Socioeconomic status and mortality in Dutch elderly people: The Rotterdam study

Background: The aim of the study was to describe the relationshipbetween socioeconomic status and mortality in Dutch elderlypeople. Methods: A prospective follow-up study was performedamong 4,878 women and 3,105 men aged 55 years and over livingin Ommoord, a district of Rotterdam, The Netherlands. At baseline,data on education, occupation and income were collected. Dataon mortality were obtained from the municipal population registryand general practitioners. Relative risks of mortality by indicatorsof socioeconomic status were estimated after an average follow-upperiod of 4.1 years. Separate age-adjusted analyses were performedfor men and women. Results: The findings in this study indicatethat for men (mean age at baseline of 69 ± 9 years),differences in mortality exist for all three indicators of socioeconomicstatus. Mortality risks were higher for lower educated men,unskilled manual workers and those with a lower equivalent householdincome. For women (mean age 72 ± 10 years), the relativerisks of mortality were also higher for lower educated groups,but lower equivalent household income and occupational statusappeared not to be related to mortality. Conclusions: In elderlyDutch people, there are clear differences in mortality acrossgroups of different socioeconomic status. The mechanisms forexplaining the apparent inequalities in health among older subjectsrequire further research.     

Education and nutrient intake in Dutch elderly people. The Rotterdam Study

OBJECTIVE: Unfavourable dietary habits might explain a part of the increased cardiovascular morbidity and mortality among the lower socioeconomic groups. The aim of the study was to describe differences in dietary intake in older subjects by socioeconomic status, as indicated by educational level. DESIGN: A cross-sectional analysis of socioeconomic status in relation to dietary intake. SETTING: The Rotterdam Study. SUBJECTS: 2213 men and 3193 women, aged 55 y and over living between 1990 and 1993 in a district of Rotterdam, The Netherlands. METHODS: Dietary data were assessed with a semiquantitative food frequency questionnaire, containing 170 food items in 13 food groups. RESULTS: In general, the dietary differences between socioeconomic groups were small. Lower educated subjects had a higher intake of almost all macronutrients compared with higher educated subjects. The total energy intake of men/women with the lowest educational level differed from those with the highest education in the following respect: 9.60/7.54 vs 8.94/7.17 MJ/day. Furthermore, fat composition was more adverse in the lower educated strata; in lower educated subjects, relatively more energy was derived from saturated fat (14.5/14.6 vs 13.8/13.8 energy%), the ratio of polyunsaturated saturated fat was lower (for men: 0.50 vs 0. 55) and the intake of cholesterol higher (271/220 vs 240/204 mg/day). These differences could be explained by a higher intake of visible fat (46/37 vs 44/34 g/day) and more meat consumption (130/100 vs 116/86 g/day). In addition, the composition of these products differed: the higher educated used relatively more lean meat and low-fat milk products. Furthermore, the intake of fibre was lower among the lower educated (1.88/2.17 vs 2.03/2.29 g/MJ). Among lower educated groups there were more abstainers (15.5/31.5 vs 12.3/26.9%) and the type of alcoholic beverages also differed between the groups. Intake of antioxidant vitamins from food alone did not differ between educational groups. CONCLUSIONS: In Dutch elderly people, there are socioeconomic differences in dietary intake. Although these differences are small, these findings support the role of diet in the explanation of socioeconomic inequalities in cardiovascular health. Sponsorship: Erasmus Centre for Research on Aging, Erasmus University Rotterdam. European Journal of Clinical Nutrition (2000) 54, 159-165     

Socioeconomic conditions of elderly people in Kosovo: a cross-sectional study

ABSTRACT: BACKGROUND: Kosovo is the newest state in Europe facing a particularly difficult socioeconomic and political transition. The available evidence on socioeconomic conditions and quality of life of elderly people in Kosovo is scarce notwithstanding the ageing trend due to lowering of fertility rates and a higher life-expectancy. In this context, the aim of our study was to assess the socioeconomic conditions of elderly people in post-war Kosovo. METHODS: A cross-sectional study was conducted in Kosovo in January-March 2011 including an age- sex-and residence (urban vs. rural)-stratified sample of 1,890 individuals (83.5% response) aged 65 years and over. A structured questionnaire included assessment of socio-demographic and socioeconomic characteristics including educational level and self-perceived poverty. Binary logistic regression was used to assess the association of self-perceived poverty with socio-demographic and socioeconomic factors. RESULTS: The educational level in this representative sample of elderly people in Kosovo was quite low, particularly among women. About 47% of respondents perceived themselves as poor, or extremely poor (41% of men and 52% of women). In multivariable-adjusted models, self-perceived poverty was higher among older women, low educated individuals, urban residents, and elderly individuals living alone. CONCLUSIONS: Findings from this study indicate that the socioeconomic situation of the elderly population in Kosovo is rather challenging. Demographic trends coupled with the economic and political transition raise serious concerns about increasing needs for socioeconomic support of elderly people in Kosovo. Specific policies and actions should be considered by a number of stakeholders, including government and civil society in transitional Kosovo.     

Vitamin status of elderly people in Germany.

In the last decade several attempts (Nationale Verzehrsstudie, NVS; Verbundstudie Ern?hrungserhebung und Risikofaktoren-Analytik, VERA: Bethanien-Ern?hrungsstudie, BEST) have been made to assess the nutritional status of the elderly in Germany. A careful evaluation of those data describing the vitamin status clearly indicate that healthy older people are not at higher risk for vitamin deficiency compared to younger adults. The results of the NVS showed that, except for folic acid, mean intake of all vitamins exceeded 80% of the current recommendations. Only 5% of blood vitamin concentrations analyzed in a subpopulation (VERA-Study) were founded to be below the physiological range. Only the incidence of low cobalamin values increased with age, presumably due to gastrointestinal problems (atrophic gastritis). In contrast, geriatric patients showed markedly lower vitamin blood concentrations compared to healthy subjects of the same age (BEST-Study). This might be explained by physical and mental deterioration, handicaps, chronic diseases and multiple chronic drug use. Underrepresentation of very old people, lack of reliable reference values for biomarkers and uncertainties in data collection may have contributed to misinterpretations. Representative studies are needed to objectively assess the nutritional status of the elderly population in Germany.     

Serum ferritin and risk of myocardial infarction in the elderly: the Rotterdam Study.

BACKGROUND: Elevated body iron stores have been suggested to be a risk factor for ischemic heart disease. OBJECTIVE: We examined whether elevated serum ferritin concentrations, other indicators of iron status, and dietary iron affected the incidence of myocardial infarction (MI) in an elderly population. DESIGN: A nested, case-control study of 60 patients who had their first MI and 112 age- and sex-matched control subjects embedded in the population-based cohort of the Rotterdam Study. RESULTS: The age- and sex-adjusted risk of MI for subjects with serum ferritin concentrations > or = 200 microg/L was 1.82 (95% CI: 0.90, 3.69; P = 0.096). The odds ratio (OR) was 1.26 (95% CI: 0.98, 1.64; P = 0.078) for the highest tertile of serum ferritin and was only slightly altered in a multivariate model. Risk of MI associated with the highest tertile of ferritin was most evident in current or former smokers (OR: 1.68; 95% CI: 1.17, 2.47; P for trend = 0.008) and in subjects with hypercholesterolemia (OR: 1.43; 95% CI: 0.99, 2.11; P for trend = 0.056) or diabetes (OR: 2.41; 95% CI: 1.12, 7.67; P for trend = 0.027). No association with risk of MI was observed for tertiles of serum iron, serum transferrin, or total dietary iron. For dietary heme iron, risk of MI was significantly increased in a multivariate model in which dietary energy, fat, saturated fat, and cholesterol were adjusted for (OR: 4.01; 95% CI: 1.17, 15.87; P for trend = 0.031). CONCLUSION: In the presence of other risk factors, serum ferritin may adversely affect ischemic heart disease risk in the elderly.     

Adverse outcomes of frailty in the elderly: the Rotterdam Study

To investigate the prevalence of frailty in a Dutch elderly population and to identify adverse health outcomes associated with the frailty phenotype independent of the comorbidities. Cross-sectional and longitudinal analyses within the Rotterdam Study (the Netherlands), a prospective population-based cohort study in persons aged ≥55 years. Frailty was defined as meeting three or more of five established criteria for frailty, evaluating nutritional status, physical activity, mobility, grip strength and exhaustion. Intermediate frailty was defined as meeting one or two frailty criteria. Comorbidities were objectively measured. Health outcomes were assessed by means of questionnaires, physical examinations and continuous follow-up through general practitioners and municipal health authorities for mortality. Of 2,833 participants (median age 74.0 years, inter quartile range 9) with sufficiently evaluated frailty criteria, 163 (5.8 %) participants were frail and 1,454 (51.3 %) intermediate frail. Frail elderly were more likely to be older and female, to have an impaired quality of life and to have fallen or to have been hospitalized. 108 (72.0 %) frail participants had ≥2 comorbidities, compared to 777 (54.4 %) intermediate frail and 522 (44.8 %) non-frail participants. Adjusted for age, sex and comorbidities, frail elderly had a significantly increased risk of dying within 3 years (HR 3.4; 95 % CI 1.9–6.4), compared to the non-frail elderly. This study in a general Dutch population of community-dwelling elderly able to perform the frailty tests, demonstrates that frailty is common and that frail elderly are at increased risk of death independent of comorbidities.     

Antioxidant vitamin status and carotid atherosclerosis in the elderly

BACKGROUND: The oxidative modification of LDL is thought to play a crucial role in the initiation of atherosclerosis. Antioxidant vitamins can protect LDL from oxidation, and high intakes or blood concentrations of these vitamins have been linked with a reduced risk of cardiovascular disease. Few data are available on the importance of antioxidant vitamins in earlier stages of atherogenesis. OBJECTIVE: We investigated the cross-sectional relation between antioxidant vitamin status and carotid atherosclerosis in a group of elderly persons. DESIGN: The study sample comprised 468 men and women aged 66-75 y living in Sheffield, United Kingdom. Duplex ultrasonography was used to measure intima-media thickness and the degree of stenosis in the extracranial carotid arteries. Antioxidant vitamin status was assessed by measuring fasting plasma concentrations of vitamin C, vitamin E, and beta-carotene. RESULTS: In the men, after adjustment for age and cardiovascular disease risk factors, a 20% higher plasma vitamin C concentration was associated with a 0.004-mm smaller intima-media thickness; a 20% higher beta-carotene concentration was associated with a 0.005-mm smaller intima-media thickness. Compared with men with high blood concentrations of beta-carotene or cholesterol-adjusted vitamin E, those with low blood concentrations of these vitamins were 2.5 times as likely to have carotid stenosis of >30%. We found no significant trends between plasma concentrations of antioxidant vitamins and either measure of carotid atherosclerosis in the women. CONCLUSION: A high antioxidant vitamin status may help to prevent the initiation and progression of early atherosclerotic lesions in men.     

Incidence and risk factors of disability in the elderly: the Rotterdam Study

BACKGROUND: This study analyzed the incidence of disability and its risk factors in multiple dimensions in community-dwelling women and men of older age, between 1990 and 1999, in Rotterdam, The Netherlands. METHODS: For this community-based prospective longitudinal study, data were obtained from the Rotterdam Study that comprised a cohort of 7983 elderly who are 55 and over. The study sample for incident disability consisted of 4258 subjects who were disability free at baseline and had complete outcome data at follow-up, 6 years later. Sociodemographic factors, lifestyle variables, health conditions and disability status were assessed at baseline and follow-up. Disability was defined as a Disability Index (DI) > or =0.50 according to the Health Assessment Questionnaire. RESULTS: Multivariate analyses, performed separately due to gender differences, revealed that age, self-rated health, overweight, depression, joint complaints, medication use were predictors of disability for both men and women. Stroke, falling and presence of comorbidities predicted disability in men only while having a partner, poor cognitive functioning, osteoarthritis and morning stiffness only predicted disability in women. CONCLUSION: Identified risk factors in this study are to some extent modifiable, enabling interventive strategies, reckoning with gender differences in risk profile, in order to prevent disability.     

Serum caeruloplasmin as a coronary risk factor in the elderly: the Rotterdam Study.

Serum Cu and caeruloplasmin levels have been suggested to be independent risk factors for CHD operating through oxidative modification of LDL. However, given its function as an acute-phase protein, the question has been raised whether an elevated caeruloplasmin level is not merely an indicator of inflammation. In the current study, we investigated whether serum caeruloplasmin was associated with subsequent myocardial infarction, taking into account indices of inflammation. The study population consisted of 210 cases of first myocardial infarction and controls, frequency-matched on age (5-year categories) and sex, selected from the population-based cohort of the Rotterdam Study. Serum caeruloplasmin levels were significantly elevated in cases of myocardial infarction compared with controls (510 (SD 110) v. 470 (SD 100) mg/l; P = 0.007). Risk of myocardial infarction for the highest compared with the lowest quartile of caeruloplasmin was 2.46 (95% CI 1.04, 6.00; Ptrend = 0.043) after adjustment for age, sex, BMI, pack-years smoked, serum cholesterol, systolic blood pressure, and income. The relative risk was most evident in current smokers. Adjustment for C-reactive protein and leucocyte count reduced the excess risk by 33%. This suggests that a substantial part of the observed association between serum caeruloplasmin and CHD may be attributed to inflammation processes rather than to the pro-oxidant activity of caeruloplasmin.     

Socioeconomic status and mortality among the elderly: findings from four US communities

The effect of socioeconomic status (SES) on mortality was examined in the community-dwelling elderly. Data were obtained from four population-based studies that enrolled elderly residents of four US communities (East Boston, Massachusetts; New Haven, Connecticut; east-central Iowa; and the Piedmont region of North Carolina) and followed them for 9 years, starting in 1982 or 1986. Higher SES, whether measured by education, by household income, or by occupational prestige, was generally associated with lower mortality. However, the pattern of findings varied by gender and by community. For men, all three SES indicators were associated with mortality in the majority of cohorts. For women, this was true only for income. SES-mortality associations were attenuated but not eliminated after adjustment for behavior and health status. SES-mortality associations were stronger in New Haven and North Carolina than in East Boston and Iowa. The latter communities are more homogeneous with respect to ethnicity, urbanization, and occupational history than the former. Future research should investigate the relative validity of traditional SES measures for men and women and develop more balanced assessment methods. These findings also suggest that it is important to consider not only individual characteristics but also community attributes that mediate or modify the pathways through which socioeconomic conditions may influence health.     

Malnourished elderly people and lipid status

Protein-energy malnutrition is common in the elderly. The relationship between protein-energy malnutrition and lipid status remains uncertain and few studies are available. The aim of this study was to evaluate the lipid status of malnourished elderly subjects recently hospitalized in a geriatric medical care unit. Classical parameters such as total cholesterol, HDL cholesterol, apoproteins A1 et B, vitamins A and E were measured. Particular attention was given to other parameters such as fatty acids. The studied population included 86 elderly subjects. They were divided into two groups, according to serum albumin (alb) and Body Mass Index (BMI). Fifty patients aged 81.5 7.3 years were considered to be well-nourished (WN) with albumin 35 g/l and BMI 21 kg/m2. Thirty six patients aged 84.1 6.6 years were considered to be malnourished (MN) with albumin < 35 g/l and BMI < 21 kg/m2. Our main findings shown significant decrease in all classical lipid parameters : total cholesterol (p< 0.001), HDL cholesterol (p< 0.005), apoproteins A1 (p< 0.001) and B (p< 0.001) in the malnourished group. We found an increase in the rate of v9 fatty acids (p< 0.001 for the oleic acid; p< 0.05 for the eicosatrienoic acid) and also an increase in the triene/tetraene ratio (p< 0.05) as a result of malnutrition. CONCLUSION: Protein-energy malnutrition is accompanied by lipid status alterations.     

Socioeconomic status and electrolyte intake in black adults: the Pitt County Study.

BACKGROUND. Although the inverse association between socioeconomic status (SES) and blood pressure has often been observed, little is known about the relationship between SES and dietary risk factors for elevated blood pressure. Therefore, this study described the distribution of dietary intakes of sodium, potassium, and calcium and examined the association between electrolyte intake and SES among 1784 Black men and women aged 25 to 50 residing in eastern North Carolina. METHODS. Household interviews were conducted in 1988 to obtain information on psychosocial and dietary correlates of blood pressure. Electrolyte intake (mg/day) was assessed using a food frequency questionnaire adapted to reflect regional and ethnic food preferences. SES was categorized into three levels defined by the participant's educational level and occupation. RESULTS. After adjustment for age and energy intake, potassium and calcium intake increased with increasing SES for both sexes. Sodium intake was high for all groups and did not vary markedly with SES, but sodium to potassium and sodium to calcium ratios decreased with increasing SES. In addition, high SES individuals were more likely to believe that diet affects risk for disease and to report less salt use at the table and less current sodium consumption than in the past. CONCLUSION. These data indicate that nutritional beliefs as well as the consumption of electrolytes are associated with SES in Black adults.     

Socioeconomic inequalities in mortality among elderly people in 11 European populations

STUDY OBJECTIVE: To describe mortality inequalities related to education and housing tenure in 11 European populations and to describe the age pattern of relative and absolute socioeconomic inequalities in mortality in the elderly European population. DESIGN AND METHODS: Data from mortality registries linked with population census data of 11 countries and regions of Europe were acquired for the beginning of the 1990s. Indicators of socioeconomic status were educational level and housing tenure. The study determined mortality rate ratios, relative indices of inequality (RII), and mortality rate differences. The age range was 30 to 90+ years. Analyses were performed on the pooled European data, including all populations, and on the data of populations separately. Data were included from Finland, Norway, Denmark, England and Wales, Belgium, France, Austria, Switzerland, Barcelona, Madrid, and Turin. MAIN RESULTS: In Europe (populations pooled) relative inequalities in mortality decreased with increasing age, but persisted. Absolute educational mortality differences increased until the ages 90+. In some of the populations, relative inequalities among older women were as large as those among middle aged women. The decline of relative educational inequalities was largest in Norway (men and women) and Austria (men). Relative educational inequalities did not decrease, or hardly decreased with age in England and Wales (men), Belgium, Switzerland, Austria, and Turin (women). CONCLUSIONS: Socioeconomic inequalities in mortality among older men and women were found to persist in each country, sometimes of similar magnitude as those among the middle aged. Mortality inequalities among older populations are an important public health problem in Europe.     

Socioeconomic status and health-related quality of life among elderly people: results from the Joint Canada/United States Survey of Health

The objective of this study was to assess the independent effect of income on health-related quality of life (HRQL) among older adults in Canada and the United States. Data were obtained from the 2002-2003 Joint Canada/United States Survey of Health. The sample consisted of 755 Canadians and 1,151 Americans aged 65 years or older. HRQL was measured with the multidimensional Health Utilities Index Mark 3 (HUI3). The results indicated that in the elderly population, HRQL was significantly associated with household income in the United States but not in Canada, controlling for sociodemographic and health indicators. Various explanations for the positive linear relationship between HRQL and income in the elderly population are discussed, including the roles of access to health care and socioeconomic inequalities in the United States and Canada.     

Socioeconomic position,resilience, and health behaviour among elderly people

Objectives  

Healthy psychological functioning, the ability to respond rapidly to environmental changes, has been associated with better health outcomes. Less work has examined the association with health behaviour. This study explores whether resilience (a specific expression of healthy psychological functioning) is positively associated with health behaviour in an elderly population aged ≥65 years and whether this association differs in different socioeconomic groups.