Socioeconomic differences in health among older adults in Mexico

Although the relationship between socioeconomic status (SES) and health is well-established in Western industrialized countries, few studies have examined this association in developing countries, particularly among older cohorts. We use the Mexican Health and Aging Study (MHAS), a nationally representative survey of Mexicans age 50 and older, to investigate the linkages between three indicators of SES (education, income, and wealth) and a set of health outcomes and behaviors in more and less urban areas of Mexico. We consider three measures of current health (self-rated health and two measures of physical functioning) and three behavioral indicators (obesity, smoking, and alcohol consumption). In urban areas, we find patterns similar to those in industrialized countries: higher SES individuals are more likely to report better health than their lower SES counterparts, regardless of the SES measure considered. In contrast, we find few significant SES-health associations in less urban areas. The results for health behaviors are generally similar between the two areas of residence. One exception is the education-obesity relationship. Our results suggest that education is a protective factor for obesity in urban areas and a risk factor in less urban areas. Contrary to patterns in the industrialized world, income is associated with higher rates of obesity, smoking, and excessive alcohol consumption. We also evaluate age and sex differences in the SES-health relationship among older Mexicans. The results suggest that further economic development in Mexico may lead to a widening of socioeconomic inequalities in health. The study also provides insight into why socioeconomic gradients in health are weak among Mexican-Americans and underscores the importance of understanding health inequalities in Latin America for research on Hispanic health patterns in the US.     

人群健康综合测量——健康期望寿命的发展及应用

健康期望寿命是人群健康综合测量的代表性指标,本文介绍了其产生与发展的历程,总结了健康状态期望寿命与健康调整期望寿命两大类指标的特点：前者为两分或多分型指标,计算简便易于解释和理解;后者为权重调整型指标,在指标设计层面更为科学全面,但测算过程复杂。文章介绍了健康调整期望寿命、健康寿命年等指标在世界卫生组织、欧盟等国际组织及地区的应用现状,分析了各自的优劣及前景,并建议我国未来应重视健康期望寿命的研究和应用。     

Dimensions of self-rated health in older adults

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.     

Changing health status and health expectancies among older adults in China: Gender differences from 1992 to 2002

Numerous studies document improvements in health status and health expectancies among older adults over time. However, most evidence is from developed nations and gender differences in health trends are often inconsistent. It remains unknown whether changes in health in developing countries resemble Western trends or whether patterns of health improvement are unique to the country's epidemiologic transition and gender norms. Using two nationally representative samples of non-institutionalized adults in China aged 65 years and older, this study investigates gender differences in the improvements in disability, chronic disease prevalence, and self-rated health from 1992 to 2002. Results from multivariate logistic regression models show that all three indicators of health improved over the 10-year period, with the largest improvement in self-rated health. With the exception of disability, the health of women improved more than men. Using Sullivan's decomposition methods, we also show that active life expectancy, disease-free life expectancy, and healthy life expectancy increased over this decade and were patterned differently according to gender. Overall, the findings demonstrate that China experienced broad health improvements during its early stages of the epidemiologic transition and that these changes were not uniform by gender. We discuss the public health implications of the findings in the context of China's rapidly aging population.     

上海市徐汇区成年居民健康行为与健康状态相关性分析

目的:了解徐汇区18岁以上成年居民的健康状态、自评健康、锻炼行为及就医行为的相关性.方法:使用2010年徐汇区居民健康监测调查资料中的成年人相关数据,以Stata 11.0统计软件进行频率分析及卡方检验,共分析样本11 233人.结果:徐汇区18岁以上成年居民的慢性病患病率、自评健康状况、锻炼行为与年龄、教育程度、婚姻状况、身体质量指数(BMI)等影响因素有关,居民就医行为与性别、年龄及医疗保险有关.结论:不同层次居民的健康状态与健康行为、就医行为互相影响,在制定区域卫生政策时要区别对待,提高针对性.     

The joint action on healthy life years (JA: EHLEIS)

Background

Life expectancy has been increasing during the last century within the European Union (EU). To measure progress in population health it is no longer sufficient to focus on the duration of life but quality of life should be considered. Healthy Life Years (HLY) allow estimating the quality of the remaining years that a person is expected to live, in terms of being free of long-standing activity limitation. The Joint Action on Healthy Life Years (JA: EHLEIS) is a joint action of European Member States (MS) and the European Union aiming at analysing trends, patterns and differences in HLY, as well as in other Summary Measures of Population Health (SMPH) indicators, across the European member states.

Methods

The JA: EHLEIS consolidates existing information on life and health expectancy by maximising the European comparability; by analysing trends in HLY within the EU; by analysing the evolution of the differences in HLY between Member States; and by identifying both macro-level as micro-level determinants of the inequalities in HLY. The JA: EHLEIS works in collaboration with the USA, Japan and OECD on the development of new SMPHs to be used globally. To strengthen the utility of the HLY for policy-making, annual meetings with policy-makers are planned.

Results

The information system allows the estimation of a set of health indicators (morbidity and disability prevalence, life and health expectancies) for Europe, Member States and shortly their regional levels. An annual country report on HLY in the national languages is available. The JA: EHLEIS is developing statistical attribution and decomposition tools which will be helpful to determine the impact of specific diseases, life styles or other determinants on differences in HLY. Through a set of international workshops the JA: EHLEIS aims to develop a blueprint for an international harmonized Summary Measure of Population Health.

Conclusion

The JA: EHLEIS objectives are to monitor progress towards the headline target of the Europe 2020 strategy of increasing HLY by 2 years by 2020 and to support policy development by identifying the main determinants of active and healthy ageing in Europe.     

武汉市社区老年人生命质量及影响因素分析

目的 了解武汉市社区老年人的生命质量及其相关影响因素。方法 采用现况研究方法,对抽取的1 272例老年人采用欧洲五维度健康量表（EuroQol five dimensions questionnaire,EQ-5D）进行生命质量评价和问卷调查。数据采用多元线性逐步回归模型分析。结果 武汉市社区老年人生命质量总体评价较好,其EQ-5D指数评分为（0.79±0.25）分,通过视觉模拟量表（visual analogue scale,VAS）的评分为（60.76±23.53）分。在行动能力、自我照顾能力、日常活动能力、身体疼痛或不适、焦虑或沮丧五个维度中没有问题的占比分别为86.00%、91.03%、87.18%、75.53%、90.17%。多因素分析显示与老年人生命质量相关的因素有慢性病、体育锻炼、社会网络规模,标准化偏回归系数β'分别为：慢性病（-0.068 3）、锻炼3~4次/周（0.056 6）、锻炼5~7次/周（0.078 2）、日接触10~19人（0.106 5）、日接触20人及以上（0.099 7）。慢性病中与老年人生命质量有关的主要有高血压、糖尿病、缺血性心脏病、胃肠炎,其标准化偏回归系数β'为：-0.085 5、-0.137 2、-0.144 6、-0.065 7（均有P<0.05）。结论 患有慢性病、缺乏锻炼、社会网络少会导致老年人生命质量得分下降。     

浙江省居民健康期望寿命分析

目的 分析浙江省居民1998、2003和2008年健康期望寿命以及年龄、性别和城乡之间的差异.方法 利用浙江省死因监测资料和浙江省卫生服务调查家庭户成员相关健康资料,采用Sullivan法计算健康期望寿命.结果 浙江省居民期望寿命、健康期望寿命和健康期望寿命比值,1998年为73.89岁、58.09岁和78.62%,2003年为75.91岁、57.76岁和76.08%,2008年为76.70岁、59.57岁和77.66%.浙江省居民期望寿命、健康期望寿命和健康期望寿命比值均随着年龄的上升而下降.女性期望寿命高于男性,男性健康期望寿命比值高于女性.城市居民期望寿命高于农村居民,但是农村居民健康期望寿命和健康期望寿命比值均高于城市居民.结论 浙江省居民期望寿命随着年份递增而递增,不同年龄、不同性别和不同地区的健康期望寿命存在差异,应采取不同卫生政策.     

糖尿病患病和死亡对浙江省居民健康期望寿命的影响

目的 评估糖尿病患病和死亡对居民健康期望寿命的影响。方法 采用去病因健康期望寿命计算方法,整合人群死因、健康自评以及糖尿病患病等资料,定量分析糖尿病对人群健康期望寿命的影响以及造成健康损失的内部构成。结果 2013年浙江省15岁居民健康期望寿命为55.80岁,去除糖尿病病因,男、女性居民健康期望寿命分别增加0.86岁和1.13岁,城市和农村居民分别增加1.04岁和0.66岁,女性居民增幅大于男性居民,城市居民增幅大于农村居民;糖尿病死亡、患病造成的健康寿命损失分别为0.10岁和0.79岁,患病/死亡健康寿命损失之比为7.92。结论 2013年浙江省居民糖尿病患病导致的健康寿命损失远大于死亡,应降低城市地区,特别是女性人群的糖尿病流行水平是减少糖尿病对人群健康寿命影响的重要措施。     

Integration and continuity of Care in health care network models for frail older adults

A detailed review was conducted of the literature on models evaluating theeffectiveness of integrated and coordinated care networks for the olderpopulation. The search made use of the following bibliographic databases:Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelvearticles on five different models were included for discussion. Analysis of theliterature showed that the services provided were based on primary care,including services within the home. Service users relied on the integration ofprimary and hospital care, day centers and in-home and social services. Careplans and case management were key elements in care continuity. This approachwas shown to be effective in the studies, reducing the need for hospital care,which resulted in savings for the system. There was reduced prevalence offunctional loss and improved satisfaction and quality of life on the part ofservice users and their families. The analysis reinforced the need for change inthe approach to health care for older adults and the integration andcoordination of services is an efficient way of initiating this change.     

健康预期寿命研究进展

近年来,随着老年人口的增多和寿命的延长,寿命中的生命质量日益成为社会关注的热点.之前用于评估人群健康状态和决定老龄人口政策制订所采用的指标是预期寿命(life expectancy),但预期寿命只能反映生命的数量,无法反映生命的质量.     

Disability in instrumental activities of daily living among older adults: gender differences

OBJECTIVE

To analyze gender differences in the incidence and determinants of disability regarding instrumental activities of daily living among older adults.

METHODS

The data were extracted from the Saúde, Bem-Estar e Envelhecimento (SABE – Health, Wellbeing and Ageing) study. In 2000, 1,034 older adults without difficulty in regarding instrumental activities of daily living were selected. The following characteristics were evaluated at the baseline: sociodemographic and behavioral variables, health status, falls, fractures, hospitalizations, depressive symptoms, cognition, strength, mobility, balance and perception of vision and hearing. Instrumental activities of daily living such as shopping and managing own money and medication, using transportation and using the telephone were reassessed in 2006, with incident cases of disability considered as the outcome.

RESULTS

The incidence density of disability in instrumental activities of daily living was 44.7/1,000 person/years for women and 25.2/1,000 person/years for men. The incidence rate ratio between women and men was 1.77 (95%CI 1.75;1.80). After controlling for socioeconomic status and clinical conditions, the incidence rate ratio was 1.81 (95%CI 1.77;1.84), demonstrating that women with chronic disease and greater social vulnerability have a greater incidence density of disability in instrumental activities of daily living. The following were determinants of the incidence of disability: age ≥ 80 and worse perception of hearing in both genders; stroke in men; and being aged 70 to 79 in women. Better cognitive performance was a protective factor in both genders and better balance was a protective factor in women.

CONCLUSIONS

The higher incidence density of disability in older women remained even after controlling for adverse social and clinical conditions. In addition to age, poorer cognitive performance and conditions that adversely affect communication disable both genders. Acute events, such as a stroke, disables elderly men more, whereas early deficits regarding balance disable women more.     

Using multidimensional health measures in older persons to identify risk of hospitalization and skilled nursing placement

We examine the relationship between multidimensional measures of function and outcomes in a cohort of older persons admitted to the residential care level of a multi-level long-term care facility. We collected self-reported measures of various aspects of health using the Medical Outcome Study Short-form Health Survey (SF-20) and the Dartmouth COOP charts, as well as performance-based measures of physical and cognitive function. Subjects (mean age 84.3 years) were followed for a median of 557 days. In multivariate analyses, emotional function (measured by either the SF-20 or COOP method) was a predictor of placement in skilled care. Self-reported overall health (measured by either the SF-20 or COOP method) and timed manual performance were predictive of hospitalization. Change on the functional status measures between 2 points in time was not associated with later placement in skilled care except in the case of timed manual performance. In an older population at risk for frequent and numerous health events, this study shows that two popularized self-report methods for assessing function yield results that predict future outcomes of great importance to older persons. However, measures that predict use of long-term care may not predict use of the hospital and vice versa.This work was supported by grants from the University of California Academic Geriatric Resource Program and the National Institute on Aging (Older Americans Independence Center and Academic Award to A.L.S.).     

北京市居民健康期望寿命测算研究

目的：基于卫生系统现有数据测算北京市居民健康期望寿命,对该指标本土化研究与应用提出建议。资料与方法：利用2008年北京市年度人口和死亡资料,第四次国家卫生服务调查和第二次全国残疾人抽样调查资料,基于沙利文法测算常用健康期望寿命指标。结果：2008年北京市居民0岁自评健康期望寿命为72．75岁,男性71．22岁,女性73．89岁。0岁无失能期望寿命75．18岁,男性73．85岁,女性76．56岁。0岁无慢性病期望寿命62．73岁,男性61．87岁,女性63．75岁。北京居民健康期望寿命在期望寿命中的占比男性通常高于女性,但老年人口中,男性健康期望寿命在期望寿命中的占比低于女性。政策建议：使用健康期望寿命作为居民健康状况评价的重要指标,借鉴国外成熟经验建立本土化的数据报告和收集制度,推进居民全生命周期人口相关信息数据的整合与利用,重视老年人口的长期照护需求及其健康支持体系建设。     

Hospitalization of older adults due to ambulatory care sensitive conditions

OBJECTIVE

To analyze the temporal evolution of the hospitalization of older adults due to ambulatory care sensitive conditions according to their structure, magnitude and causes.

METHODS

Cross-sectional study based on data from the Hospital Information System of the Brazilian Unified Health System and from the Primary Care Information System, referring to people aged 60 to 74 years living in the state of Rio de Janeiro, Souhteastern Brazil. The proportion and rate of hospitalizations due to ambulatory care sensitive conditions were calculated, both the global rate and, according to diagnoses, the most prevalent ones. The coverage of the Family Health Strategy and the number of medical consultations attended by older adults in primary care were estimated. To analyze the indicators’ impact on hospitalizations, a linear correlation test was used.

RESULTS

We found an intense reduction in hospitalizations due to ambulatory care sensitive conditions for all causes and age groups. Heart failure, cerebrovascular diseases and chronic obstructive pulmonary diseases concentrated 50.0% of the hospitalizations. Adults older than 69 years had a higher risk of hospitalization due to one of these causes. We observed a higher risk of hospitalization among men. A negative correlation was found between the hospitalizations and the indicators of access to primary care.

CONCLUSIONS

Primary healthcare in the state of Rio de Janeiro has been significantly impacting the hospital morbidity of the older population. Studies of hospitalizations due to ambulatory care sensitive conditions can aid the identification of the main causes that are sensitive to the intervention of the health services, in order to indicate which actions are more effective to reduce hospitalizations and to increase the population’s quality of life.     

Medical technologies,nonhuman aids,human assistance,and environmental factors in the assessment of health states

Researchers have developed various health state measures to capture the value of living well. They have reached a consensus that health state measures focus on functionality and general symptoms. One can assess functionality and general symptoms with or without medical technologies (for example, medication, laser surgery, or a pacemaker), nonhuman aids (for example, glasses or a wheelchair), human assistance (for example, the help of another person), and accommodating environmental factors (for example, a barrier-free physical environment). Researchers have paid little attention to these distinctions. In this paper, I discuss why such distinctions are important and explore what implications they have for the construction and application of health state measures. I use the Health Utilities Index Mark 3 (HUI) and the health state measure in the World Health Survey (WHS) as examples of pioneer measures that explicitly acknowledge different levels of functionality and general symptoms. I conclude that the inclusion of medical technologies and nonhuman aids in the assessment of health is reasonable, but not human assistance or accommodating environmental factors. While this conclusion is in line with the HUI and WHS, I discuss a rationale for this boundary and make further suggestions regarding scoring of health states.     

Poverty, wealth inequality and health among older adults in rural Cambodia

Little research exists on health determinants among adults living in economically deprived regions despite the fact that these areas comprise a good part of the world. This paper examines the distribution of wealth then tests associations between wealth inequality and a variety of health outcomes, among older adults, in one of the world's poorest regions--rural Cambodia. Data from the 2004 Survey of the Elderly in Cambodia are employed. Using a disablement framework to conceptualize health, associations between four health components and a wealth inequality measure are tested. The wealth inequality measure is based on an index that operationalizes wealth as ownership of household assets and household structural components. Results confirm difficult economic conditions in rural Cambodia. The lowest wealth quintile lives in households that own nothing, while the next quintiles are only slightly better off. Nevertheless, logistic regressions that adjust for other covariates indicate heterogeneity in health across quintiles that appear qualitatively similar, with the bottom quintiles reporting the most health problems. An exception is disability, which presents a U-shaped association. It is difficult to determine mechanisms behind the relationship using cross-sectional data, but the paper speculates on possible causal directions, both from wealth to health and vice-versa. The analysis suggests the ability to generalize the relationship between wealth inequality and health to extremely poor populations as a very small difference in wealth makes a relatively large difference with respect to health associations among those in meager surroundings.     

中美欧中老年人健康预期寿命及其社会经济因素比较研究

目的 计算和比较中国、美国、欧盟发展中国家和发达国家中老年人健康预期寿命（HLE）,分析社会经济因素对不同国家或地区中老年人生命长度及质量的影响。方法 使用2010-2019年调查,数据分别来自中国老年健康与退休追踪调查、美国老年人健康和退休调查以及欧洲健康、老龄化和退休调查,其中欧盟发达国家和欧盟发展中国家被分为两组分别计算。选择文化程度、家庭经济水平以及工作退休状态作为社会经济指标,日常生活自理能力作为健康状态指标。使用多状态生命周期表法计算在某一时段内不同健康状态间的转换概率,测算HLE。结果 研究共纳入69 544例中老年人,年龄上,欧盟发达国家和美国中老年人在各年龄段中均有更高HLE;性别上,仅中国女性的HLE低于中国男性。社会经济因素上,文化程度较高、家庭经济水平高的中老年人有更高HLE;在中国,工作的中老年人有更高的HLE,而在美国女性和欧盟发达国家,退休/无业的中老年人有更高的HLE。结论 人口和社会经济因素对不同国家或地区中老年人的HLE影响有所不同,作为发展中国家,中国应当更加关注女性、文化程度较低、家庭经济水平低的退休中老年人健康。     

北京市门头沟区农村居民健康状况及健康需求现况调查

目的了解门头沟区农村居民健康状况及健康需求,分析门头沟区农村居民目前存在的主要健康问题。方法采用北京市健康教育所设计的调查问卷,按照等距抽样原则,抽取900名农村居民进行问卷调查。结果除厕所卫生条件外农村居民卫生保健状况较好,调查比例均在70%以上,农村居民总吸烟率为38.9%,47.6%的农村居民做过健康体检,83.7%的农村居民去年没有患病,农村居民对慢性病知识的需求占44.9%。结论改善农村居民的厕所卫生条件,加强控烟工作力度,提高农村居民体育锻炼和健康体检的积极性,增强农村居民对隐患疾病的认识,以及有针对性地开展疾病相关知识的健康讲座将是今后我们健康教育工作的重点。