Document Detail

Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study.
MedLine Citation:
PMID:  22389633     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: 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.
Cleusa P Ferri; Daisy Acosta; Mariella Guerra; Yueqin Huang; Juan J Llibre-Rodriguez; Aquiles Salas; Ana Luisa Sosa; Joseph D Williams; Ciro Gaona; Zhaorui Liu; Lisseth Noriega-Fernandez; A T Jotheeswaran; Martin J Prince
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-02-28
Journal Detail:
Title:  PLoS medicine     Volume:  9     ISSN:  1549-1676     ISO Abbreviation:  PLoS Med.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-03-05     Completed Date:  2012-06-26     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  101231360     Medline TA:  PLoS Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e1001179     Citation Subset:  IM    
King's College London Institute of Psychiatry, Section of Epidemiology, Health Service and Population Research Department, London, United Kingdom.
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MeSH Terms
Age Factors
Aged, 80 and over
Cause of Death
China / epidemiology
Chronic Disease / epidemiology,  mortality
Cohort Studies
Developing Countries
India / epidemiology
Latin America / epidemiology
Longitudinal Studies
Proportional Hazards Models
Rural Population
Sex Factors
Socioeconomic Factors*
Urban Population
Grant Support
066133//Wellcome Trust; 080002//Wellcome Trust; GR066133//Wellcome Trust; GR08002//Wellcome Trust

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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