Abstract
BackgroundThe global phenomenon of population ageing is creating new challenges in both high and middle income countries, as functional limitations are expected to increase with age. The attribution method has been proposed to identify which conditions contribute most to disability using cross-sectional data. Although the original method was based on binary outcomes, we recently proposed an extension to multinomial responses, since different disability levels are often investigated in surveys. This is the first application of the extended method to evaluate differences in the contribution of chronic conditions to functional limitations in the older population of Brazil and Belgium.MethodsRepresentative data from individuals aged ≥65 years who participated in the 2008 or 2013 Health Interview Surveys in Belgium (N = 4521) or in the 2008 National Household Sample Survey in Brazil (N = 28,437) were analysed. Individuals were classified as without, moderate or severe functional limitations, based on three activities of daily living: eating, showering, and toileting. Six chronic conditions common to the surveys – diabetes, heart diseases, musculoskeletal conditions, depression, chronic respiratory diseases, and cancer – were included in the analysis. Separate multinomial additive hazards models by gender for each country were fitted.ResultsThe prevalence of moderate functional limitations was larger in men in Brazil (8.4%) compared to Belgium (6.0%) and similar in women (approximately 12.0%). Conversely, the severe prevalence in men was similar in the two countries (around 8.0%) and higher in women from Belgium (16.6%) than from Brazil (9.1%). Musculoskeletal conditions were the main contributors to the prevalence of functional limitations in men and women in Belgium but only in men and women with moderate functional limitations in Brazil. Depression and heart diseases contributed most to the severe prevalence of functional limitations in men and women in Brazil, respectively.ConclusionsOur findings provide a better understanding of differences in the prevalence of different levels of functional limitations in Brazil and Belgium. These differences can be related to differences in socioeconomic conditions, health care access and quality, disease diagnosis, stage of epidemiology transition, life expectancy, and the prevalence of lifestyle risk factors in the two countries.
Highlights
The global phenomenon of population ageing is creating new challenges in both high and middle income countries, as functional limitations are expected to increase with age
The age distribution of individuals without functional limitations is similar between the countries, a higher proportion of older individuals is observed in the Belgian population with moderate and severe functional limitations compared to Brazil
The proportion of men and women who did not report any selected chronic conditions was similar among men and women without functional limitations in the two countries, but higher in Brazilian men and women with moderate and severe functional limitations compared to Belgium
Summary
The global phenomenon of population ageing is creating new challenges in both high and middle income countries, as functional limitations are expected to increase with age. The original method was based on binary outcomes, we recently proposed an extension to multinomial responses, since different disability levels are often investigated in surveys This is the first application of the extended method to evaluate differences in the contribution of chronic conditions to functional limitations in the older population of Brazil and Belgium. Besides the cultural differences in reporting functional limitations, the similarity in the prevalence of functional limitations in the two countries can be related to a mortality selection during childhood in the older population in Brazil [33] This means that the current older individuals in Brazil were highly selected in terms of health. This is supported by the similarity in the proportion of healthy life years (very good, good or fair self-perceived health) at age 65 in Belgium (men: 86%; women: 78%) [34] and at age 60 in Brazil (men: 87%; women: 86%) [35] in 2013
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