Patterns of SES Health Disparities Among Older Adults in Three Upper Middle- and Two High-Income Countries.

OBJECTIVES: To examine the socioeconomic status (SES) health gradient for obesity, diabetes, and hypertension within a diverse group of health outcomes and behaviors among older adults (60+) in upper middle-income countries benchmarked with high-income countries. METHOD: We used data from three upper middle-income settings (Colombia-SABE-Bogotá, Mexico-SAGE, and South Africa-SAGE) and two high-income countries (England-ELSA and US-HRS) to estimate logistic regression models using age, gender, and education to predict health and health behaviors. RESULTS: The sharpest gradients appear in middle-income settings but follow expected patterns found in high-income countries for poor self-reported health, functionality, cognitive impairment, and depression. However, weaker gradients appear for obesity, hypertension, diabetes, and other chronic conditions in Colombia and Mexico and the gradient reverses in South Africa. Strong disparities exist in risky health behaviors and in early nutritional status in the middle-income settings. DISCUSSION: Rapid demographic and nutritional transitions, urbanization, poor early life conditions, social mobility, negative health behavior, and unique country circumstances provide a useful framework for understanding the SES health gradient in middle-income settings. In contrast with high-income countries, the increasing prevalence of obesity, an important risk factor for chronic conditions and other aspects of health, may ultimately change the SES gradient for diseases in the future.

Early Life Displacement Due to Armed Conflict and Violence, Early Nutrition, and Older Adult Hypertension, Diabetes, and Obesity in the Middle-Income Country of Colombia.

Objective: We examine the importance of early life displacement and nutrition on hypertension (HTN) and diabetes in older Colombian adults (60+ years) exposed to rapid demographic, epidemiological, and nutritional transitions, and armed conflict. We compare early life nutritional status and adult health in other middle- and high-income countries. Method: In Colombia (Survey of Health, Wellbeing and Aging [SABE]-Bogotá), we estimate the effects of early life conditions (displacement due to armed conflict and violence, hunger, low height, and not born in the capital city) and obesity on adult health; we compare the effects of low height on adult health in Mexico, South Africa (Study on Global Ageing and Adult Health [SAGE]), the United States, and England (Health and Retirement Study [HRS], English Longitudinal Study of Ageing [ELSA]). Results: Early life displacement, early poor nutrition, and adult obesity increase the risk of HTN and diabetes in Colombia. Being short is most detrimental for HTN in Colombian males. Discussion: Colombian data provide new evidence into how early life conditions and adult obesity contribute to older adult health.

Factores socioeconómicos y contextuales que determinan la actividad reproductiva de las adolescentes en Colombia / Socioeconomic and contextual determinants of reproductive activity among adolescent women in Colombia

OBJETIVO: Contribuir a un mejor entendimiento de la problemática del embarazo en las adolescentes y de sus factores determinantes, próximos y socioeconómicos, en dos contextos culturalmente diferentes, las ciudades de Cali y Santa Fe de Bogotá, en Colombia. MÉTODO: De carácter longitudinal, el estudio combina métodos de investigación cuantitativa y cualitativa. Se basa en la encuesta retrospectiva, cuantitativa y cualitativa de salud de los adolescentes de 2003. La encuesta cuantitativa tuvo una muestra de 1 100 adolescentes representativas de cada estrato socioeconómico. Para el análisis de los factores determinantes se utilizaron modelos de riesgo proporcional de tiempo discreto. Para el estudio cualitativo se efectuaron 72 entrevistas a profundidad y cuatro grupos focales. Asimismo, se identificaron las categorías que surgían de pautas y recurrencias en los datos, para generar patrones socioculturales por sexo, estrato y ciudad. RESULTADOS: Los patrones de actividad sexual, unión y maternidad difieren considerablemente entre estratos en las dos ciudades. Las adolescentes del estrato bajo inician las relaciones sexuales, se unen a compañeros y son madres con mucha mayor antelación e intensidad que las de estratos más altos. El principal factor determinante del comportamiento reproductivo de las adolescentes es el conjunto de influencias contextuales y socioeconómicas del hogar, principalmente el contexto familiar (ambiente y supervisión) y el clima educativo. CONCLUSIONES: Resulta evidente el escaso impacto que ha tenido la educación sexual que se imparte en las escuelas, desde 1993, en el comportamiento reproductivo de las adolescentes.

[Socioeconomic and contextual determinants of reproductive activity among adolescent women in Colombia]. / Factores socioeconómicos y contextuales que determinan la actividad reproductiva de las adolescentes en Colombia.

OBJECTIVE: To contribute to a better understanding of the problems of pregnancy among adolescent women, including proximate and socioeconomic determining factors, in two large, culturally different cities in Colombia: Santa Fe de Bogotá and Cali. METHODS: This longitudinal study combined quantitative and qualitative research methods, using information generated by a survey of adolescents conducted in 2003. The survey included 550 adolescents in Bogotá and 550 adolescents in Cali, from all socioeconomic strata. To analyze the determinants, discrete-time proportional hazards models were used. For the qualitative study, 72 in-depth interviews and four focus groups were done. With the information organized by subjects and categories that were defined in relation to the purposes of the study, categories were identified that arose from the patterns and recurrences in the data, in order to see sociocultural trends by sex, stratum, and city. RESULTS: The patterns of sexual activity, union (married or unmarried relationship), and maternity differ considerably among the socioeconomic strata, in both of the cities. The adolescent women in the low stratum begin having sexual relations, form unions, and become mothers earlier in life and with greater frequency than do adolescent women in the medium or high strata. The main determinant of the reproductive behavior of adolescent women is the set of contextual and socioeconomic factors in the home, mainly the family context (environment and supervision) and the educational climate (the average number of years of formal education of the family members over the age of 15). CONCLUSIONS: Sex education has been provided in the schools in Colombia since 1993, but our results clearly indicate that it has had only a limited impact on the reproductive behavior of adolescent women.

Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries.

OBJECTIVE: To explore and describe inequalities in health and use of health care as revealed by self-report in 12 countries of Latin America and the Caribbean. METHODS: A descriptive and exploratory study was performed based on the responses to questions on health and health care utilization that were included in general purpose household surveys. Inequalities are described by quintile of household expenditures (or income) per capita, sex, age group (children, adults, and older adults), and place of residence (urban vs. rural area). For those who sought health care, median polishing was performed by economic status and sex, for the three age groups. RESULTS: Although the study is exploratory and descriptive, its findings show large economic gradients in health care utilization in these countries, with generally small differences between males and females and higher percentages of women seeking health care than men, although there were some exceptions among the lower economic strata in urban areas. CONCLUSIONS: Inequalities in self-reported health problems among the different economic strata were small, and such problems were usually more common among women than men. The presence of small inequalities may be due to cultural and social differences in the perception of health. However, in most countries included in the study, large inequalities were found in the use of health care for the self-reported health problems. It is important to develop regional projects aimed at improving the questions on self reported health in household interview surveys so that the determinants of the inequalities in health can be studied in depth. The authors conclude that due to the different patterns of economic gradients among different age groups and among males and females, the practice of standardization used in constructing concentration curves and in computing concentration indices should be avoided. At the end is a set of recommendations on how to improve these sources of data. Despite their shortcomings, household interview surveys are very useful in understanding the dimensions of health inequalities in these countries.

Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries / Desigualdades de salud en América Latina y el Caribe: resultados descriptivos y exploratorios basados en la autonotificación de problemas de salud y atención de salud en doce países

Objective. To explore and describe inequalities in health and use of health care as revealed by self-report in 12 countries of Latin America and the Caribbean. Methods. A descriptive and exploratory study was performed based on the responses to questions on health and health care utilization that were included in general purpose household surveys. Inequalities are described by quintile of household expenditures (or income) per capita, sex, age group (children, adults, and older adults), and place of residence (urban vs. rural area). For those who sought health care, median polishing was performed by economic status and sex, for the three age groups. Results. Although the study is exploratory and descriptive, its findings show large economic gradients in health care utilization in these countries, with generally small differences between males and females and higher percentages of women seeking health care than men, although there were some exceptions among the lower economic strata in urban areas. Conclusions. Inequalities in self-reported health problems among the different economic strata were small, and such problems were usually more common among women than men. The presence of small inequalities may be due to cultural and social differences in the perception of health. However, in most countries included in the study, large inequalities were found in the use of health care for the self-reported health problems. It is important to develop regional projects aimed at improving the questions on selfreported health in household interview surveys so that the determinants of the inequalities in health can be studied in depth. The authors conclude that due to the different patterns of economic gradients among different age groups and among males and females, the practice of standardization used in constructing concentration curves and in computing concentration indices should be avoided. At the end is a set of recommendations on how to improve these sources of data. Despite their shortcomings, household interview surveys are very useful in understanding the dimensions of health inequalities in these countries

Objetivo. Explorar y describir las desigualdades detectadas a partir de la autonotificación de problemas de salud y de la búsqueda de atención sanitaria en 12 países de América Latina y el Caribe. Métodos. Se analizan las preguntas sobre los problemas de salud y la búsqueda de atención en encuestas de hogares de tipo general y se describen las desigualdades correspondientes de acuerdo con quintiles de gasto (o ingreso) doméstico per cápita, sexo, grupo de edad (niños, adultos y adultos mayores) y área urbana o rural. En el caso de las personas que buscaron atención de salud, se aplica la técnica de pulimiento de medianas por nivel económico y sexo para los tres grupos de edad. Resultados. Aun cuando el trabajo es exploratorio y descriptivo, los resultados muestran en los países estudiados la existencia de importantes gradientes en la utilización de servicios de salud según nivel económico, y la presencia de diferencias generalmente pequeñas entre hombres y mujeres, con algunas excepciones en los estratos económicos más bajos en áreas urbanas. Conclusiones. Las desigualdades detectadas a partir de la autonotificación de problemas de salud son muy pequeñas entre personas de diferente nivel económico y los problemas suelen ser más frecuentes entre las mujeres que entre los hombres. Esto se debe posiblemente a diferencias culturales y sociales en la percepción de la salud. Las desigualdades en la búsqueda de atención son grandes en la mayoría de los países estudiados. Es muy importante que se desarrollen proyectos regionales encaminados a mejorar las preguntas para la autonotificación de problemas de salud con el fin de poder estudiar a fondo los factores que determinan las desigualdades en el ámbito sanitario. Los autores concluyen que debido a que los gradientes económicos muestran patrones diferentes en los distintos grupos de edad y en hombres y mujeres, los datos no deben estandarizarse a la hora de derivar curvas de concentración y calcular los índices de concentración. Al final hay una lista de recomendaciones sobre cómo mejorar estas fuentes de datos. Pese a sus deficiencias, las encuestas de hogares nos ayudan a entender las complejidades de las desigualdades de salud en estos países.

Inequalities in health in Latin America and the Caribbean: descriptive and exploratory results for self-reported health problems and health care in twelve countries

Objective: To explore and describe inequalities in health and use of health care as revealed by self-report in 12 countries of Latin America and the Caribbean. Methods: A descriptive and exploratory study was performed based on the responses to questions on health and health care utilization that were included in general purpose household surveys. Inequalities are described by quintile of household expenditures (or income) per capita, sex, age group (children, adults, and older adults), and place of residence (urban vs. rural area). For those who sought health care, median polishing was performed by economic status and sex, for the three age groups. Results: Although the study is exploratory and descriptive, its findings show large economic gradients in health care utilization in these countries, with generally small difference between males and females and higher percentages of women seeking health care than men, although there were some exceptions among the lower economic strata in urban areas. Conclusions: Inequalities in self-reported health problems among the different economic strata were small, and such problems were usually more common among women than men. The presence of small inequalities may be due to cultural and social differences in the perception of health. However, in most countries included in the study, large inequalities were found in the use of health care for the self-reported health problems. It is important to develop regional projects aimed at improving the questions on self-reported health in household interview surveys so that the determinants of the inequalities in health can be studied in depth. The authors conclude that due to the different patterns of economic gradients among different age groups, and among males and females, the practice of standardization used in constructing concentration curves and in computing concentration indices should be avoided. At the end is a set of recommendations on how to improve these sources of data. Despite their shortcomings, household interview surveys are very useful in understanding the dimensions of health inequalities in these countries (AU)