Abstract
Non-Communicable Chronic Diseases (NCCDs) are the leading causes of ill health in elderly populations and are associated with increased risk of death. Then, the aim of this paper is to estimate the effect of High Blood Pressure on all-causes mortality among subjects aged ≥65 years old in three scenarios with different socio-economic backgrounds and urbanization processes by using flexible parametric survival models. Three cohorts coming from Brazil (n=365, 8 years of follow-up), Argentina (n=1800, 10 years of follow-up) and Italy (n=2472, 30 years of follow-up) were considered and only subjects older than 64 years included. Time to death (months) from enrolment and all-causes mortality were considered. Statistical analysis included Frailty Cox's Model and Flexible Parametric Survival Analysis. Due to the two-level structure of variability (subjects nested into cohorts), multilevel mixed-effect survival regression models were fitted. For modeling purposes, only the first twelve years of follow-up were considered. Frailty Cox model showed significant positive effects of age and an effect modification of High Blood Pressure and Non-communicable diseases, but not effects proportionality. Multilevel modeling evidenced a positive statistically significant effect of Age, Non-Communicable Chronic Diseases and Smoking. There was also an effect modification of Non-Communicable Chronic Diseases on High Blood Pressure. High Blood Pressure and Non-Communicable Chronic Diseases are important causal components and strong risk factors of cardiovascular mortality in these countries.
Highlights
The increase in the proportion of elderly population worldwide is one of the most important demographic facts both in developed countries and developing ones.[1,2,3]Non-Communicable Chronic Diseases (NCCDs) are the leading causes of ill health in elderly populations and are associated with increased risk of death. [4]
Smoking and NCCDs were defined as dichotomous variables if the subject was currently smoking or had smoked in the last five years and if he/she had Cardiovascular Diseases (CVDs), Dyslipidemia, Cancers, or Respiratory Chronic Diseases (RCDs), respectively
More than 60% of participants were ≤75 years old, without Diabetes Mellitus (DM), had High Blood Pressure (HBP), 50% had NCCDs and more than 50% were smokers for Italy
Summary
The increase in the proportion of elderly population worldwide is one of the most important demographic facts both in developed countries and developing ones.[1,2,3]Non-Communicable Chronic Diseases (NCCDs) are the leading causes of ill health in elderly populations and are associated with increased risk of death. [4]. Non-Communicable Chronic Diseases (NCCDs) are the leading causes of ill health in elderly populations and are associated with increased risk of death. CVDs mortality rates are decreasing, but the pace of this decline suggests that these diseases will still be in the future as will be their leading risk factors, namely HBP, DM, smoking and Dyslipidemia.[5]. In Brazil in 2010, 7.4% of the population was ≥65 years old (Aging Index 44.8) and life expectancy of 71,88 and 78,04 years for men and women, respectively. [8] Sixteen percent of the urban population of Argentina is ≥65 years old (Aging Index 46), while in rural areas, this value decreases to 10% with life expectancy of 75 and 79 years. This work was aimed to estimate the effect of HBP on all-cause mortality among subjects with age greater than 65 years old in three scenarios with different socio-economic background and urbanization process while considering countries variability
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