Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study.
Socioeconomic factors and all cause and cause-specific mortality among older people in Latin America, India, and China: a population-based cohort study.
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拉丁美洲，印度和中国老年人的社会经济因素以及所有原因和特定原因的死亡率：一项基于人群的研究研究。
DOI：
10.1371/journal.pmed.1001179
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发表时间：
2012-02
期刊：
影响因子：
15.8
通讯作者：
Prince MJ
中科院分区：
文献类型：
--
作者：
Ferri CP;Acosta D;Guerra M;Huang Y;Llibre-Rodriguez JJ;Salas A;Sosa AL;Williams JD;Gaona C;Liu Z;Noriega-Fernandez L;Jotheeswaran AT;Prince MJ
Cleusa Ferri及其同事研究了拉丁美洲、印度和中国超过12000名65岁及以上老年人的死亡率，结果表明慢性病是导致死亡的主要原因，而教育对死亡率有重要影响。即使在低收入和中等收入国家，大多数死亡也发生在老年人身上。在欧洲，更好的教育和住房所有权对死亡率的影响似乎持续到老年，但这些影响可能不会推广到中低收入国家。缺乏关于死亡原因和决定因素的可靠数据。在拉丁美洲、印度和中国进行基线调查后，确定了年龄在65岁及以上的12373人的生命状况。我们报告了粗死亡率和标准化死亡率，将死亡率与美国进行比较的标准化死亡率，并使用Cox比例风险回归估计了与社会经济因素的关联。使用InterVA算法估计病因特异性死亡率分数。粗死亡率从每1000人年27.3人到70.0人不等，在人口和经济因素标准化后仍然存在3倍的差异。与美国相比，印度城市和中国农村的死亡率要高得多，秘鲁、委内瑞拉和墨西哥城市的死亡率要低得多，其他地区的死亡率也相似。男性死亡率较高，且随年龄增长而增加。对这些影响进行调整后，发现教育、职业成就、资产和养老金收入都与死亡率呈负相关，而粮食不安全与死亡率呈正相关。相互调整后，只有教育仍然具有保护作用（合并风险比0.93,95% CI 0.89-0.98）。大多数死亡发生在家中，但除印度外，大多数人在最后患病期间都得到了医疗照顾。慢性疾病是导致死亡的主要原因，此外还有肺结核和肝病，中风是几乎所有地点的主要原因。教育似乎对晚年的死亡率有重要的潜在影响。然而，社会经济地位的组成差异并不能解释不同地点之间死亡率的差异。对老年人的社会保护以及卫生系统在预防和治疗慢性病方面的有效性可能与经济和人类发展同样重要。在世界范围内，一半的死亡发生在60岁或以上的人群中。然而，老年人死亡率是全球卫生中一个被忽视的话题。在高收入国家，84%的人要到65岁或以上才会死亡，老年人的死亡原因和影响其死亡风险的因素（决定因素）都有详细记录。例如，在欧洲，老年人死亡的主要原因是心脏病、中风和其他慢性（长期）疾病。此外，与年轻群体一样，接受更好的教育和拥有住房可以降低老年人的死亡风险。相比之下，在老年人死亡人数占四分之三的低收入和中等收入国家（LMICs），缺乏关于老年人死亡原因和决定因素的可靠数据，部分原因是许多LMICs缺乏充分的生命登记系统——所有出生和死亡的官方记录。在许多中低收入国家，慢性疾病正在取代传染性疾病，成为导致死亡和残疾的主要原因——卫生专家称之为流行病学转变（流行病学是对人口中疾病分布和原因的研究）——人口的平均年龄正在增加（人口转变）。这些变化发生在国家从工业化前经济向工业化经济转变的过程中，面对这些变化，中低收入国家的决策者需要采取措施，改善老年人的健康，减少老年人的死亡。然而，要做到这一点，他们需要关于这部分人口死亡原因和决定因素的可靠数据。在这项纵向人群队列研究（一种长期跟踪特定人群中的一组人的研究）中，10/66痴呆症研究小组的研究人员调查了生活在拉丁美洲、印度和中国的老年人的死亡率模式。该小组正在开展针对中低收入国家的痴呆症、老龄化和非传染性疾病的人群研究。2003年至2005年间，研究人员完成了一项对生活在六个拉丁美洲中低收入国家、中国和印度的65岁及以上老年人的基线调查。三到五年后，他们确定了12,373名研究参与者的生命状况（也就是说，他们确定了个人是活着还是死了），并使用标准化的“口头尸检”问卷就每次死亡采访了一名关键信息提供者（通常是亲属），其中包括有关死亡日期和地点的问题，以及医疗求助和最后疾病期间注意到的体征和症状。最后，他们使用了一种名为InterVA算法的工具，从口头尸检中计算出最可能的死亡原因。粗死亡率从秘鲁城市的27.3 / 1000人-年到印度城市的70.0 / 1000人-年不等，即使考虑到研究地点之间年龄、性别、教育、职业成就和资产数量的差异，死亡率仍然存在三倍的差异。与美国相比，印度城市和中国农村的死亡率要高得多；秘鲁的城乡、委内瑞拉和墨西哥的城市则低得多；但其他地方也类似。虽然有几个社会经济因素与死亡率有关，但在统计分析中，只有高等教育水平提供了一致的独立死亡保护。最后，慢性病是死亡的主要原因；中风是除秘鲁和墨西哥农村地区外所有地点的主要死亡原因。这些发现确定了一系列中低收入国家老年人死亡的主要原因，并表明教育与死亡率之间存在关联，这种关联一直延续到晚年。然而，这些发现可能不能推广到其他中低收入国家，甚至不能推广到所研究的中低收入国家的其他地点，而且由于关键举报人提供的一些信息可能受到回忆错误的影响，因此研究结果的准确性可能有限。然而，这些发现提示了如何改善中低收入国家老年人的健康和死亡率。具体而言，他们建议，确保普及教育的努力应带来实质性的健康效益，并应考虑针对晚年社会和经济脆弱性的干预措施，并促进获得有效组织的保健服务（特别是中风）。请通过本摘要的在线版本（http://dx.doi.org/10.1371/journal.pmed.1001179）访问这些网站。世界卫生组织提供关于世界各地死亡率和到2030年全球死亡率预测的信息。10/66痴呆症研究小组正在建立一个证据基础，为制定和执行改善低收入和中等收入国家老年人，特别是痴呆症患者的健康和社会福利的政策提供信息；维基百科有一个关于人口转型的页面（注：维基百科是一个免费的在线百科全书，任何人都可以编辑；有几种语言版本）可以使用InterVA工具解释死因解剖数据。美国疾病控制和预防中心有关于健康老龄化的信息
Cleusa Ferri and colleagues studied mortality rates in over 12,000 people aged 65 years and over in Latin America, India, and China and showed that chronic diseases are the main causes of death and that education has an important effect on mortality. 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. 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. 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. Please see later in the article for the Editors' Summary Worldwide, half of all deaths occur in people aged 60 or older. Yet mortality among older people is a neglected topic in global health. In high income countries, where 84% of people do not die until they are aged 65 years or older, the causes of death among older people and the factors (determinants) that affect their risk of dying are well documented. In Europe, for example, the leading causes of death among older people are heart disease, stroke, and other chronic (long-term) diseases. Moreover, as in younger age groups, having a better education and owning a house reduces the risk of death among older people. By contrast, in low and middle income countries (LMICs), where three-quarters of deaths of older people occur, reliable data on the causes and determinants of death among older people are lacking, in part because many LMICs have inadequate vital registration systems—official records of all births and deaths. In many LMICs, chronic diseases are replacing communicable (infectious) diseases as the leading causes of death and disability—health experts call this the epidemiological transition (epidemiology is the study of the distribution and causes of disease in populations)—and the average age of the population is increasing (the demographic transition). Faced with these changes, which occur when countries move from a pre-industrial to an industrial economy, policy makers in LMICs need to introduce measures to improve health and reduce deaths among older people. However, to do this, they need reliable data on the causes and determinants of death in this section of the population. In this longitudinal population-based cohort study (a type of study that follows a group of people from a defined population over time), researchers from the 10/66 Dementia Research Group, which is carrying out population-based research on dementia, aging, and non-communicable diseases in LMICs, investigate the patterns of mortality among older people living in Latin America, India, and China. Between 2003 and 2005, the researchers completed a baseline survey of people aged 65 years or older living in six Latin American LMICs, China, and India. Three to five years later, they determined the vital status of 12,373 of the study participants (that is, they determined whether the individual was alive or dead) and interviewed a key informant (usually a relative) about each death using a standardized “verbal autopsy” questionnaire that includes questions about date and place of death, and about medical help-seeking and signs and symptoms noted during the final illness. Finally, they used a tool called the InterVA algorithm to calculate the most likely causes of death from the verbal autopsies. Crude mortality rates varied from 27.3 per 1,000 person-years in urban Peru to 70.0 per 1,000 person-years in urban India, a three-fold difference in mortality rates that persisted even after allowing for differences in age, sex, education, occupational attainment, and number of assets among the study sites. Compared to the US, mortality rates were much higher in urban India and rural China; much lower in urban and rural Peru, Venezuela, and urban Mexico; but similar elsewhere. Although several socioeconomic factors were associated with mortality, only a higher education status provided consistent independent protection against death in statistical analyses. Finally, chronic diseases were the main causes of death; stroke was the leading cause of death at all the sites except those in rural Peru and Mexico. These findings identify the main causes of death among older adults in a range of LMICs and suggest that there is an association of education with mortality that extends into later life. However, these findings may not be generalizable to other LMICs or even to other sites in the LMICs studied, and because some of the information provided by key informants may have been affected by recall error, the accuracy of the findings may be limited. Nevertheless, these findings suggest how health and mortality might be improved in elderly people in LMICs. Specifically, they suggest that efforts to ensure universal access to education should confer substantial health benefits and that interventions that target social and economic vulnerability in later life and promote access to effectively organized health care (particularly for stroke) should be considered. Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001179. The World Health Organization provides information on mortality around the world and projections of global mortality up to 2030 The 10/66 Dementia Research Group is building an evidence base to inform the development and implementation of policies for improving the health and social welfare of older people in LMICs, particularly people with dementia; its website includes background information about demographic and epidemiological aging in LMICs Wikipedia has a page on the demographic transition (note: Wikipedia is a free online encyclopedia that anyone can edit; available in several languages) Information about the InterVA tool for interpreting verbal autopsy data is available The US Centers for Disease Control and Prevention has information about healthy aging
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影响因子：
2.8
作者：
Albanese E;Liu Z;Acosta D;Guerra M;Huang Y;Jacob KS;Jimenez-Velazquez IZ;Llibre Rodriguez JJ;Salas A;Sosa AL;Uwakwe R;Williams JD;Borges G;Jotheeswaran AT;Klibanski MG;McCrone P;Ferri CP;Prince MJ
通讯作者：
Prince MJ
影响因子：
4.5
作者：
Acosta, Daisy;Rottbeck, Ruth;Prince, Martin J.
通讯作者：
Prince, Martin J.
影响因子：
5.5
作者：
Fottrell, Edward;Byass, Peter
通讯作者：
Byass, Peter
DOI：
10.1590/s0102-311x2011001500006
发表时间：
2011-01-01
期刊：
Cadernos de Saúde Pública
影响因子：
--
作者：
Lima-Costa, Maria Fernanda;Peixoto, Sergio Viana;Uchôa, Elizabeth
通讯作者：
Uchôa, Elizabeth
DOI：
10.2471/blt.05.028712
发表时间：
2006-03-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Fantahun, Mesganaw;Fottrell, Edward;Byass, Peter
通讯作者：
Byass, Peter