Abstract
Even in low and middle income countries most deaths occur in older adults. In Europe, the effects of better education and home ownership upon mortality seem to persist into old age, but these effects may not generalise to LMICs. Reliable data on causes and determinants of mortality are lacking. The vital status of 12,373 people aged 65 y and over was determined 3-5 y after baseline survey in sites in Latin America, India, and China. We report crude and standardised mortality rates, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Cox's proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89-0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites. Education seems to have an important latent effect on mortality into late life. However, compositional differences in socioeconomic position do not explain differences in mortality between sites. Social protection for older people, and the effectiveness of health systems in preventing and treating chronic disease, may be as important as economic and human development.
Highlights
Mortality among older people is a neglected topic in global health
In this paper we aim to provide a comprehensive overview of patterns of mortality among older people as observed through the follow-up period between baseline and incidence waves of the 10/66 Dementia Research Group catchment area studies in Latin America, India, and China
The current global health agenda for chronic diseases is strongly premised on the concept of ‘‘premature mortality’’ and is informed, largely, by an attempt to reduce mortality among working age adults [40]
Summary
Mortality among older people is a neglected topic in global health. In 2005, 30.2 million of the 58.8 million deaths worldwide occurred in people aged 60 y and older, accounting for 84% of deaths in high income countries, 61% in middle income countries, and 33% in low income countries [1]. Seventy-six percent of the deaths among older people occurred in low and middle income countries (LMICs) [1], where chronic diseases are fast replacing communicable diseases as the leading causes of death and disability [2] For these countries, the study of old-age mortality trends and their life course determinants is becoming increasingly relevant [3]. In Europe, the protective effects of better education and home ownership upon mortality seem to persist into old age, with attenuation of the gradient from middle into late life [4] These findings may not generalise to LMICs, where the social patterning of disease is complex, and evolving rapidly with the epidemiologic and demographic transitions. In low and middle income countries (LMICs), where threequarters of deaths of older people occur, reliable data on the causes and determinants of death among older people are lacking, in part because many LMICs have inadequate vital registration systems—official records of all births and deaths
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