Wednesday, March 7, 2012

[EQ] Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China

Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in
Latin America, India, and China: A Population-Based Cohort Study

Academic Editor: Peter Byass, Umea° Centre for Global Health Research, Sweden
Cleusa P. Ferri1*, Daisy Acosta2, Mariella Guerra1,3, Yueqin Huang4, Juan J. Llibre-Rodriguez1,5, Aquiles Salas6,7, Ana Luisa Sosa1,8, Joseph D. Williams9, Ciro Gaona10, Zhaorui Liu4, Lisseth Noriega-Fernandez11, A. T. Jotheeswaran12, Martin J. Prince1

PLoS Med 9(2): e1001179. doi:10.1371/journal.pmed.1001179 February 2012

Available online at:

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

Methods and Findings: The vital status of 12,373 people aged 65 y and over was determined 3–5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox’s proportional hazards regression.

Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China,

much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89–0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites.

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

1 King’s College London Institute of Psychiatry, Section of Epidemiology, Health Service and Population Research Department, London, United Kingdom,
2 Internal Medicine Department, Universidad Nacional Pedro Henriquez Uren˜ a, Santo Domingo, Dominican Republic,
3 Department of Psychiatry, Universidad Peruana Cayetano Heredia, Lima, Peru,
4 Peking University, Institute of Mental Health, Beijing, China,
5 Medical University of Havana, Havana, Cuba,
6 Medicine Department, Caracas University Hospital, Caracas, Venezuela,
7 Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela,
8 National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Mexico City, Mexico,
9 Community Health Department, Voluntary Health Services, Chennai, India,
10 Clinica Loira, Caracas, Venezuela,
11 Mental Health Community Centre of Marianao, Havana, Cuba,
12 Indian Institute of Public Health, Hyderabad, India



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