Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison
Abstract
:1. Introduction
2. Materials and Methods
2.1. Main Outcome Variable
2.2. Covariates
2.2.1. Sociodemographic Factors
2.2.2. Health Behaviours and Chronic Conditions
2.3. Statistical Analysis
2.4. Ethical Consideration
3. Results
4. Discussion
Strengths and Limitations of the Study
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
Appendix A
Variables | China | Ghana | India | Mexico | Russian Federation | South Africa | All countries |
---|---|---|---|---|---|---|---|
Angina (%) | 8.0 | 12.2 | 17 | 14 | 36.4 | 7.9 | 16.7 |
Stroke (%) | 1.9 | 1.5 | 1.0 | 1.9 | 3.1 | 2.7 | 1.8 |
Asthma (%) | 3.9 | 3.7 | 10.8 | 3.7 | 5.9 | 6.6 | 7.0 |
Chronic lung disease (%) | 4.9 | 0.3 | 2.2 | 0.6 | 6.8 | 1.6 | 4.1 |
Diabetes (%) | 6.5 | 3.8 | 6.8 | 17.5 | 6.9 | 9.4 | 6.7 |
Hypertension (%) | 25.2 | 13.1 | 14.1 | 25.4 | 51.3 | 30.0 | 25.8 |
Arthritis (%) | 20.5 | 23.5 | 23.7 | 12.3 | 33.5 | 26.3 | 24.3 |
Depression (%) | 2.0 | 9.1 | 19.1 | 14.3 | 7.0 | 5.5 | 9.6 |
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Sociodemographic variables | China (n = 12,085) | Ghana (n = 4057) | India (n = 6257) | Mexico (n = 3940) | Russian Federation (n = 3422) | South Africa (n = 2806) | |
---|---|---|---|---|---|---|---|
Gender (%) | |||||||
Men | 49.3 | 52.5 | 51.2 | 46.3 | 39.7 | 40.7 | |
Women | 50.7 | 47.5 | 48.8 | 53.7 | 60.3 | 59.3 | |
Age group (%) | |||||||
50–59 years | 45.2 | 40.5 | 49.2 | 50.7 | 46.8 | 49.3 | |
60–69 years | 32.0 | 27.4 | 30.9 | 25.4 | 24.7 | 31.0 | |
70–79 years | 18.5 | 22.8 | 15.7 | 17.0 | 21.6 | 14.3 | |
80+ years | 4.2 | 9.3 | 4.2 | 6.9 | 6.9 | 5.3 | |
Marital status (%) | |||||||
Partnered | 85.3 | 59.4 | 77.5 | 73.9 | 59.4 | 52.3 | |
Not currently partnered | 14.7 | 40.6 | 22.5 | 26.1 | 40.6 | 47.7 | |
Education level (%) | |||||||
High | 3.9 | 3.7 | 5.2 | 7.7 | 17.7 | 6.1 | |
Medium | 31.9 | 21.6 | 19.2 | 12.6 | 75.2 | 22.5 | |
Low | 64.1 | 74.7 | 75.6 | 79.7 | 7.1 | 71.4 | |
Access to social capital (%) | |||||||
Structural and cognitive | 36.9 | 88.9 | 60.7 | 45.4 | 37.1 | 55.5 | |
Structural only | 0.5 | 5.3 | 5.5 | 11.1 | 16.9 | 39.3 | |
Cognitive only | 61.2 | 5.5 | 29.9 | 36.3 | 29.0 | 2.8 | |
Neither | 1.3 | 0.4 | 3.9 | 7.2 | 17.0 | 2.4 | |
Wealth status (%) | |||||||
5th quintile | 20.6 | 21.3 | 24.0 | 27.1 | 24.5 | 21.5 | |
4th quintile | 23.6 | 21.0 | 19.7 | 16.0 | 21.8 | 18.6 | |
3rd quintile | 20.6 | 20.4 | 19.0 | 16.3 | 18.8 | 19.8 | |
2nd quintile | 18.7 | 19.0 | 19.0 | 25.6 | 19.5 | 20.4 | |
1st quintile | 16.5 | 18.3 | 18.3 | 15.0 | 15.5 | 19.7 | |
Area of Residence (%) | |||||||
Urban | 46.0 | 40.7 | 25.7 | 78.0 | 72.5 | 65.3 | |
Rural | 54.0 | 59.3 | 74.3 | 22.0 | 27.5 | 34.7 | |
Body Mass Index (%) | |||||||
Underweight | 6.3 | 19.3 | 44.1 | 1.0 | 1.6 | 4.6 | |
Normal | 58.5 | 51.2 | 43.0 | 20.7 | 23.1 | 23.1 | |
Overweight | 26.5 | 16.6 | 9.3 | 40.8 | 33.7 | 22.4 | |
Obese | 8.8 | 12.9 | 3.5 | 37.5 | 41.6 | 49.8 | |
Physical activity level (%) | |||||||
High | 45.8 | 63.1 | 53.3 | 40.9 | 60.5 | 29.2 | |
Moderate | 26.8 | 12.4 | 23.1 | 23.0 | 16.0 | 13.6 | |
Low | 27.4 | 24.5 | 23.7 | 36.0 | 23.5 | 57.2 | |
Chronic conditions (%) | |||||||
None | 51.8 | 54.1 | 44.9 | 44.7 | 27.9 | 46.9 | |
1 chronic condition | 30.8 | 29.4 | 29.9 | 31.7 | 26.8 | 29.8 | |
Multimorbidity | 17.4 | 16.6 | 25.2 | 23.6 | 45.3 | 23.4 | |
Depression (%) | 2.0 | 9.1 | 19.1 | 14.3 | 7.0 | 5.5 |
Odds Ratio (95% CI) | |||||||
---|---|---|---|---|---|---|---|
China | Ghana | India | Mexico | Russian Federation | South Africa | ||
Gender | Men | 1 | 1 | 1 | 1 | 1 | 1 |
Women | 1.14 * (1.01–1.29) | 1.22 * (1.01–1.48) | 1.65 *** (1.37–1.99) | 1.26 (0.75–2.10) | 0.77 (0.46–1.27) | 1.00 (0.76–1.31) | |
Age group | 50–59 | 1 | 1 | 1 | 1 | 1 | 1 |
60–69 | 1.49 *** (1.24–1.79) | 1.40 *** (1.16–1.71) | 1.31 ** (1.08–1.59) | 1.05 (0.63–1.76) | 1.73 * (1.04–2.86) | 1.12 (0.84–1.49) | |
70–79 | 2.60 *** (2.06–3.29) | 2.45 *** (1.94–3.08) | 1.87 *** (1.44–2.43) | 1.43 (0.90–2.28) | 3.50 *** (1.74–7.04) | 2.10 *** (1.48–2.97) | |
80+ | 4.99 *** (3.66–6.80) | 3.89 *** (2.79–5.44) | 3.24 *** (2.17–4.83) | 3.52 *** (1.71–7.22) | 8.52 *** (4.27–17.0) | 3.63 *** (2.05–6.44) | |
Marital status | Partnered | 1 | 1 | 1 | 1 | 1 | 1 |
Not partnered | 0.99 (0.83–1.17) | 1.16 (0.95–1.41) | 1.01 (0.82–1.24) | 0.50 ** (0.30–0.83) | 1.44 (0.97–2.14) | 1.21 (0.89–1.63) | |
Education level | High | 1 | 1 | 1 | 1 | 1 | 1 |
Medium | 1.39 (0.90–2.13) | 1.20 (0.76–1.90) | 1.79 ** (1.20–2.67) | 0.94 (0.23–3.76) | 1.80 * (1.15–2.80) | 1.60 (0.76–3.39) | |
Low | 1.91 ** (1.30–2.79) | 1.58 * (1.01–2.47) | 2.54 *** (1.71–3.79) | 1.28 (0.43–3.78) | 3.54 *** (1.69–7.42) | 1.79 (0.84–3.79) | |
Access to social capital | Both | 1 | 1 | 1 | 1 | 1 | 1 |
Structural only | 0.78 (0.25–2.45) | 0.86 (0.46–1.62) | 0.99 (0.67–1.46) | 0.69 (0.30–1.56) | 2.21 * (1.08–4.55) | 1.36 * (1.03–1.81) | |
Cognitive only | 1.07 (0.83–1.38) | 0.83 (0.51–1.35) | 0.80 * (0.65–1.00) | 2.54 *** (1.54–4.21) | 1.59 * (1.09–2.31) | 1.84 (0.91–3.73) | |
Neither | 2.57 *** (1.54–4.31) | 1.24 (0.39–3.97) | 1.21 (0.81–1.79) | 1.03 (0.36–2.92) | 1.68 (0.88–3.24) | 4.11 *** (1.79–9.43) | |
Wealth status | 1st quintile | 2.03 *** (1.39–2.96) | 1.23 (0.88–1.70) | 1.59 ** (1.20–2.11) | 1.96 * (1.01–3.83) | 1.11 (0.73–1.69) | 0.95 (0.57–1.59) |
2nd quintile | 1.91 ** (1.31–2.77) | 1.34 (0.99–1.82) | 1.45 ** (1.15–1.83) | 0.80 (0.37–1.72) | 1.13 (0.71–1.81) | 0.93 (0.60–1.45) | |
3rd quintile | 2.24 *** (1.63–3.08) | 1.86 *** (1.40–2.47) | 1.50 ** (1.13–1.98) | 1.74 (0.84–3.60) | 0.98 (0.58–1.67) | 0.75 (0.49–1.16) | |
4th quintile | 1.65 ** (1.19–2.29) | 1.09 (0.85–1.39) | 1.28 (0.99–1.65) | 0.73 (0.37–1.43) | 0.49 ** (0.29–0.82) | 0.76 (0.54–1.07) | |
5th quintile | 1 | 1 | 1 | 1 | 1 | 1 | |
Residence | Urban | 1 | 1 | 1 | 1 | 1 | 1 |
Rural | 2.16 *** (1.73–2.69) | 1.12 (0.83–1.50) | 0.94 (0.75–1.19) | 2.39 * (1.16–4.92) | 0.98 (0.63–1.51) | 1.13 (0.81–1.58) | |
Body mass index (BMI) | Underweight | 0.90 (0.74–1.08) | 1.09 (0.86–1.39) | 1.16 (0.93–1.43) | 1.64 (0.43–6.27) | 1.96 (0.75–5.13) | 0.93 (0.52–1.67) |
Normal | 1 | 1 | 1 | 1 | 1 | 1 | |
Overweight | 0.86 (0.74–1.00) | 0.97 (0.77–1.21) | 1.12 (0.87–1.45) | 3.72 *** (1.93–7.17) | 0.95 (0.56–1.59) | 0.81 (0.57–1.15) | |
Obese | 1.00 (0.81–1.23) | 1.06 (0.83–1.34) | 1.12 (0.68–1.85) | 2.33 ** (1.27–4.27) | 1.82 * (1.09–3.04) | 0.95 (0.69–1.31) | |
Physical activity | High | 1 | 1 | 1 | 1 | 1 | 1 |
Moderate | 1.38 *** (1.17–1.63) | 1.37 * (1.02–1.82) | 1.20 (0.99–1.45) | 1.82 (0.91–3.64) | 1.09 (0.75–1.59) | 0.64 * (0.43–0.96) | |
Low | 2.13 *** (1.74–2.61) | 1.17 (0.87–1.59) | 1.70 *** (1.38–2.10) | 1.94 * (1.11–3.38) | 2.20 ** (1.64–2.96) | 1.03 (0.75–1.43) | |
Mental health | No Depression | 1 | 1 | 1 | 1 | 1 | 1 |
Depression | 2.54 *** (1.82–3.54) | 1.51 * (1.05–2.15) | 2.49 *** (1.99–3.11) | 2.28 * (1.20–4.33) | 1.05 (0.58–1.87) | 1.90 ** (1.20–3.00) | |
Presence of chronic disease | None | 1 | 1 | 1 | 1 | 1 | 1 |
One chronic disease | 1.59 *** (1.28–1.96) | 1.57 *** (1.30–1.89) | 1.72 *** (1.46–2.03) | 1.72 (0.98–3.02) | 1.82 * (1.13–2.93) | 1.69 *** (1.25–2.30) | |
Multimorbidity | 2.91 *** (2.43–3.47) | 3.18 *** (2.42–4.18) | 2.64 *** (2.08–3.36) | 3.44 *** (1.92–6.17) | 4.72 *** (2.54–8.79) | 2.83 *** (1.91–4.18) |
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Lestari, S.K.; Ng, N.; Kowal, P.; Santosa, A. Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison. Int. J. Environ. Res. Public Health 2019, 16, 1341. https://doi.org/10.3390/ijerph16081341
Lestari SK, Ng N, Kowal P, Santosa A. Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison. International Journal of Environmental Research and Public Health. 2019; 16(8):1341. https://doi.org/10.3390/ijerph16081341
Chicago/Turabian StyleLestari, Septi Kurnia, Nawi Ng, Paul Kowal, and Ailiana Santosa. 2019. "Diversity in the Factors Associated with ADL-Related Disability among Older People in Six Middle-Income Countries: A Cross-Country Comparison" International Journal of Environmental Research and Public Health 16, no. 8: 1341. https://doi.org/10.3390/ijerph16081341