Adult Health Wave Research Articles

Sex and racial/ethnic differences in the association between childhood attention-deficit/hyperactivity disorder symptom subtypes and body mass index in the transition from adolescence to adulthood in the United States.

While attention-deficit/hyperactivity disorder (ADHD) has been associated with higher body mass index (BMI), little research has focused on how this association differs by sex or race/ethnicity. To investigate the association between ADHD and BMI by sex and race/ethnicity (ie, European [EA], African [AA], and Hispanic American [HA]). Data came from the National Longitudinal Survey of Adolescent to Adult Health Waves II to IV (n=13332, age: 12-34years). On the basis of self-reported childhood ADHD symptoms between the ages of 5 and 12years, participants were categorized into: ADHD predominantly hyperactive/impulsive (ADHD-HI); ADHD predominantly inattentive (ADHD-I); ADHD combined (ADHD-C; a combination of ADHD-HI and ADHD-I symptoms); and non-ADHD. The patterns of ADHD-BMI associations in the transition period between adolescence and young adulthood differed by sex and race/ethnicity. Compared with non-ADHD, ADHD-HI was associated with higher BMI among EA males and females, while ADHD-I was associated with higher BMI among EA females. ADHD-C was associated with higher BMI for HA females. We found no evidence of an association among AA males and females and HA males. These study results suggest that the association between ADHD subtypes and BMI might differ across population subgroups in the United States.

The role of intergenerational educational mobility and household wealth in adult obesity: Evidence from Wave 2 of the World Health Organization's Study on global AGEing and adult health.

BackgroundObesity has emerged as a major risk factor for non-communicable diseases in low and middle-income countries but may not follow typical socioeconomic status (SES)-related gradients seen in higher income countries. This study examines the associations between current and lifetime markers of SES and BMI categories (underweight, normal weight, overweight, obese) and central adiposity in Ghanaian adults.MethodsData from 4,464 adults (2,610 women) who participated in the World Health Organization’s Study on global AGEing and adult health (SAGE) Wave 2 were examined. Multilevel multinomial and binomial logistic regression models were used to examine associations. SES markers included parental education, individual education, intergenerational educational mobility and household wealth. Intergenerational educational mobility was classified: stable-low (low parental and low individual education), stable-high (high parental and high individual education), upwardly (low parental and high individual education), or downwardly mobile (high parental and low individual education).ResultsThe prevalence of obesity (12.9%) exceeded the prevalence of underweight (7.2%) in the population. High parental and individual education were significantly associated with higher odds of obesity and central adiposity in women. Compared to the stable low pattern, stable high (obesity: OR = 3.15; 95% CI: 1.96, 5.05; central adiposity: OR = 1.75; 95% CI: 1.03, 2.98) and upwardly (obesity: OR = 1.71; 95% CI: 11.13, 2.60; central adiposity: OR = 1.60; 95% CI: 1.08, 2.37) mobile education patterns were associated with higher odds of obesity and central adiposity in women, while stable high pattern was associated with higher odds of overweight (OR = 1.88; 95% CI: 1.11, 3.19) in men. Additionally, high compared to the lowest household wealth was associated with high odds of obesity and central adiposity in both sexes.ConclusionStable high and upwardly mobile education patterns are associated with higher odds of obesity and central adiposity in women while the stable high pattern was associated with higher odds of overweight in men.

Categorical Frailty Phenotype and Continuous Frailty Index: A Conceptual Overview of Frailty and Its Components among Older Persons in India

Background: Frailty indicator can be an important indicator of understanding ageing and health in India. It will be interesting to examine and compared different model of frailty using the same dataset. The present paper aimed to compare two frailty models and examine the association between socioeconomic status with frailty and frailty components among older persons in India. Methods: The WHO Study on Global AGEing and Adult Health (SAGE) Wave 1, collected between 2007 and 2010 in India was used for this study. Two frailty model was constructed. Education and wealth quintile was used as socio economic indicators. Sensitivity and specificity were calculated for comparing both frailty models. Linear regression and logistic regression were used. The regression analysis was separately done for each age group and gender category. The coefficients were reported separately for education and wealth quintile categories. Results: Low sensitivity was observed between the two frailty models. The results suggest that frailty index was more useful in depicting wealth and education inequality among different gender and age groups in India. Wealth and education differences in, number of morbidities, morbidity symptoms and Self rated health (SRH) were most consistently significant across age groups and gender categories. BMI and functional limitation were even found significant at p-value <0.01 for education and wealth quintile. Conclusion: The results of the analysis suggest that frailty index covers more dimension than categorical phenotype categories, and can be used as an indicator to depict the healthy aging.

Ideal Cardiovascular Health and Cognitive Test Performance: Testing a Modified Index of Life's Simple 7 Among Older Chinese Adults.

Evidence suggests that cognitive decline in older adults is influenced by cardiovascular health (CVH), with metabolic and vascular mechanisms hypothesized to underlie the etiology of cognitive impairment. Research in high-income nations suggests that improved CVH is linked with decreased cognitive impairment risk, but it is unclear if this pattern is evident in low-income countries. Nationally-representative data collected in China were drawn from the World Health Organization's Study on global AGing and adult health Wave 1 (2007–2010; n = 11,295). Seven CVH factors were classified as “ideal” or “not ideal”: smoking and drinking frequency, body mass index, physical activity level, blood pressure, diet, and self-reported anxiety. Additionally, scores from five cognitive performance tests (immediate and delayed verbal recall, forward and backward digit span, verbal fluency) were used to create a composite cognitive function variable. Linear regression analyses tested whether ideal CVH measures were associated with higher composite cognitive performance, controlling for sociodemographic factors. As hypothesized, ideal CVH was generally associated with higher cognitive performance. Low anxiety levels and reliable access to sufficient food (including produce) were particularly associated with higher cognitive function. These results suggest early detection and controlling modifiable CVH risks may protect aging individuals in China from cognitive decline.

Predictors of hypertension awareness, treatment and control in South Africa: results from the WHO-SAGE population survey (Wave 2).

South Africa has one of the highest levels of hypertension globally, coupled with poor rates of diagnosis, treatment and control. Risk factors that predict hypertension in high income countries may perform differently in the African context, where communicable disease, obesity and malnutrition co-exist. This study investigated traditional risk factors alongside other health and sociodemographic indicators to determine predictors of hypertension prevalence and management. Participants were recruited from households across South Africa as part of WHO's Study on global AGEing and adult health (WHO SAGE) Wave 2 (2015). Blood pressure (BP) was measured in triplicate and sociodemographic and health data collected by survey (n = 1847; 30% 18-39 years, 39% 40-59 years, 31% 60 years+; median age 51 years; 68% female). Of all adults, 43% were hypertensive (n = 802), of which 58% (n = 398) were unaware, 33% (n = 267) were on medication, with only 18% (n = 141) controlled on medication (BP < 140/90 mmHg). Multivariate logistic regression showed waist-to-height ratio > 0.5 and diabetes comorbidity were the most significant predictors of hypertension presence, awareness and treatment. Individuals with diabetes were twice as likely to have hypertension, 7.0 times more likely to be aware, 3.3 times more likely to be on antihypertensive medication, and 2.4 times more likely to be controlled on medication. Women and individuals reporting lower salt use were more likely to be aware and treated for hypertension. Applying the 2017 AHA/ACC hypertension guidelines showed only 1 in 4 adults had normal BP. As with HIV, similarly intensive efforts are now needed in the region to improve non-communicable disease diagnosis and management.

Disability, quality of life and all-cause mortality in older Mexican adults: association with multimorbidity and frailty

BackgroundMultimorbidity and frailty are relevant conditions among older adult population. There is growing evidence about their association with poor health outcomes like disability, worst quality of life, and death. Nonetheless, the independent associations of both conditions have been studied, and few evidence exists about an interaction between them. Our aims were to assess the association of frailty and multimorbidity with the disability, quality of life and all-cause mortality as well as to analyze a potential interaction between these conditions.MethodsAnalytical samples included 1410 respondents for disability and quality of life, and 1792 for mortality. We performed a longitudinal analysis with older Mexican adults aged 50, using data collected from the WHO’s Study on global AGEing and Adult Health Waves 1 and 2. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), and quality of life using the WHOQOL (WHO Quality of Life) instrument. All-cause mortality was determined by reviewing death certificates. Associations of frailty and multimorbidity with disability, quality of life and mortality were estimated using linear regression and Cox proportional hazards models.ResultsMultimorbidity assessed through three patterns (cardiopulmonary, vascular-metabolic, and mental-musculoskeletal) was associated with the three outcomes in this study. Cardiopulmonary and mental-musculoskeletal patterns increased the WHODAS mean score (β = 5.05; p < 0.01 and β = 5.10; p < 0.01, respectively) and decreased WHOQOL score (β = − 1.81; p < 0.01 and β = − 2.99; p < 0.01, respectively). Vascular-metabolic was associated with mortality (HR = 1.47; p = 0.04), disability (β = 3.27; p < 0.01) and quality of life (β = − 1.30; p = 0.02). Frailty was associated with mortality (pre-frail: HR = 1.48; p = 0.02 and frail: HR = 1.68; p = 0.03), disability (pre-frail: β = 5.02; p < 0.01; frail: β = 13.29; p < 0.01) and quality of life (pre-frail: β = − 2.23; p < 0.01; frail: β = − 4.38; p < 0.01). Interaction terms of frailty and multimorbidity were not statistically significant.ConclusionsMultimorbidity and frailty are important predictors of poor health outcomes. These results highlight the importance of carrying out health promotion and prevention actions as well as specific interventions aimed at older adults who suffer from multimorbidity and frailty, in such a way that deleterious effects on health can be avoided.

Ambient Air Pollution in Relation to Diabetes and Hemoglobin A1c Biomarker in China: A Cross-Sectional Study with Findings from National Representative Data: WHO Study on Global Ageing and Adult Health (SAGE) Wave 1

Ambient Air Pollution in Relation to Diabetes and Hemoglobin A1c Biomarker in China: A Cross-Sectional Study with Findings from National Representative Data: WHO Study on Global Ageing and Adult Health (SAGE) Wave 1

Depression and chronic diseases: Co-occurrence and communality of risk factors

BackgroundThe aim of current study is to assess the cross-sectional association of chronic non-communicable diseases (diabetes mellitus, arthritis, asthma, chronic lung disease, angina, and stroke) with both diagnosed and undiagnosed depression in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1, a study of adults in six low- and middle-income countries. MethodsA total of 41,810 participants, aged ≥ 18 years, were included. Depression status was assessed by standard methods derived from the World Mental Health Survey (WHH-CIDI). Undiagnosed depression was defined as a depressed person who did not report history of diagnosis/treatment for depression. Associations between depression/undiagnosed depression and chronic diseases, adjusting for country of residence, demographics and chronic diseases risk factors were assessed. ResultsDepression was detected in 2508 (6.0%) cases, from whom 2098 (87%) were undiagnosed. Diabetes (Odds ratio:1.47[95%CI:1.24,1.75]), arthritis (2.14[1.82,2.52]), asthma (3.36[2.73,4.14]), chronic lung disease (3.74[3.10,4.51]), angina (3.20[2.66,3.85]), and stroke (3.14[2.55,3.86]) were associated with depression (p-values < 0.001). Being older, female, underweight, and having lower education, and lower income were positively associated with depression. The estimated odds ratios were similar for undiagnosed depression. LimitationsCross-sectional design of study prevent us to determine whether depression followed exposures in time. About 12% of the participant did not have data for depression status and were excluded from the study. ConclusionsMost depression cases were undiagnosed. Depression/undiagnosed depression were strongly associated with chronic diseases; stronger than what has been reported in developed countries.

Quality of life among older adults in China and India: Does productive engagement help?

Individuals in developing countries often engage in paid and unpaid work till late in life due to low household savings and limited welfare provisions. Yet, physical disabilities associated with aging can limit their ability to work. While work can be beneficial for economic and psychological well-being, this paper investigates whether engagement in paid and unpaid work mediates the impact of physical disabilities on quality of life for older adults. We exploit the different levels of health services and social security in rural and urban China and India to examine the effect of public provisions in the process. We use nationally representative data of individuals aged 50 and above from the World Health Organization Study on Global Ageing and Adult Health Wave 1, conducted in 2008–10 in China and in 2007–08 in India. Using a causal mediation analysis framework, we find that paid work plays a minor role in mediating the effect of physical disabilities on quality of life in all societies, and the mediated effect is smaller in urban China than in other societies. Unpaid work is beneficial only in urban China, and it does not mediate the impact of physical disabilities on quality of life elsewhere. The findings indicate that promoting productive engagement alone, without improving basic public provisions, will have limited impact on improving quality of life of the aging population in developing countries.

Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians

BackgroundThere is a lack of focused research on the older population in Ghana and about issues pertaining to their access to healthcare services. Furthermore, information is lacking regarding the fairness in the access to these services. This study aimed to ascertain whether horizontal and vertical equity requirements were being met in the healthcare utilisation among older adults aged 50 years and above.MethodsThis study was based on a secondary cross-sectional data from the World Health Organization’s Study on global AGEing (SAGE) and adult health wave 1 conducted from 2007 to 2008 in Ghana. Data on 4304 older adults aged 50 years-plus were analysed. Bivariate and multivariable analyses were carried out to analyse the association between outpatient/inpatient utilisation and (1) socioeconomic status (SES), controlling for need variables (horizontal equity) and (2) need variables, controlling for SES (vertical equity). Odds ratios with 95% confidence intervals were calculated to analyse the association between relevant variables.ResultsHorizontal and vertical inequities were found in the utilisation of outpatient services. Inpatient healthcare utilisation was both horizontally and vertically equitable. Women were found to be more likely to use outpatient services than men but had reduced odds of using inpatient services. Possessing a health insurance was also significantly associated with the use of both inpatient and outpatient services.ConclusionWhilst equity exists in inpatient care utilisation, more needs to be done to achieve equity in the access to outpatient services. The study reaffirms the need to evaluate both the horizontal and vertical dimensions in the assessment of equity in healthcare access. It provides the basis for further research in bridging the healthcare access inequity gap among older adults in Ghana.

Socioeconomic inequalities in frailty among older adults in six low- and middle-income countries: Results from the WHO Study on global AGEing and adult health (SAGE)

ObjectivesThe aim of this study was to investigate socioeconomic inequalities in frailty among older adults in six low- and middle-income countries (LMICs), and to examine to what extent chronic diseases account for these inequalities. Study designData were used from the Study on global AGEing and adult health (SAGE) wave 1 (2007–2010). Nationally representative samples of adults aged 50+ years from China, Ghana, India, Mexico, the Russian Federation and South Africa were analyzed (n = 31,174). Main outcome measuresEducational level and wealth were used as socioeconomic indicators. Frailty was assessed with modified criteria for the frailty phenotype. Self-reported disease diagnoses were used. A relative index of inequality (RII) was calculated to compare socioeconomic inequalities in frailty between countries. ResultsPeople in lower socioeconomic positions had higher prevalence rates of frailty. The largest inequalities in frailty were found in Mexico (RII 3.7, 95% CI 2.1–6.4), and the smallest inequalities in Ghana (RII 1.1, 95% CI 0.7–1.8). Mediation analyses revealed that the chronic diseases considered in this study do not explain the higher prevalence of frailty seen in lower socioeconomic groups. ConclusionsSubstantial socioeconomic inequalities in frailty were observed in LMICs, but additional research is needed to find explanations for these. Given that the population of older adults in many LMICs is expanding at a greater rate than in many high-income countries, our results indicate an urgent public health need to address frailty in these countries.

Cardiovascular disease (CVD) and associated risk factors among older adults in six low-and middle-income countries: results from SAGE Wave 1

BackgroundCardiovascular disease (CVD) is one of the leading causes of death worldwide. Our study aimed to investigate the prevalence of two conditions, angina and stroke, and relevant risk factors among older adults in six low- and middle- income countries(LMICs).MethodsThe data was from World Health Organization (WHO) Study on global AGEing and adult Health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russian Federation and South Africa. Presence of CVD was based on self-report of angina and stroke. Multivariate logistic regression was performed to examine the relationship between CVD and selected variables, including age, sex, urban/rural setting, household wealth, and risk factors such as smoking, alcohol drinking, fruit/vegetable intake, physical activity and BMI.ResultsThe age standardized prevalence of angina ranged from 9.5 % (South Africa) to 47.5 % (Russian Federation), and for stoke from 2.0% (India) to 6.1 % (Russia). Hypertension was associated with angina in China, India and Russian Federation after adjustment for age, sex, urban/rural setting, education and marital status (OR ranging from 1.3 [1.1-1.6] in India to 3.8 [2.9-5.0] in Russian Federation), furthermore it was a risk factor of stroke in five countries except Mexico. Low or moderate physical activity were also associated with angina in China, and were also strongly associated with stroke in all countries except Ghana and India. Obesity had a stronger association with angina in Russian Federation and China(ORs were 1.5[1.1-2.0] and 1.2 [1.0-1.5] respectively), and increased the risk of stroke in China. Smoking was associated with angina in India and South Africa(ORs were 1.6[1.0-2.4] and 2.1 [1.2-3.6] respectively ), and was also a risk factor of stroke in South Africa. We observed a stronger association between frequent heavy drinking and stroke in India. Household income was associated with reduced odds of angina in China, India and Russian Federation, however higher household income was a risk factor of angina in South Africa.ConclusionWhile the specific mix of risk factors contribute to disease prevalence in different ways in these six countries – they should all be targeted in multi-sectoral efforts to reduce the high burden of CVD in today’s society.

Arthritis diagnosis and symptoms are positively associated with specific physical job exposures in lower- and middle-income countries: cross-sectional results from the World Health Organization\u2019s Study on global AGEing and adult health (SAGE)

BackgroundIn higher income countries, work-related squatting and heavy lifting have been associated with increased arthritis risk. Here, we address the paucity of data regarding associations between arthritis and work-related physical stressors in lower- and middle-income countries.MethodsData were extracted from the Study on global AGEing and adult health (SAGE) Wave 1 (2007–10) for adults (aged ≥50 years) from Ghana, India, Russia and South Africa for whom detailed occupation data was available (n = 21,389; 49.2% women). Arthritis cases were identified using a symptom-defined algorithm (current) and self-reported doctor-diagnosis (lifetime). A sex-specific Job Exposure Matrix was used to classify work-related stressors: heavy physical work, kneeling/squatting, heavy lifting, arm elevation and awkward trunk posture. Using the International Standard Classification of Occupations, we linked SAGE and the Job Exposure Matrix. Logistic regression was used to investigate associations between arthritis and work-related stressors, adjusting for age (10 year age groupings), potential socioeconomic-related confounders, and body mass index. Excess exposure risk due to two-way interactions with other risk factors were explored.ResultsDoctor-diagnosed arthritis was associated with heavy physical work (adjusted odds ratios [OR] 1.12, 95%CI 1.01–1.23), awkward trunk posture (adjusted OR 1.23, 95%CI 1.12–1.36), kneeling or squatting (adjusted OR 1.25, 95%CI 1.12–1.38), and arm elevation (adjusted OR 1.66, 95%CI 1.37–2.00). Symptom-based arthritis was associated with kneeling or squatting (adjusted OR 1.27, 95%CI 1.08–1.50), heavy lifting (adjusted OR 1.33, 95%CI 1.11–1.58), and arm elevation (adjusted OR 2.16, 95%CI 1.63–2.86). Two-way interactions suggested excess arthritis risk existed for higher body mass index, and higher income or education.ConclusionsMinimization of occupational health risk factors is common practice in higher income countries: attention should now be directed toward reducing work-related arthritis burden in lower- and middle-income countries.

Racial or Ethnic Health Disparities among Older Adults in Four Population Groups in South Africa

Background:Racial or ethnic health disparities have been evidently apparent during the apartheid era in South Africa. This study aims to assess ethnic health disparities in four elderly population groups.Methods:Data for this study emanated from the 2008 study of “Global AGEing and adult health (SAGE) wave 1” (N = 3284) aged 50 years or older in South Africa. Associations between exposure variables and outcome variables (health status variables and chronic conditions) were examined through bivariate analyses and multivariable logistic regression.Results:Indians or Asians reported the highest prevalence of poor self-rated health (23.7%) and functional disability (11.6% and 29.1%). Coloureds had the lowest grip strength (55.3%) and Whites the highest cognitive functioning (80.1%). Coloureds had the highest prevalence of hypertension (85.0%), stroke and/or angina (15.0%), edentulism (26.8%) and low vision (50.6%); and Indians or Asians had the highest prevalence of arthritis (43.5%) and diabetes (24.4%). In adjusted analysis, Whites (Odds Ratio [OR]: 0.24, Confidence Interval [CI]: 0.11, 0.57) and Coloureds (OR: 0.50, CI: 0.29, 0.87) had lower odds of self-reported health status compared to Black Africans. Coloureds (OR: 0.36, CI: 0.22, 0.61) had lower odds of grip strength than Black Africans. Indians or Asians had higher odds of functional disability (OR: 1.87, CI: 1.03, 3.02) and diabetes (OR: 2.65, CI: 1.45, 4.83) than Black Africans. Whites (OR: 3.92, CI: 1.63, 9.41) and Coloureds (OR: 2.14, CI: 1.21, 3.78) had higher odds of cognitive functioning than Black Africans. Whites had lower odds (OR: 0.54, CI: 0.31, 0.93) and Indians or Asians had higher odds (OR: 1.91, CI: 1.91, 1.01, 3.59) of arthritis than Black Africans. Coloureds had a higher prevalence of hypertension (OR: 1.71, CI: 1.14, 2.58), stroke and/or angina (OR: 1.74, CI = 1.36, 2.22), edentulism (OR: 6.51, CI: 4.07, 10.41) and low vision (OR: 1.68, CI: 1.29, 2.19) than Black Africans.Conclusion:There are still ethnic health disparities in South Africa in the post-apartheid era (i.e., Black Africans [lower cognitive functioning], Whites [poor self-reported health status and edentulism], Coloureds [poor self-reported health status, lower grip strength, arthritis, hypertension, stroke and/or angina, edentulism and low vision], Indians or Asians [poor functional disability, arthritis and diabetes]). Understanding these ethnic health disparities may help in developing better strategies to improve health across population groups.

Urbanicity of residence and depression among adults 50 years and older in Ghana and South Africa: an analysis of the WHO Study on Global AGEing and Adult Health (SAGE)

ABSTRACTObjectives: As the primary cause of disability worldwide, depression is a significant contributor to global morbidity and mortality and often disproportionately affects older adults. Several studies have demonstrated a link between urban residence and depression, but few studies have examined this association among older adult populations, and even fewer have studied it within an African context. Given that African societies are aging and urbanizing at rapid rates, this study aimed to assess the relationship between urbanicity and depression within older adult populations in two African countries.Method: Data were drawn from the Ghana and South Africa samples of the World Health Organization Study on Global AGEing and Adult Health (SAGE) wave 1 (2007–2008). Depression over the past 12 months was measured using self-reported treatment and depressive symptoms based on ICD-10 criteria in 4209 Ghanaian and 3148 South African adults aged 50 years and older residing in their current location for over one year.Results: The 12-month prevalence of depression was 7.5% and 4.0% in Ghana and South Africa, respectively; 41.1% and 65.6%, respectively, lived in urban areas. Comparing urban to rural residents, the adjusted odds ratio (OR) for depression in multivariable analysis was 1.13 (95% CI: 0.71–1.79) in South Africa and 0.85 (95% CI: 0.55–1.31) in Ghana.Conclusion: Results do not support a significant urban-rural difference in 12-month depression among Ghanaian or South African SAGE participants. Mental health resources in rural areas should therefore be enhanced in these countries for more equitable distributions between the two settings given similar need.

Employment and Life Satisfaction Among Middle- and Old-Aged Adults in China

The population in China has been aging rapidly over the past two decades, raising concerns about how to meet the health and long-term care needs of the growing older adult population. The productive aging framework has been applied to promote the active roles that older adults can play in society and to improve physical and psychological well-being. Employment, as an essential form of productive aging, is central to personal control, self-identify, economic resources, and social connectedness. However, there is no clear role or accommodation for older workers in China due to the mandatory retirement policy and traditional culture of gender roles. Using the World Health Organization (WHO) Study on Global Aging and Adult Health (SAGE) Wave 1 data, we examined the relationship between employment and life satisfaction in middle- and old-aged Chinese. Multiple regression analyses indicated that employment and certain work characteristics were positively related to life satisfaction in both the total and male samples. Overall, rural residents had higher levels of satisfaction than urban residents after equalizing socioeconomic resources and health. Policy and practice implications are discussed on how to improve life satisfaction through employment and how to address gender and residency gaps.

Impact of informal caregiving on older adults’ physical and mental health in low-income and middle-income countries: a cross-sectional, secondary analysis based on the WHO’s Study on global AGEing and adult health (SAGE)

ObjectivesA high proportion of care stemming from chronic disease or disability in low-income and middle-income countries is provided by informal caregivers. The goal of this study was to determine the...

Disability and ageing in China and India \u2013 decomposing the effects of gender and residence. Results from the WHO study on global AGEing and adult health (SAGE)

BackgroundChina and India are the world’s two most populous countries. Although their populations are growing in number and life expectancies are extending they have different trajectories of economic growth, epidemiological transition and social change. Cross-country comparisons can allow national and global insights and provide evidence for policy and decision-making. The aim of this study is to measure and compare disability in men and women, and in urban and rural dwellers in China and India, and assess the extent to which social and other factors contribute to the inequalities.MethodsNational samples of adults aged 50 to 79 years in China (n = 11,694) and India (n = 6187) from the World Health Organization (WHO) longitudinal Study on global AGEing and adult health (SAGE) Wave 1 were analysed. Stratified multiple linear regressions were undertaken to assess disability differences by sex and residence, controlling for other biological and socioeconomic determinants of disability. Oaxaca-Blinder decomposition partitioned the two-group inequalities into explained and unexplained components.ResultsIn both countries women and rural residents reported more disability. In India, the gender inequality is attributed to the distribution of the determinants (employment, education and chronic conditions) but in China about half the inequality is attributed to the same. In India, more than half of the urban rural inequality is attributed to the distribution of the determinants (education, household wealth) compared with under 20% in China.ConclusionsEducation and employment were important drivers of these measured inequalities. Overall inequalities in disability among older adults in China and India were shaped by gender and residence, suggesting the need for policies that target women and rural residents. There is a need for further research, using both qualitative and quantitative methods, to question and challenge entrenched practices and institutions and grasp the implications of global economic and social changes that are impacting on population health and ageing in China and India.

Predictors of self-reported health among the elderly in Ghana: a cross sectional study

BackgroundSelf-reported health is a widely used measure of health status across individuals. As the ageing population increases, the health of the elderly also becomes of growing concern. The elderly go through life facing social, economic and financial hardships. These hardships are known to affect the health status of people as they age. The purpose of this study is to assess social and health related factors of self-reported health among the elderly in Ghana.MethodsA multivariate regression analysis in form of a binary and ordinal logistic regression were used to determine the association between socioeconomic, demographic and health related factors, on self-reported health. The data used for this study was drawn from the World Health Organization (WHO) Study on Global Ageing and Adult Health (SAGE) Wave 1.ResultsIn total, out of 2613 respondent, 579 (20.1%) rated their health status as poor and 2034 (79.9%) as good. The results showed that the odds of reporting poor health was 2.5 times higher among the old-old compared to the young old. The elderly with one or more than one chronic condition had the odds of 1.6 times and 2 times respectively, of reporting poor health. Engaging in mild to moderate exercise increased the chances of reporting poor health by 1.8 times. The elderly who had never worked in a lifetime were 2 times more likely to report poor health. In the same way, residents of Eastern and Western parts of Ghana were 2 times more likely to report poor health compared to those in the Upper West region. Respondents with functional limitations and disabilities were 3.6 times and 2.4 times respectively, more likely to report poor health. On the other hand, the odds of reporting poor health was 29, 36 and 27% less among respondents in the highest income quintiles, former users of tobacco and those satisfied with certain aspects of life respectively. Also, current alcohol users were 41% less likely to report poor health.ConclusionThe health status of the elderly is to an extent determined by the circumstances in which they are born, grow and live. The findings suggest that addressing social issues faced by individuals in youthful age will go a long way to achieving good health in the future. People with physical limitations and disabilities are most vulnerable to unmet healthcare needs and support system from government, policy makers and family.

Adolescent peer networks and the moderating role of depressive symptoms on developmental trajectories of cannabis use

This paper investigated how depressive symptoms moderate the role of peer cannabis use on developmental patterns of individual cannabis use from adolescence to young adulthood, controlling for a broad set of individual and family factors. Data from two sources were analyzed separately: two saturated schools in the National Longitudinal Study of Adolescent to Adult Health Waves I–III (N=1550) covering 1994–2001; and three schools in the CARBIN study, covering 2012–2014. Discrete mixture models identified developmental trajectories of cannabis use in each data source, and logit models linked network and depressive symptom information to the trajectories. Five similar cannabis use trajectories were identified in both datasets: Nonuse, Low, Moderate, Increasing, and High. Peer cannabis use at baseline predicted higher individual cannabis use trajectories, controlling for a wide range of factors. However, the association between peer cannabis use and higher levels of use (Moderate and High) attenuated as the adolescent's level of depressive symptoms increased. Although these results may suggest that depression dampers adolescents' susceptibility to peer influence, these results are also consistent with the notion that depressed adolescents withdraw from their peer groups, distancing them from the initial source of peer influence over time. The resulting isolation may place adolescents at higher risk of adverse outcomes.