Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study.
Fecha
2012Autor
Ferri, Cleusa P.
Acosta, Daisy
Guerra, Mariella
Huang, Yueqin
Llibre Rodríguez, Juan J.
Salas, Aquiles
Sosa, Ana Luisa
Williams, Joseph D.
Gaona, Ciro
Liu, Zhaorui
Noriega, L.
Jotheeswaran, A. T.
Prince, Martin J.
Metadatos
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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.
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