Socioeconomic inequalities in disability in Europe: contribution of behavioral, work-related and living conditions.

BACKGROUND: Previous studies have shown the existence of social inequalities in disability in many European countries. However, it is not clear what factors are associated with these inequalities. The aim of this study was to assess the contribution of behavioral factors, work-related factors and living conditions to educational inequalities in disability. METHODS: We pooled data from the seventh wave of the European Social Survey (2014) which included self-reported disability measured with the Global Activity Limitations Indicator for 19 European countries. We used multivariate logistic regression to determine the contributions of behavioral factors, work-related and living conditions to educational inequalities in disability among respondents aged 30-79. RESULTS: We found that adjusting simultaneously for three groups of determinants (behavioral, work-related and living conditions) reduces the greatest proportion of inequalities in disability in both men and women, in a range >70%. Each group of determinants contributes substantially to explain inequalities in disability. CONCLUSIONS: Inequalities in disability are a major challenge for public health in most European countries. Our findings suggest that these inequalities can be reduced by diminishing inequalities in exposure to well-known health determinants.

Housing conditions and risk of physical function limitations: a prospective study of community-dwelling older adults.

Background: Poor housing conditions have been associated with an increased risk of morbidity and mortality in old age. Methods: Prospective cohort of 1602 older adults followed from 2012 to 2015. Poor conditions were defined as living in a walk-up building, lacking piped hot water or heating, feeling frequently cold at home, lacking a bathtub/shower, a refrigerator, a washing machine, an own room or a landline. Frailty was assessed with the Fried criteria, lower extremities performance with the Short Physical Performance Battery (SPPB), and disability in instrumental activities of daily living (IADL) with the Lawton and Brody questionnaire. Results: During follow-up, 55 individuals (4.2%) developed frailty and 107 (7.2%) IADL disability. Mean (SD) SPPB values at baseline and at follow-up were 8.5 (2.5) and 8.6 (2.4), respectively. After multivariate adjustment, participants who lived in homes with ≥1 poor conditions showed a higher risk of frailty (odds ratio [OR] = 2.02; 95% confidence interval [95% CI]: 1.09-3.75) and transportation disability (OR = 3.50; 95% CI: 1.38-8.88). Lacking heating and feeling frequently cold were associated with an increased risk of exhaustion (OR = 2.34; 95% CI: 1.00-5.48) and transportation disability (OR = 3.31; 95% CI: 1.07-10.2), respectively. Conclusions: Prevention programs targeting functional limitations in older adults should ensure that they live in suitable housing conditions.

Desigualdades sociales en los factores de riesgo cardiovascular de los adultos mayores de España: estudio ENRICA-Seniors / Social inequalities in cardiovascular risk factors among older adults in Spain: The Seniors-ENRICA study

Introducción y objetivos: Examinar la distribución de los principales factores de riesgo cardiovascular (FRCV) de los adultos mayores de España según su nivel socioeconómico (NSE). Métodos: Estudio transversal realizado en 2008-2010 sobre 2.699 personas representativas de la población española no institucionalizada de edad ≥ 60 años. El NSE se valoró mediante el nivel educativo, la ocupación de los individuos y la ocupación del padre. Los FRCV se midieron de manera estandarizada e incluyeron factores tanto conductuales como biológicos. Resultados: En análisis ajustados por sexo y edad, el mayor nivel educativo se asoció con mayor frecuencia de consumo de alcohol y actividad física en tiempo libre moderados y menos tiempo mirando la televisión. Se observó un gradiente educativo inverso en la frecuencia de obesidad (estudios universitarios frente a primarios o menos, odds ratio [OR] = 0,44; intervalo de confianza del 95% [IC95%], 0,33-0,57; p de tendencia < 0,01), síndrome metabólico (OR = 0,56; IC95% 0,43-0,71; p de tendencia < 0,01), diabetes (OR = 0,68; IC95%, 0,49-0,95; p de tendencia < 0,05) y enfermedad cardiovascular (OR = 0,52; IC95%, 0,29-0,91; p de tendencia < 0,05). La ocupación manual se asoció a mayor frecuencia de muchos FRCV que la ocupación no manual; esta asociación era más fuerte que la observada con la ocupación del padre. Las diferencias en los FRCV según el NSE habitualmente eran mayores en las mujeres que en los varones. Conclusiones: Existen importantes desigualdades en los FRCV de los adultos mayores en España. Reducir estas desigualdades acercando los niveles de los FRCV de los sujetos de menor NSE a los de mayor NSE podría disminuir sustancialmente la prevalencia de FRCV en los adultos mayores (AU)

Introduction and objectives: To examine the distribution of the main cardiovascular risk factors (CVRF) according to socioeconomic level (SEL) among older adults in Spain. Methods: A cross-sectional study conducted in 2008-2010 with 2699 individuals representative of the noninstitutionalized Spanish population aged ≥ 60 years. Socioeconomic level was assessed using educational level, occupation, and father's occupation. The CVRF included behavioral and biological factors and were measured under standardized conditions. Results: In age- and sex-adjusted analyses, higher educational level was associated with a higher frequency of moderate alcohol consumption and leisure time physical activity, and less time spent watching television. An inverse educational gradient was observed for frequency of obesity (odds ratio [OR] in university vs primary level or below education, 0.44; 95% confidence interval [95%CI], 0.33-0.57; P-trend < .01), metabolic syndrome (OR = 0.56; 95%CI, 0.43-0.71; P-trend < .01), diabetes (OR = 0.68; 95%CI, 0.49-0.95; P-trend < .05), and cardiovascular disease (OR = 0.52; 95%CI, 0.29-0.91; P-trend < .05). Compared with a nonmanual occupation, having a manual occupation was associated with a higher frequency of several CVRF; this association was stronger than that observed for father's occupation. Differences in CVRF across SELs were generally greater in women than in men. Conclusions: There are significant social inequalities in CVRF among older adults in Spain. Reducing these inequalities, bringing the levels of CVRF in those from lower SEL in line with the levels seen in higher SEL, could substantially reduce the prevalence of CVRF in the older adult population (AU)

Social Inequalities in Cardiovascular Risk Factors Among Older Adults in Spain: The Seniors-ENRICA Study.

INTRODUCTION AND OBJECTIVES: To examine the distribution of the main cardiovascular risk factors (CVRF) according to socioeconomic level (SEL) among older adults in Spain. METHODS: A cross-sectional study conducted in 2008-2010 with 2699 individuals representative of the noninstitutionalized Spanish population aged ≥ 60 years. Socioeconomic level was assessed using educational level, occupation, and father's occupation. The CVRF included behavioral and biological factors and were measured under standardized conditions. RESULTS: In age- and sex-adjusted analyses, higher educational level was associated with a higher frequency of moderate alcohol consumption and leisure time physical activity, and less time spent watching television. An inverse educational gradient was observed for frequency of obesity (odds ratio [OR] in university vs primary level or below education, 0.44; 95% confidence interval [95%CI], 0.33-0.57; P-trend < .01), metabolic syndrome (OR = 0.56; 95%CI, 0.43-0.71; P-trend < .01), diabetes (OR = 0.68; 95%CI, 0.49-0.95; P-trend < .05), and cardiovascular disease (OR = 0.52; 95%CI, 0.29-0.91; P-trend < .05). Compared with a nonmanual occupation, having a manual occupation was associated with a higher frequency of several CVRF; this association was stronger than that observed for father's occupation. Differences in CVRF across SELs were generally greater in women than in men. CONCLUSIONS: There are significant social inequalities in CVRF among older adults in Spain. Reducing these inequalities, bringing the levels of CVRF in those from lower SEL in line with the levels seen in higher SEL, could substantially reduce the prevalence of CVRF in the older adult population.

Housing conditions and limitations in physical function among older adults.

INTRODUCTION: Housing conditions are an important social determinant of health. However, to the best of our knowledge, no previous study has systematically assessed the association between housing conditions and physical function limitations in older adults; moreover, whether this association is independent of the socioeconomic status achieved earlier in life is still uncertain. METHODS: Cross-sectional analysis conducted among 2012 non-institutionalised individuals aged ≥60 years, who participated in the Seniors-ENRICA cohort. Participants reported the following poor housing conditions: living in a walk-up building, lacking heating, or feeling cold frequently. We assessed lower extremity performance with the Short Physical Performance Battery (SPPB), mobility or agility limitations with standardised questions, frailty according to the Fried criteria, and disability in instrumental activities of daily living (IADL) with the Lawton and Brody questionnaire. RESULTS: In analyses adjusting for demographic, behavioural and comorbidity variables, when compared with those living in homes without poor housing conditions, those with ≥2 poor conditions showed worse scores in the SPPB (ß -1.06; 95% CI -1.46 to -0.65) and a higher frequency of agility limitation (OR 1.62; 95% CI 1.00 to 2.61) and frailty (OR 8.78; 95% CI 3.00 to 25.60). These associations held after adjustment for educational and occupational levels. Living in a walk-up building was associated with a higher frequency of frailty, while lacking heating was linked to lower scores in the 3 SPPB tests, as well as with an increased frequency of frailty and 4 of its components (exhaustion, slow walking speed, low physical activity and weakness). Feeling cold was linked to increased exhaustion. No association was found between housing conditions and IADL disability. CONCLUSIONS: Poor housing conditions, particularly living in a walk-up building and lacking heating, are independently associated with limitations in physical function in older adults. This entails serious inequalities in functional status, which should be firmly addressed.

Factores asociados con mortalidad por infección respiratoria aguda en una población de niños menores de cinco años residentes en la ciudad de Bogotá / Factors Affecting Mortality from Acute Respiratory Infections in a Population of Children under Five Years Living in the city of Bogota

Introducción: Las infecciones respiratorias agudas (IRA), principalmente la neumonía y en segundo lugar la bronquiolitis, son la causa infecciosa más frecuente de muerte en niños menores de cinco años de edad. Objetivo: Determinar el papel de potenciales factores de riesgo como predictores de mortalidad por infección respiratoria aguda. Método: Estudio observacional analítico de casos y controles con 258 pacientes pediátricos menores de cinco años con enfermedad respiratoria aguda atendidos en cuatro hospitales de la zona suroriental de Bogotá. Resultados: Los hallazgos de acidosis metabólica, acidemia al momento del ingreso a la unidad de cuidado intensivo (UCI) y el antecedente de ingreso a la UCI en los meses de marzo, abril y mayo, respecto al ingreso en los demás meses del año, fueron predictores de la mortalidad. Entre tanto, la presencia de aleteo nasal y la administración de antibióticos en la segunda consulta, mostraron reducir el riesgo de mortalidad. Palabras clave: neumonía, mortalidad, infección, enfermedad pulmonar intersticial.

Introduction: In acute respiratory infections (ARI), pneumonia in the first place and bronchiolitis in the second place are the most common infectious cause of death in children under five years old. Objective: To establish the role of potential risk factors as predictors of mortality from acute respiratory infection. Method: An observational/analytic case-control study was conducted with 258 pediatric patients younger than five years old with acute respiratory disease (ARD) treated at four south-eastern hospitals in Bogotá. Results: Findings of metabolic acidosis and acidemia at ICU admission, as well as patients’ clinical history at ICU admission were taken as mortality predictors in the months of March, April and May, with regard to their admission in other months, and the presence of nasal flaring and the administration of antibiotics at the second consultation decreased mortality risk. Key words: Pneumonia, mortality, infection, interstitial lung disease.

Algunos factores de riesgo asociados a la mortalidad infantil en la ciudad de Bogotá, 2008 / Some risk factors associated with infant mortality in Bogota in 2008

Introducción: La tasa de mortalidad infantil en el Distrito Capital para el 2006 fue de 13,5 casos por 1.000 nacidos vivos. Aunque ha venido disminuyendo levemente en los últimos cinco años, la tendencia es a mantenerse estable. Para Bogotá era necesario caracterizar los factores asociados a la mortalidad infantil, que facilitaría las intervenciones de prevención y atención en la niñez menor de un año. Objetivo: Identificar algunos factores asociados a la mortalidad infantil en la ciudad de Bogotá en el 2008, mediante las variables incluidas en los certificados de defunción y los certificados de nacidos vivos. Método: Estudio de casos y controles. 1) Casos: defunciones en menores de un año durante el 2008 en Bogotá, y 2) controles: los nacidos vivos en el 2007 en Bogotá. Se utilizó un análisis bivariado estratificando por bajo peso y edad gestacional. Se empleó un modelo de regresión logística que incluía las variables con un valor de p < 0,10 en el análisis bivariado. Resultados: Los factores de riesgo para mortalidad infantil fueron: la edad gestacional menor de 37 semanas, el peso al nacer menor de 2.500 g, el niveleducativo de la madre con primaria o sin educación, la afiliación al régimen subsidiado y el sexo masculino. Conclusiones: Se identificaron factores de riesgo propios del recién nacido y del control prenatal, así como de la vinculación al Sistema de Seguridad en Salud. Estos factores son potencialmente modificables. Palabras clave: factor de riesgo, mortalidad infantil, peso bajo al nacer, baja edad gestacional, estudio caso-control.

Introduction: Infant mortality in the Bogota for 2006 was 13.5 cases per 1,000 live births. While it has been declining slightly over the past five years the trend has been stable. For Bogota it’s necessary to characterize the factors associated with infant mortality which facilitate the prevention and care interventions in this type of population. Objective: To identify some factors ssociated with infant mortality in Bogotá in 2008 through the variables included in 1death certificates and certificates of live births. Materials and methods: Case-Control Studies: (1) Case: eaths under one year old in 2008 in the Capital District, and (2) control: live births in 2007 in the Capital District. It was used a bivariate analysis, stratified by weight and gestational age. It was used a logistic regression model including the variables with p < 0.10 in the bivariate analysis. Results: The risk factors for infant mortality were: gestational age less than 37 weeks, birth weight less than 2,500 g, mother’s educational level with primary or no education, affiliation to the subsidized regime and males. Conclusions: There are risk factors that can be modified hrough the maternal health care which will prevent preterm births and children with low birth weight. It can reduce the risk of infant mortality, ensuring a good education of the population, improving the quality of care in health services and giving greater attention to males, which is not only risk factor for infant mortality but for some morbidities. Key words: Risk factors, infant mortality, low birth weight, low gestational age, case-control study.