Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population Authors
First Online: 25 July 2013 Received: 19 September 2006 Accepted: 18 December 2006 DOI:
Cite this article as: Guerra, R.O., Alvarado, B.E. & Zunzunegui, M.V. Aging Clin Exp Res (2008) 20: 53. doi:10.1007/BF03324748
Background and aims: To examine life course social, gender and ethnic inequalities in ADL disability in a Brazilian urban elderly population. Methods: We used the São Paulo-SABE study (health, well-being and aging in Latin America and the Caribbean) to assess the associations between ADL disability and gender, ethnicity and life course social conditions (childhood socio-economic and health status, education, lifetime occupation, current perception of income), controlling for current physical and mental health (cognitive impairment and co-morbidity). ADL disability was defined as the presence of one or more difficulties with six tasks: bathing, toileting, dressing, walking across the room, eating, and getting out of bed. Results: Results suggest that social inequalities during the life course (hunger and poverty in early life; illiteracy, a low skilled occupation, having been a housewife; insufficient income) tend to result in disability in later life. The prevalence of ADL disability was higher among women (22.4%) than among men (14.8%). Mestizo/Native elders reported higher prevalence of disability compared with Whites and Blacks/Mulattos. Ethnic inequalities concerning ADL disability were explained by social and health conditions, but the gender gap persisted (OR women vs men= 2.16; 95% CI 1.32–3.55). Despite their higher rate of ADL disability in old age, women appear to be more resilient than men toward poor socio-economic conditions throughout the life course. Chronic conditions were more likely to result in ADL disability among men than women (OR= 1.83; 95% CI 1.41–2.38 in women; OR= 3.42; 95% CI 2.41–4.86 in men). Conclusions: Decreasing social inequalities during childhood and adulthood will reduce socio-economic inequalities in disability in old age, especially among men.
Activities of daily living
Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J, Power C. Life course epidemiology. J Epidemiol Community Health 2003; 57: 778–83.
Wadsworth ME. Health inequalities in the life course perspective. Soc Sci Med 1997; 44: 859–69.
Beland F, Zunzunegui MV. Predictors of functional status in older people living at home. Age Ageing 1999; 28: 153–9.
Coppin AK, Ferrucci L, Lauretani F, et al. Low socioeconomic status and disability in old age: evidence from the InChianti study for the mediating role of physiological impairments. J Gerontol A Biol Sci Med Sci 2006; 61: 86–91.
Keddie AM, Peek MK, Markides KS. Variation in the associations of education, occupation, income, and assets with functional limitations in older Mexican Americans. Ann Epidemiol 2005; 15: 579–89.
Beydoun MA, Popkin BM. The impact of socio-economic factors on functional status decline among community-dwelling older adults in China. Soc Sci Med 2005; 60: 2045–57.
von dem Knesebeck O, Luschen G, Cockerham WC, Siegrist J. Socioeconomic status and health among the aged in the United States and Germany: a comparative cross-sectional study. Soc Sci Med 2003; 57: 1643–52.
Minkler M, Fuller-Thomson E, Guralnik JM. Gradient of disability across the socioeconomic spectrum in the United States. N Engl J Med 2006; 355: 695–703.
Lamb VL. Gender differences in correlates of disablement among the elderly in Egypt. Soc Sci Med 1997; 45: 127–36.
Leveille SG, Penninx BW, Melzer D, Izmirlian G, Guralnik JM. Sex differences in the prevalence of mobility disability in old age: the dynamics of incidence, recovery, and mortality. J Gerontol B Psychol Sci Soc Sci 2000; 55: S41–50.
Murtagh KN, Hubert HB. Gender differences in physical disability among an elderly cohort. Am J Public Health 2004; 94: 1406–11.
Wray LA, Blaum CS. Explaining the role of sex on disability: a population-based study. Gerontologist 2001; 41: 499–510.
Arber S. Cooper H. Gender differences in health in later life: the new paradox? Soc Sci Med 1999; 48: 61–76.
Peek CW, Coward RT, Henretta JC, Duncan RP, Dougherty MC. Differences by race in the decline of health over time. J Gerontol B Psychol Sci Soc Sci 1997; 52: S336–44.
Stump TE, Clark DO, Jonhson RJ, Wolinsky FD. The structure of health status among Hispanic. African American, and White older adults. J Gerontol 1997; 52B: 49–60.
Kington RS, Smith JP. Socioeconomic status and racial and ethnic differences in functional status associated with chronic diseases. Am J Public Health 1997; 87: 805–10.
Mendes de Leon CF, Beckett LA, Fillenbaum GG, et al. Black-white differences in risk of becoming disabled and recovering from disability in old age: a longitudinal analysis of two EPESE populations. Am J Epidemiol 1997; 145: 488–97.
Zsembik BA, Peek MK, Peek CW. Race and ethnic variation in the disablement process. J Aging Health 2000; 12: 229–49.
Hayward MD, Crimmins EM, Miles TP, Yang Y. The significance of socioeconomic status in explaining the racial gap in chronic health conditions. Am Soc Rev 2000; 65: 910–30.
Kahn JR. Fazio EM. Economic status over the life course and racial disparities in health. J Gerontol B Psychol Sci Soc Sci 2005; 60: 76–84.
Leveille SG, Guralnik JM, Ferrucci L, Corti MC, Kasper J, Fried LP. Black/white differences in the relationship between MMSE scores and disability: the Women’s Health and Aging Study. J Gerontol B Psychol Sci Soc Sci 1998; 53: 201–8.
Markides KS, Stroup-Benham CA, Goodwin JS, Perkowski LC, Lichtenstein M, Ray LA. The effect of medical conditions on the functional limitations of Mexican-American elderly. Ann Epidemiol 1996; 6: 386–91.
Pelaez M, Palloni A, Albala C, et al. SABE survey on health, wellbeing, and aging in the Latin America and the Caribbean, 2000. Ann Arbor: Inter-university Consortium for Political and Social Research; 2004.
Barbosa AR, Souza JM, Lebrao ML, Laurenti R, Marucci MF. Functional limitations of Brazilian elderly by age and gender differences: data from SABE Survey. Cad Saude Publica 2005; 21: 1177.
Parahyba MI, Veras R, Melzer D. Disability among elderly women in Brazil. Rev Saude Publica 2005; 39: 383–90.
Reyes-Ortiz CA, Ostir GV, Pelaez M, Ottenbacher KJ. Cross-national comparison of disability in Latin American and Caribbean persons aged 75 and older. Arch Gerontol Geriatr 2006; 42: 21–33.
Quiroga P, Albala C, Klaasen G. Validation of a screening test for age associated cognitive impairment, in Chile. Rev Med Chil 2004; 132: 467–78.
Pfeffer RI, Kurosaki TT, Harrah CH, Jr., Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982; 37: 323–9.
Kuh D, Power C, Bartley M, Kuh D, Ben-Shlomo Y. Social pathways between childhood and adult health. In: A Life course approach to chronic disease epidemiology. New York: Oxford University Press; 1997, p. 169.
Kaplan GA, Turrell G, Lynch JW, Everson SA, Helkala EL, Salonen JT. Childhood socioeconomic position and cognitive function in adulthood. Int J Epidemiol 2001; 30: 256–63.
Wray LA, Alwin DF, McCammon RJ. Social status and risky health behaviors: results from the health and retirement study. J Gerontol B Psychol Sci Soc Sci 2005; 60 Spec No 2: 85–92.
Alvarado BE, Zunzunegui MV, Del Ser T, Beland F. Cognitive decline is related to education and occupation in a Spanish elderly cohort. Aging Clin Exp Res 2002; 14: 132–42.
Mansson NO, Rastam L, Eriksson KF, Israelsson B. Socioeconomic inequalities and disability pension in middle-aged men. Int J Epidemiol 1998; 27: 1019–25.
Arndt V, Rothenbacher D, Daniel U, Zschenderlein B, Schuberth S, Brenner H. Construction work and risk of occupational disability: a ten year follow up of 14.474 male workers. Occup Environ Med 2005; 62: 559–66.
Khlat M, Sermet C, Le PA. Women’s health in relation with their family and work roles: France in the early 1990s. Soc Sci Med 2000; 50: 1807–25.
Ajrouch KJ, Blandon AY, Antonucci TC. Social networks among men and women: the effects of age and socioeconomic status. J Gerontol B Psychol Sci Soc Sci 2005; 60: S311–7.
Tran TV, Williams LF. Poverty and impairment in activities of living among elderly Hispanics. Soc Work Health Care 1998; 26: 59–78.
Cheng YH, Chi I, Boey KW, Ko LS, Chou KL. Self-rated economic condition and the health of elderly persons in Hong Kong. Soc Sci Med 2002; 55: 1415–24.
Lynch JW, Kaplan GA, Shema SJ. Cumulative impact of sustained economic hardship on physical, cognitive, psychological, and social functioning. N Engl J Med 1997; 337: 1889–95.
Marmot MG. Understanding social inequalities in health. Perspect Biol Med 2003; 46: S9–23.
Porell FW, Miltiades HB. Access to care and functional status change among aged Medicare beneficiaries. J Gerontol B Psychol Sci Soc Sci 2001;56: S69–83.
Wallace SP, Gutierrez VF. Equity of access to health care for older adults in four major Latin American cities. Rev Panam Salud Publica 2005; 17: 394–409.
Noronha KV, Andrade MV. Social inequality in health and the utilization of health services among the elderly in Latin America. Rev Panam Salud Publica 2005; 17: 410–8.
Berkman LF, Glass T, Brissette I, Seeman TE. From social integration to health: Durkheim in the new millennium. Soc Sci Med 2000; 51: 843–57.
Janssen I, Heymsfield SB, Ross R. Low relative skeletal muscle mass (sarcopenia) in older persons is associated with functional impairment and physical disability. J Am Geriatr Soc 2002; 50: 889–96.
Brach JS, VanSwearingen JM. Physical impairment and disability: relationship to performance of activities of daily living in community-dwelling older men. Phys Ther 2002; 82: 752–61.
Ferrucci L, Turchi A, Fumagalli S, et al. Sex-related differences in the length of disability prior to death in older persons. Aging Clin Exp Res 2003; 15: 310–4.
Veijola J, Puukka P, Lehtinen V, Moring J, Lindholm T, Vaisanen E. Sex differences in the association between childhood experiences and adult depression. Psychol Med 1998; 28: 21–7.
Mathers CD, Murray CJ, Lopez AD, Sadana R, Salomon JA. Global patterns of healthy life expectancy for older women. J Women Aging 2002; 14: 99–117.
Melzer D, Parahyba MI. Socio-demographic correlates of mobility disability in older Brazilians: results of the first national survey. Age Ageing 2004; 33: 253–9.
Chor D, Lima CR. Epidemiologie aspects of racial inequalities in health in Brazil. Cad Saude Publica 2005; 21: 1586–94.
Dwyer JW, Lovell P. Earnings differentials between Whites and Japanese: the case of Brazil. Sociol Perspect 1990; 33: 185–99.
Kauhanen L, Lakka HM, Lynch JW, Kauhanen J. Social disadvantages in childhood and risk of all-cause death and cardiovascular disease in later life: a comparison of historical and retrospective childhood information. Int J Epidemiol 2006; 35: 962–8.
Adamson JA, Ebrahim S, Hunt K. The psychosocial versus material hypothesis to explain observed inequality in disability among older adults: data from the West of Scotland Twenty-07 Study. J Epidemiol Community Health 2006; 60: 974–80.
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