physical activity questionnaire,IPAQ-s）对老年人日常身体活动量进行评估。使用Logistic回归分析模型分析肌少症与日常身体活动量、锻炼习惯之间的关系。  结果  社区老年人肌少症患病率为12.3%。在调整了人口学特征和生活习惯等混杂因素后,无锻炼习惯老年人肌少症患病率是有锻炼习惯者的2.759倍（OR=2.759,95% CI:1.213~5.919,P=0.017）。坚持锻炼年数每增加1年,老年人罹患肌少症的风险减少0.070（OR=0.930,95% CI:0.878~0.985,P=0.013）。每次锻炼时间增加1 h,老年人罹患肌少症的风险减少0.611（OR=0.389,95% CI:0.187~0.809,P=0.012）。  结论  我国≥65岁老年人肌少症患病率较高。尽早开始每周2 d以上、每次25 min以上的体育锻炼可降低老年人肌少症的患病风险。     

江苏省18～69岁男性自报慢性病与戒烟行为关系

  目的  探讨江苏省成年男性自报慢性病患病与戒烟行为的关系。  方法  分别于2007、2010、2013年采用多阶段分层整群抽样的方法,在江苏省14个成人慢性病及其危险因素监测点中抽取居民进行调查,以18~69岁男性为研究对象,分析慢性病患病与吸烟、戒烟行为的关系。  结果  18~69岁男性共8 313名,自报心脑血管疾病、恶性肿瘤、哮喘和慢性阻塞性肺部疾病（chronic obstructive pulmonary disease,COPD）患病率分别为1.5%、1.1%、1.5%和2.8%。戒烟者4种慢性病自报患病率均高于现在吸烟和不吸烟者（均有P < 0.05）。多因素分析显示,患心脑血管疾病、恶性肿瘤、哮喘和COPD者戒烟率分别是未患者的3.356倍（95% CI:1.966~5.728）、3.864倍（95% CI:2.277~6.555）、2.103倍（95% CI:1.321~3.345）和2.586倍（95% CI:1.872~3.573）。  结论  患有慢性病者戒烟率高于未患病者,提示患病后会促进吸烟者的戒烟行为。     

福建省牙龈癌患者预后风险预测模型的构建

  目的  探讨福建地区牙龈癌患者预后影响因素并构建预后风险预测模型。  方法  收集福建医科大学附属第一医院口腔颌面外科2005年1月―2017年6月经病理确诊的牙龈癌患者共198例,对其进行随访。利用多因素COX回归分析模型分析计算死亡风险比值（hazard rate,HR）及其95%置信区间（95% confidence interval,95% CI）,筛出牙龈癌患者预后的影响因素,并基于β系数构建每个个体的预后指数（prognostic index,PI）。运用X-tile软件确定PI的最佳截断点,并根据最佳截断点把研究对象分成低、中、高危组。  结果  在牙龈癌患者中,年龄≥60岁（HR=1.668,95% CI:1.002~2.777,P=0.049）,有复发转移（HR=3.996,95% CI:2.295~6.959,P < 0.001）的患者预后更差;临床Ⅳ期与临床Ⅰ期相比预后更差（HR=3.002,95% CI:1.134~7.947,P=0.027）;经手术治疗的患者与未经手术治疗的相比预后更好（HR=0.246,95% CI:0.118~0.511,P < 0.001）。此外,构建的PI预后预测模型预测性能良好（AIC=611.605,C-index=0.747,AUC=0.765）。  结论  本研究发现年龄（≥60岁）、临床分期高、未进行手术治疗及存在复发转移均是影响牙龈癌患者预后的危险因素,且构建的PI预后预测模型能够较好的预测患者预后。     

中国成人BMI和腹型肥胖与急性心肌梗死发病关系的前瞻性研究

  目的  了解中国成人BMI和腹型肥胖与急性心肌梗死(acute myocardial infarction, AMI)的发病关系。  方法  从2010年中国慢性病及危险因素监测中抽取11个省(市),再从中选择60个监测点作为随访点,并于2016―2017年进行随访调查,共随访到27 604人,数据清理后共26 794名调查对象纳入分析。采用Cox比例风险回归模型分析BMI和腹型肥胖与AMI发病的关系。  结果  26 794名调查对象,平均随访6.0年,随访期间共观察到256例AMI事件。在调整相关混杂因素后,与腰围(waist circumference, WC)正常、BMI < 24 kg/m2组相比,腹型肥胖、BMI < 24 kg/m2组AMI的发病风险增加85%(HR=1.85, 95% CI: 1.14~3.01),腹型肥胖、BMI≥24 kg/m2组AMI的发病风险增加56%(HR=1.56, 95% CI: 1.11~2.18),而WC正常、BMI≥24 kg/m2组与AMI的发病风险无相关(HR=0.85, 95% CI: 0.49~1.47)。  结论  无论BMI值为多少,腹型肥胖都是AMI发病的重要危险因素。     

贵州黔南民族地区农村60岁以上老年人衰弱现况及影响因素

  目的  了解贵州黔南民族地区农村老年人衰弱现况及分析其影响因素,为提高老年人的健康水平及生命质量提供理论依据。  方法  采用多阶段整群抽样方法在贵州黔南民族地区3个镇10个村抽取1 352名农村老年人进行问卷调查,采用SPSS 22.0进行统计分析,单因素分析采用χ2检验;多因素分析采用二分类Logistic回归分析模型分析。  结果  贵州黔南民族地区1 352名农村老年人中衰弱者497人,衰弱率为36.76%;Logistic回归分析模型分析结果显示,民族（β=0.40,OR=1.49,95% CI:1.16~1.91,P＜0.001）、年龄（β=0.27,OR=1.31,95% CI:1.09~1.57,P＜0.001）、家庭年收入（β=-0.28,OR=0.76,95% CI:0.67~0.86,P＜0.001）、饮食类型（β=0.29,OR=1.33,95% CI:1.17~1.52,P＜0.001）、居住情况（β=-0.76,OR=0.47,95% CI:0.32~0.69,P＜0.001）、慢性病（β=1.01,OR=2.75,95% CI:2.10~3.60,P＜0.001）和日常生活功能状况（β=0.78,OR=2.17,95% CI:1.66~2.85,P＜0.001）是影响该地区老年人衰弱的主要因素。  结论  贵州黔南民族地区农村老年人衰弱严重程度相对较高,尤其高龄、少数民族、日常生活活动能力受损及患慢性病老年人是衰弱防治的重点人群,应积极开展慢性病管理及老年人合理膳食的指导,引导老年人形成健康的生活方式,以预防或延缓老年人衰弱的发生发展。     

社会经济地位、健康生活方式与高血压发病的前瞻性队列研究

  目的  探讨社会经济地位(socioeconomic status, SES)、健康生活方式与高血压发病的关系,为高血压的防控提供参考依据。  方法  采用分层整群随机抽样于2010年对抽取的贵州省12个县(市、区)≥18岁常住居民共9 280人进行基线调查,于2016—2020年对该队列所有人群进行随访;采用t检验、χ2检验进行单因素分析,使用Cox比例风险回归模型分析SES、健康生活方式对高血压发病的影响。  结果  研究有效样本量为3 401人,高血压发病765人,人群高血压发病密度为32.53/1 000人年。多因素Cox回归结果显示:与低SES(＜9分)人群相比,高SES(≥9分)人群高血压发病风险下降29.9%(HR=0.701, 95% CI: 0.584~0.842);与≤2种健康生活方式的人群相比,4种、≥5种健康生活方式人群发病风险分别降低25.7%(HR=0.743, 95% CI: 0.581~0.950)、39.2%(HR=0.608, 95% CI: 0.455~0.812)。与SES低且健康生活方式≤2种的人群相比,SES低且具有3种、4种、≥5种健康生活方式人群高血压发病风险的差异均无统计学意义(均有P＞0.05);SES高且具有3种、4种、≥5种健康生活方式的人群高血压发病风险分别降低36.3%(HR=0.637, 95% CI: 0.446~0.909)、44.0%(HR=0.560, 95% CI: 0.391~0.802)、55.8%(HR=0.442, 95% CI: 0.295~0.662)。  结论  SES较低人群是贵州省高血压防控的重点人群,应采取措施提高其SES,并有针对性地开展健康教育与健康促进工作。     

HIV单阳家庭配偶阳转情况及先证者生存分析

  目的   分析安徽省阜阳市艾滋病病毒(human immunodeficiency virus, HIV)单阳家庭配偶阳转的比例及先证者抗病毒治疗的生存分析。   方法   资料来源于艾滋病综合防治数据信息系统中的病例报告数据库, 筛选出1997年9月1日-2018年9月1日间确诊的HIV单阳家庭, 建立队列, 根据研究对象进行抗病毒治疗的时机, 将研究对象分为未治疗组、常规治疗组和提前治疗组, 比较三组阴性配偶阳转率及生存状况。   结果   共纳入单阳家庭598户, 三组人群总随访时间分别为:258.92人年、4 987.17人年和862.25人年, HIV阳转率分别为6.18/100人年, 0.48/100人年和0.23/100人年, 多因素Cox比例风险模型显示:相对于未治疗组, 常规治疗组(HR=0.052, 95% CI:0.037~0.074)和早期治疗组(HR=0.011, 95% CI:0.003~0.035)患者死亡的风险有下降的趋势; 女性死亡风险低于男性(HR=0.667, 95% CI:0.472~0.944);年龄越大, 其死亡风险越高(HR=1.041, 95% CI:1.026~1.056), 而相对于农民, 无业者死亡风险较高(HR=1.571, 95% CI:1.037~2.381)。   结论   应针对不同特征的单阳家庭制定有针对性的干预措施, 以推动尽早开展抗病毒治疗。     

中国中老年人睡眠时间与高血压患病率的相关性——基于健康与养老追踪调查

  目的  探究中国中老年人群睡眠时间与高血压患病率的关联。  方法  采用横断面研究分析方法,数据来源北京大学中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)。共纳入7 885名研究对象,按照夜间睡眠时长分为5组:≤5 h、＞5~ < 6 h、6~ < 7 h(参照)、7~ < 8 h、≥8 h。采用多因素Logistic回归分析模型分析并建立3个模型,在调整不同协变量下逐步探索不同夜间睡眠时长对高血压发生的影响,获得OR值和95% CI值。  结果  以夜间睡眠时长6~ < 7 h为对照,夜间睡眠时长≤5 h患高血压风险较高(OR=1.37, 95% CI: 1.12~1.69, P=0.002)。进一步按照性别分层分析,逐步调整混杂后,男性睡眠时长≤5 h组患高血压的风险是6~ < 7 h组的1.72倍(95% CI: 1.14~2.59, P=0.009)。而在女性中,调整混杂后并未发现关联(OR=1.26, 95% CI: 0.99~1.59, P=0.055)。  结论  在中国中老年人群中,夜间睡眠时长≤5 h可能是高血压患病的独立危险因素,男性夜间睡眠时长≤5 h会增加高血压的患病风险。     

中老年人脉压与肾功能下降的关联研究

  目的  探讨中老年人脉压(pulse pressure, PP)与肾功能下降的关系。  方法  以2015年1月1日—2019年12月31日在重庆医科大学附属第一医院参加健康体检的46 605例中老年人(≥45岁)为研究对象,按其PP水平分为四组(< 40 mm Hg、40~ < 50 mm Hg、50~ < 60 mm Hg、≥60 mm Hg),采用非条件Logistic回归分析模型分析PP与肾功能下降的关联。  结果  本研究46 605例中老年人年龄为54(48, 60)岁,肾功能下降者占27.37%(其中轻度占26.45%,中重度占0.92%)。与同年龄人群对照组相比,PP < 40 mm Hg和PP≥60 mm Hg组中老年人发生肾功能下降的风险分别升高11%和28%;按年龄分层后,45~ < 60岁中年人仅PP < 40 mm Hg组发生肾功能下降的风险升高13%(OR=1.13, 95% CI: 1.05~1.22),≥60岁老年人PP为50~ < 60 mm Hg和PP≥60 mm Hg组发生肾功能下降的风险分别升高12%(OR=1.12, 95% CI: 1.02~1.24)和66%(OR=1.66, 95% CI: 1.48~1.86)。限制性立方样条结果提示PP与肾功能下降的关联强度呈非线性关系,中年人PP < 42 mm Hg,老年人PP>55 mm Hg时肾功能下降风险增加。PP与肾功能下降程度关联分析结果显示,中年人仅PP < 40 mm Hg组发生肾功能轻度下降的风险升高13%(OR=1.13, 95% CI: 1.05~1.22);老年人PP为50~ < 60 mm Hg组发生肾功能轻度下降的风险升高11%(OR=1.11, 95% CI: 1.01~1.23),PP≥60 mm Hg组发生肾功能轻度和中重度下降的风险分别升高61%(OR=1.61, 95% CI: 1.43~1.81)和179%(OR=2.79, 95% CI: 1.94~4.02)。  结论  PP对肾功能下降及下降程度发生风险的影响在中年人和老年人中并不相同,应特别关注PP减小的中年人和PP增大的老年人的肾功能情况。     

65岁及以上社区老年人高血压病收缩压控制情况与认知功能关联性

  目的  探究老年高血压病人SBP控制情况和认知功能的关系。  方法  采用多阶段整群抽样,对年龄≥65岁的社区老年人进行现场调查, 使用标准水银血压计连续两次测量右臂血压值,采用简明精神状态量表(mini-mental state examination, MMSE)评估认知功能,并采用多因素Logistic回归分析模型分析SBP控制情况和认知功能的关系。  结果  强化控制(SBP＜120 mm Hg)(OR=1.519,95% CI:1.187~1.945)增高认知障碍患病风险。年龄分层发现,强化控制增加70岁及以上老人的认知障碍患病风险(均有P < 0.05)。对高血压病史分层发现,10年以上高血压病程老人,强化控制和控制不良(SBP≥140 mm Hg)均与认知障碍患病率增加正相关(均有P < 0.05)。进一步对10年以上高血压病程老人年龄分层,发现65~69岁老人中,控制不良与认知障碍患病风险增加相关(P=0.023)。  结论  高血压病程较长的老人中,65~69岁老人应严格控制SBP,70岁及以上老人应谨慎控制SBP。     

Reversible Cognitive Frailty,Dementia, and All-Cause Mortality. The Italian Longitudinal Study on Aging

Objectives

Cognitive frailty, a condition describing the simultaneous presence of physical frailty and mild cognitive impairment, has been recently defined by an international consensus group. We estimated the predictive role of a “reversible” cognitive frailty model on incident dementia, its subtypes, and all-cause mortality in nondemented older individuals. We verified if vascular risk factors or depressive symptoms could modify this predictive role.

中国60岁及以上男性老年人参军经历与健康的关联研究

目的 分析中国男性老年人参军经历与其健康状况的关系,以期为今后政策的制定提供借鉴.方法 数据来源于中国家庭追踪调查(China Family Panel Studies,CFPS)2018年的调查数据.研究对象为3706位≥60岁男性老年人.身体健康由是否患慢性病和自评健康测量,心理健康由流调中心抑郁量表(Center...     

2型糖尿病患者体重指数与死亡风险的前瞻性研究

  目的  探讨体重指数（body mass index,BMI）与2型糖尿病患者全死因死亡风险的关联。  方法  研究对象为江苏省苏南、苏北地区纳入国家基本公共卫生服务管理的17 638名2型糖尿病患者,应用Cox比例风险回归模型计算基线时不同BMI组人群在随访期间的全死因死亡风险（hazard ratio,HR）值及95%置信区间（confidence interval,CI）。  结果  研究对象累计随访77 451人年,平均随访4.39年,随访期间共死亡1 274人,低体重组BMI < 18.5 kg/m2、正常体重组（18.5 kg/m2 ≤ BMI < 24.0 kg/m2）、超重组（24.0 kg/m2 ≤ BMI < 28.0 kg/m2）、肥胖组（BMI ≥ 28.0 kg/m2）死亡人数分别为39人、575人、484人和176人,相应的死亡率分别为15.6%、9.5%、6.2%、5.1%。调整混杂因素后,以正常体重组为参照,低体重组、超重组、肥胖组死亡风险的HR值（95%CI）分别为1.66（95%CI:1.20~2.30）,0.68（95%CI:0.61~0.77）,0.58（95%CI:0.48~0.68）。  结论  在2型糖尿病患者中,与正常体重人群相比,低体重人群的全死因死亡风险最高,超重和肥胖人群的死亡风险较低,超重和肥胖可以降低2型糖尿病患者死亡风险。     

慢性阻塞性肺疾病患者死亡危险因素队列研究的系统综述和荟萃分析

目的 系统评价慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者死亡危险因素。方法 检索PubMed、Cochrane Library、Web of Science、Embase、中国知网、维普网、万方数据知识服务平台和中国生物医学文献数据库有关COPD患者死亡危险因素的研究,再筛选文献、提取数据和质量评价,并进行荟萃分析。结果 纳入15篇队列研究,纽卡斯尔-渥太华(Newcastle-Ottawa Scale, NOS)量表评分7～9分。荟萃分析结果显示：高龄(HR=1.074, 95%CI:1.048～1.101,P<0.001)、吸烟(HR=1.390, 95%CI:1.298～1.490,P<0.001)、低BMI(HR=1.434, 95%CI:1.190～1.727,P<0.001)、高改良英国医学研究学会呼吸困难指数(modified British medical research council, mMRC)(HR=1.597, 95%CI:1.550～1.646,P<0.001)、高...     

Successful Aging and Mortality Risk: The Korean Longitudinal Study of Aging (2006-2014)

ObjectivesThe aim of this study is to examine the association of successful aging with mortality and further find gender differences in the effect of components of successful aging on mortality risks.DesignRetrospective cohort study.Setting and participantsA total of 3848 adults aged 65 and older from the Korean Longitudinal Study of Aging (2006-2014) data.MeasuresSuccessful aging was defined as success in the following 7 components: absence of major disease, no depression, no freedom from disability, high cognitive and physical function, active social engagement, and satisfaction with life. All-cause mortality was measured by death certificate and family interview.ResultsIn both genders, the mortality rate was higher in the older adults who did not achieve successful aging than in their counterparts (men: hazard ratio [HR] = 1.69, 95% confidence interval [CI] 1.18-2.43; and women: HR = 2.37, 95% CI 1.21-4.63). All components of no successful aging were associated with an increased risk of mortality except for no satisfaction with life in females. Mortality rates were predominant in major disease (HR = 1.86, 95% CI 1.54-2.25) and depressive symptoms (HR = 1.62, 95% CI 1.26-2.10) in males, and disability (HR = 2.08, 95% CI 1.68-2.57) and low physical functioning (HR = 2.31, 95% CI 1.79-2.98) were predominant in females.Conclusion/ImplicationWe found that older Koreans who did not achieve successful aging had a higher risk of all-cause mortality than successful agers. There were gender differences in mortality risks across all components of successful aging.     

Information Processing Speed and 8-Year Mortality Among Community-Dwelling Elderly Japanese

Background

Cognitive function is an important contributor to health among elderly adults. One reliable measure of cognitive functioning is information processing speed, which can predict incident dementia and is longitudinally related to the incidence of functional dependence. Few studies have examined the association between information processing speed and mortality. This 8-year prospective cohort study design with mortality surveillance examined the longitudinal relationship between information processing speed and all-cause mortality among community-dwelling elderly Japanese.

Methods

A total of 440 men and 371 women aged 70 years or older participated in this study. The Digit Symbol Substitution Test (DSST) was used to assess information processing speed. DSST score was used as an independent variable, and age, sex, education level, depressive symptoms, chronic disease, sensory deficit, instrumental activities of daily living, walking speed, and cognitive impairment were used as covariates.

Results

During the follow-up period, 182 participants (133 men and 49 women) died. A multivariate Cox proportional hazards model showed that lower DSST score was associated with increased risk of mortality (hazard ratio [HR] = 1.62, 95% CI = 0.97–2.72; HR = 1.73, 95% CI = 1.05–2.87; and HR = 2.55, 95% CI = 1.51–4.29, for the third, second, and first quartiles of DSST score, respectively).

Conclusions

Slower information processing speed was associated with shorter survival among elderly Japanese.Key words: all-cause mortality, cognition, community elderly, information processing speed     

Effectiveness of pneumococcal vaccination in older adults with chronic respiratory diseases: results of the EVAN-65 study

A prospective cohort study evaluating the clinical effectiveness of the 23-valent pneumococcal polysaccharide vaccine was conducted among 1298 Spanish older adults with chronic respiratory diseases (bronchitis, emphysema or asthma) who were followed between 2002 and 2005. Main outcomes were all-cause community-acquired pneumonia (CAP) and 30 days mortality from CAP. The association between vaccination and the risk of each outcome was evaluated by multivariable Cox proportional-hazard models adjusted for age and comorbidity pneumococcal vaccination did not alter significantly the risk of overall CAP (hazard ratio [HR]: 0.77; 95% confidence interval [CI]: 0.56-1.07) and 30 days mortality from CAP (HR: 0.87; 95% CI: 0.33-2.28). However, a borderline significant reduction of 30% in the risk of all-cause hospitalisation for CAP was observed among vaccinated subjects (HR: 0.70; 95% CI: 0.48-1.00; p=0.052). The effectiveness of the vaccine on the combined endpoint of pneumococcal and unknown organism infections reached 34% (HR: 0.66; 95% CI: 0.43-1.01; p=0.059). Although our findings suggest moderate benefits from the vaccination, the evidence of clinical effectiveness appears limited.     

Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke

ABSTRACT: BACKGROUND: The combined effect of diabetes and stroke on disability and mortality remains largely unexplored in Brazil and Latin America. Previous studies have been based primarily on data from developed countries. This study addresses the empirical gap by evaluating the combined impact of diabetes and stroke on disability and mortality in Brazil. METHODS: The sample was drawn from two waves of the Survey on Health and Well-being of the Elderly, which followed 2,143 older adults in Sao Paulo, Brazil, from 2000 to 2006. Disability was assessed via measures of activities of daily living (ADL) limitations, severe ADL limitations, and receiving assistance to perform these activities. Logistic and multinomial regression models controlling for sociodemographic and health conditions were used to address the influence of diabetes and stroke on disability and mortality. RESULTS: By itself, the presence of diabetes did not increase the risk of disability or the need for assistance; however, diabetes was related to increased risks when assessed in combination with stroke. After controlling for demographic, social and health conditions, individuals who had experienced stroke but not diabetes were 3.4 times more likely to have ADL limitations than those with neither condition (95% CI 2.26-5.04). This elevated risk more than doubled for those suffering from a combination of diabetes and stroke (OR 7.34, 95% CI 3.73-14.46). Similar effects from the combination of diabetes and stroke were observed for severe ADL limitations (OR 19.75, 95% CI 9.81- 39.76) and receiving ADL assistance (OR 16.57, 95% CI 8.39-32.73). Over time, older adults who had experienced a stroke were at higher risk of remaining disabled (RRR 4.28, 95% CI 1.53,11.95) and of mortality (RRR 3.42, 95% CI 1.65,7.09). However, risks were even higher for those who had experienced both diabetes and stroke. Diabetes was associated with higher mortality. CONCLUSIONS: Findings indicate that a combined history of stroke and diabetes has a great impact on disability prevalence and mortality among older adults in Sao Paulo, Brazil.