Disability Transitions and Health Expectancies among Adults 45 Years and Older in Malawi: A Cohort-Based Model
Background:
Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA); by 2060, persons aged 45 y and older are projected to be 25% of SSA's population, up from 10% in 2010. Aging in SSA is associated with unique challenges because of poverty and inadequate social supports. However, despite its importance for understanding the consequences of population aging, the evidence about the prevalence of disabilities and functional limitations due to poor physical health among older adults in SSA continues to be very limited.
Methods and Findings:
Participants came from 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Health, a study of the rural population in Malawi. We investigate how poor physical health results in functional limitations that limit the day-to-day activities of individuals in domains relevant to this subsistence-agriculture context. These disabilities were parameterized based on questions from the SF-12 questionnaire about limitations in daily living activities. We estimated age-specific patterns of functional limitations and the transitions over time between different disability states using a discrete-time hazard model. The estimated transition rates were then used to calculate the first (to our knowledge) microdata-based health expectancies calculated for SSA. The risks of experiencing functional limitations due to poor physical health are high in this population, and the onset of disabilities happens early in life. Our analyses show that 45-y-old women can expect to spend 58% (95% CI, 55%–64%) of their remaining 28 y of life (95% CI, 25.7–33.5) with functional limitations; 45-y-old men can expect to live 41% (95% CI, 35%–46%) of their remaining 25.4 y (95% CI, 23.3–28.8) with such limitations. Disabilities related to functional limitations are shown to have a substantial negative effect on individuals' labor activities, and are negatively related to subjective well-being.
Conclusions:
Individuals in this population experience a lengthy struggle with disabling conditions in adulthood, with high probabilities of remitting and relapsing between states of functional limitation. Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in SSA inadequately target the physical health of mature and older adults.
Please see later in the article for the Editors' Summary
Vyšlo v časopise:
Disability Transitions and Health Expectancies among Adults 45 Years and Older in Malawi: A Cohort-Based Model. PLoS Med 10(5): e32767. doi:10.1371/journal.pmed.1001435
Kategorie:
Research Article
prolekare.web.journal.doi_sk:
https://doi.org/10.1371/journal.pmed.1001435
Souhrn
Background:
Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA); by 2060, persons aged 45 y and older are projected to be 25% of SSA's population, up from 10% in 2010. Aging in SSA is associated with unique challenges because of poverty and inadequate social supports. However, despite its importance for understanding the consequences of population aging, the evidence about the prevalence of disabilities and functional limitations due to poor physical health among older adults in SSA continues to be very limited.
Methods and Findings:
Participants came from 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Health, a study of the rural population in Malawi. We investigate how poor physical health results in functional limitations that limit the day-to-day activities of individuals in domains relevant to this subsistence-agriculture context. These disabilities were parameterized based on questions from the SF-12 questionnaire about limitations in daily living activities. We estimated age-specific patterns of functional limitations and the transitions over time between different disability states using a discrete-time hazard model. The estimated transition rates were then used to calculate the first (to our knowledge) microdata-based health expectancies calculated for SSA. The risks of experiencing functional limitations due to poor physical health are high in this population, and the onset of disabilities happens early in life. Our analyses show that 45-y-old women can expect to spend 58% (95% CI, 55%–64%) of their remaining 28 y of life (95% CI, 25.7–33.5) with functional limitations; 45-y-old men can expect to live 41% (95% CI, 35%–46%) of their remaining 25.4 y (95% CI, 23.3–28.8) with such limitations. Disabilities related to functional limitations are shown to have a substantial negative effect on individuals' labor activities, and are negatively related to subjective well-being.
Conclusions:
Individuals in this population experience a lengthy struggle with disabling conditions in adulthood, with high probabilities of remitting and relapsing between states of functional limitation. Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in SSA inadequately target the physical health of mature and older adults.
Please see later in the article for the Editors' Summary
Zdroje
1. ClelandJ, BernsteinS, EzehA, FaundesA, GlasierA, et al. (2006) Family planning: the unfinished agenda. Lancet 368: 1810–1827.
2. Kohler HP (2013) Population growth. In: Lomborg B, editor. Global problems, smart solutions. Cambridge (Massachusetts): Cambridge University Press.
3. HeuvelineP (2004) Impact of the HIV epidemic on population and household structure: the dynamics and evidence to date. AIDS 18: S45–S53.
4. ZabaB, WhitesideA, BoermaJT (2004) Demographic and socioeconomic impact of AIDS: taking stock of the empirical evidence. AIDS 18: S1–S7.
5. United Nations Population Division (2010) World population prospects, the 2010 revision. New York: United Nations Department of Economic and Social Affairs Population Division. Available: Available: http://esa.un.org/unpd/wpp/. Accessed 25 March 2013.
6. FreemanE, AnglewiczP (2012) HIV prevalence and sexual behavior at older ages in rural Malawi. Int J STD AIDS 23: 490–496.
7. HontelezJA, LurieMN, NewellML, BakkerR, TanserF, et al. (2011) Ageing with HIV in South Africa. AIDS 25: 1665–1667.
8. LimSS, VosT, FlaxmanAD, DanaeiG, ShibuyaK, et al. (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the global burden of disease study 2010. Lancet 380: 2224–2260.
9. VosT, FlaxmanAD, NaghaviM, LozanoR, MichaudC, et al. (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2163–2196.
10. World Health Organization (2008) Projections of mortality and burden of disease, 2004–2030. Geneva: World Health Organization. Available: http://www.who.int/healthinfo/global_burden_disease/projections/en/index.html. Accessed 30 March 2013.
11. Panel on Policy Research and Data Needs to Meet the Challenge of Aging in Africa, Cohen B, Menken J, editors (2006) Aging in sub-Saharan Africa: recommendations for further research. Washington (District of Columbia): National Academies Press.
12. Institute of Medicine (2011) Preparing for the future of HIV/AIDS in Africa: a shared responsibility. Washington (District of Columbia): National Academies Press.
13. MillsEJ, RammohanA, AwofesoN (2011) Ageing faster with AIDS in Africa. Lancet 377: 1131–1133.
14. MaherD, SekajugoJ (2011) Research on health transition in Africa: time for action. Health Res Policy Syst 9: 5.
15. MsyambozaKP, NgwiraB, DzowelaT, MvulaC, KathyolaD, et al. (2011) The burden of selected chronic non-communicable diseases and their risk factors in Malawi: nationwide STEPS survey. PLoS ONE 6: e20316 doi:10.1371/journal.pone.0020316.
16. DalalS, BeunzaJJ, VolminkJ, AdebamowoC, BajunirweF, et al. (2011) Noncommunicable diseases in sub-Saharan Africa: what we know now. Int J Epidemiol 40: 885–901.
17. LevittNS, SteynK, DaveJ, BradshawD (2011) Chronic noncommunicable diseases and HIV-AIDS on a collision course: relevance for health care delivery, particularly in low-resource settings—insights from South Africa. Am J Clin Nutr 94: 1690S–1696S.
18. AbegundeDO, MathersCD, AdamT, OrtegonM, StrongK (2007) The burden and costs of chronic diseases in low-income and middle-income countries. Lancet 370: 1929–1938.
19. ScholtenF, MugishaJ, SeeleyJ, KinyandaE, NakubukwaS, et al. (2011) Health and functional status among older people with HIV/AIDS in Uganda. BMC Public Health 11: 886.
20. HolmesMD, DalalS, VolminkJ, AdebamowoCA, NjelekelaM, et al. (2010) Non-communicable diseases in sub-Saharan Africa: the case for cohort studies. PLoS Med 7: e1000244 doi:10.1371/journal.pmed.1000244.
21. NeginJ, MillsEJ, BärnighausenT, LundgrenJD (2012) Aging with HIV in Africa: the challenges of living longer. AIDS 26 (Suppl 1) S1–S5.
22. MillsEJ, BärnighausenT, NeginJ (2012) HIV and aging—preparing for the challenges ahead. N Engl J Med 366: 1270–1273.
23. AboderinI (2010) Understanding and advancing the health of older populations in sub-Saharan Africa: policy perspectives and evidence needs. Public Health Rev 32: 356–376.
24. EbrahimS, PearceN, SmeethL, CasasJP, JaffarS, et al. (2013) Tackling noncommunicable diseases in low-and middle-income countries: is the evidence from high-income countries all we need? PLoS Med 10: e1001377 doi:10.1371/journal.pmed.1001377.
25. International Labour Organization (2011) LABORSTA Internet: economically active population, estimates and projections (6th edition, October 2011) [database]. Geneva: International Labour Organization. Available: http://laborsta.ilo.org/applv8/data/EAPEP/eapep_E.html. Accessed 25 March 2013.
26. Malawi National Statistical Office (2010) Welfare Monitoring Survey (WMS) 2009. Zomba: Malawi National Statistical Office. Available: http://www.nsomalawi.mw/images/stories/data_on_line/agriculture/wms_2009/WMS%202009%20%20%20%20%2015th%20%20JULY%202010.pdf. Accessed 31 March 2013.
27. KohlerIV, KohlerHP, AnglewiczP, BehrmanJR (2012) Intergenerational transfers in the era of HIV/AIDS: evidence from rural Malawi. Demogr Res 27: 775–834.
28. Merli GM, Palloni A (2006) The HIV/AIDS epidemic, kin relations, living arrangements and the elderly in South Africa. In: Cohen B, Menken J, editors. Aging in sub-Saharan Africa: recommendations for furthering research. Washington (District of Columbia): National Academies Press. pp. 117–165.
29. LeeRD, MasonA (2011) Generational economics in a changing world. Popul Dev Rev 37: 115–142.
30. ZimmerZ (2009) Household composition among elders in sub-Saharan Africa in the context of HIV/AIDS. J Marriage Fam 71: 1086–1099.
31. ZagheniE (2011) The impact of the HIV/AIDS epidemic on kinship resources for orphans in Zimbabwe. Popul Dev Rev 37: 761–783.
32. Kandzandira J (2007) Rural ageing and livelihood challenges: a case study of the elderly in rural areas of Zomba district, Malawi. Zomba: University of Malawi Centre for Social Research.
33. Food and Agriculture Organization of the United Nations, Bingu Silvergrey Foundation (2008) Population ageing in Malawi: understanding challenges, responding to opportunities. Rome: Food and Agriculture Organization of the United Nations. Available: ftp://ftp.fao.org/docrep/fao/010/ai581e/ai581e01.pdf. Accessed 25 March 2013.
34. Malawi Ministry of Health (2011 March 28) Malawi: health sector strategic plan 2011–2016 (Draft III). Lilongwe (Malawi): Malawi Ministry of Health.
35. Kenya Ministry of Health (2005) National health sector strategic plan II 2005–2013. Nairobi: Kenya Ministry of Health.
36. African Union (2007) Africa health strategy 2007–2012. Addis Ababa: African Union.
37. Maharaj P, editor (2013) Aging and health in Africa. International perspectives on aging 4. Berlin: Springer. doi:10.1007/978-1-4419-8357–2.
38. KohlerIV, SoldoBJ, AnglewiczP, ChilimaB, KohlerHP (2013) Association of blood lipids, creatinine, albumin and CRP with socioeconomic status in Malawi. Popul Health Metr 11: 4.
39. United Nations Development Programme (2010) Human development report 2010: the real wealth of nations—pathways to human development. New York: United Nations Development Programme. Available: http://hdr.undp.org/en/reports/global/hdr2010. Accessed 25 March 2013.
40. Malawi Ministry of Development Planning and Cooperation (2010) 2010 Malawi Millennium Development Goals report. Lilongwe (Malawi): Malawi Ministry of Development Planning and Cooperation.
41. SalomonJA, WangH, FreemanMK, VosT, FlaxmanAD, et al. (2012) Healthy life expectancy for 187 countries, 1990–2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet 380: 2144–2162.
42. World Bank (2011) Malawi at a glance. Available: http://devdata.worldbank.org/AAG/mwi_aag.pdf. Accessed 25 March 2013.
43. World Health Organization (2010) Malawi: health profile. Available: http://www.who.int/gho/countries/mwi.pdf. Geneva: World Health Organization. Accessed 25 March 2013.
44. GuebbelsE, BowieC, editors. The epidemiology of Malawi. Malawi Med J 18: No. 3 Available: http://www.ajol.info/index.php/mmj/issue/view/1412 Accessed 31 March 2013.
45. ChitsuloL, EngelsD, MontresorA, SavioliL (2000) The global status of schistosomiasis and its control. Acta Trop 77: 41–51.
46. Malawi National Statistical Office, ICF Macro (2011) Malawi Demographic and Health Survey 2010: final report. Calverton (Maryland): ICF Macro. Available: http://www.measuredhs.com/publications/publication-fr247-dhs-final-reports.cfm. Accessed 25 March 2013.
47. Strauss JA, Thomas D (2007) Health over the life course. In: Schultz TP, Strauss JA, editors. Handbook of development economics, Volume 4. Amsterdam: Elsevier. pp. 3375–3474. doi:10.1016/S1573-4471(07)04054-5
48. Malawi National Statistics Office (2002) Malawi: an atlas of social statistics. Lilongwe (Malawi): Malawi National Statistics Office. Available: http://www.ifpri.org/sites/default/files/publications/malawiatlas.pdf. Accessed 25 March 2013.
49. ReniersG (2003) Divorce and remarriage in rural Malawi. Demogr Res Special Collection 1: 175–206.
50. TrinitapoliJ, RegnerusMD (2006) Religious involvement and HIV/AIDS risk in rural Malawi. J Sci Study Relig 45: 505–528.
51. GrantMJ (2008) Children's school participation and HIV/AIDS in rural Malawi: the role of parental knowledge and perceptions. Demogr Res 19: 1603–1634.
52. KerrR (2005) Food security in northern Malawi: gender, kinship relations and entitlements in historical context. J South Afr Stud 31: 53–74.
53. ObareF, FlemingP, AnglewiczP, ThorntonR, MartinsonF, et al. (2009) Acceptance of repeat population-based voluntary counseling and testing for HIV in rural Malawi. Sex Transm Infect 85: 139–144.
54. Joint United Nations Programme on HIV/AIDS (2010) Global report: UNAIDS report on the global AIDS epidemic 2010. Geneva: Joint United Nations Programme on HIV/AIDS. Available: http://www.unaids.org/globalreport/. Accessed 25 March 2013.
55. WareJE, KosinksiM, KellerSD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34: 220.
56. AnglewiczP, AdamsJ, ObareF, KohlerHP, WatkinsS (2009) The Malawi Diffusion and Ideational Change Project 2004–06: data collection, data quality and analyses of attrition. Demogr Res 20: 503–540.
57. World Bank (2012) Malawi—Third Integrated Household Survey 2010–2011 [database]. Available: http://microdata.worldbank.org/index.php/catalog/1003. Washington (District of Columbia): World Bank. Accessed 25 March 2013.
58. CaiL, HaywardMD, SaitoY, LubitzJ, HagedornA, et al. (2010) Estimation of multi-state life table functions and their variability from complex survey data using the space program. Demogr Res 22: 129–157.
59. BrownD, HaywardM, MontezJ, HummerR, ChiuCT, et al. (2012) The significance of education for mortality compression in the United States. Demography 49: 819–840.
60. WolfDA (1986) Simulation methods for analyzing continuous-time event-history models. Sociol Methodol 16: 283–308.
61. WolfDA, LaditkaSB, LaditkaJN (2002) Patterns of active life among older women: differences within and between groups. J Women Aging 14: 9–25.
62. WachterKW, KnodelJE, VanlandinghamM (2002) AIDS and the elderly of Thailand: projecting familial impacts. Demography 39: 25–41.
63. CaiL, LubitzJ (2007) Was there compression of disability for older Americans from 1992 to 2003? Demography 44: 479–495.
64. Schoen R (1988) Modeling multigroup populations. New York: Plenum Press.
65. RaoJNK, WuCFJ (1988) Resampling inference with complex survey data. J Am Stat Assoc 83: 231–241.
66. AldermanH, BehrmanJR, KohlerHP, MaluccioJ, WatkinsSC (2001) Attrition in longitudinal household survey data: some tests for three developing country samples. Demogr Res 5: 79–123.
67. RubinDB (1996) Multiple imputation after 18+ years. J Am Stat Assoc 91: 473–489.
68. van BuurenS, BoshuizenHC, KnookDL (1999) Multiple imputation of missing blood pressure covariates in survival analysis. Stat Med 18: 681–694.
69. CrimminsEM, KimJK, Sole-AuroA (2011) Gender differences in health: results from SHARE, ELSA and HRS. Eur J Public Health 21: 81–91.
70. OksuzyanA, CrimminsE, SaitoY, O'RandA, VaupelJW, et al. (2010) Cross-national comparison of sex differences in health and mortality in Denmark, Japan and the US. Eur J Epidemiol 25: 471–480.
71. World Health Organization (2011) Health statistics and health information systems: life tables for WHO member states. Geneva: World Health Organization. Available: http://www.who.int/healthinfo/statistics/mortality_life_tables/en/index.html. Accessed 25 March 2013.
72. Malawi National Statistical Office (2012) 2008 population and housing census results—main report. Zomba: Malawi National Statistical Office. Available:http://www.nsomalawi.mw/index.php?option=com_content&view=article&id=107%3A2008-population-and-housing-census-results&catid=8%3Areports&Itemid=1. Accessed 25 March 2013.
73. SeemanTE, MerkinSS, CrimminsEM, KarlamanglaAS (2010) Disability trends among older Americans: National Health and Nutrition Examination Surveys, 1988–1994 and 1999–2004. Am J Public Health 100: 100–107.
74. CrimminsEM, HaywardMD, HagedornA, SaitoY, BrouardN (2009) Change in disability-free life expectancy for Americans 70 years old and older. Demography 46: 627–646.
75. SchaibleUE, KaufmannSHE (2007) Malnutrition and infection: complex mechanisms and global impacts. PLoS Med 4: e115 doi:10.1371/journal.pmed.0040115.
76. AmunaP, ZotorFB (2008) Epidemiological and nutrition transition in developing countries: impact on human health and development. Proc Nutr Soc 67: 82–90.
77. Darnton-HillI, NishidaC, JamesW (2004) A life course approach to diet, nutrition and the prevention of chronic diseases. Public Health Nutr 7: 101–121.
78. GillTM, AlloreH, HardySE, HolfordTR, HanL (2005) Estimates of active and disabled life expectancy based on different assessment intervals. J Gerontol A Biol Sci Med Sci 60: 1013–1016.
79. WolfD, GillT (2009) Modeling transition rates using panel current-status data: how serious is the bias? Demography 46: 371–386.
80. CaiL, SchenkerN, LubitzJ, DiehrP, ArnoldA, et al. (2008) Evaluation of a method for fitting a semi-Markov process model in the presence of left-censored spells using the Cardiovascular Health Study. Stat Med 27: 5509–5524.
81. Beard J, Biggs S, Bloom D, Fried L, Hogan P, et al.. (2012) Global population ageing: peril or promise? Program on the Global Demography of Aging Working Paper No. 89. Global Agenda Council on Ageing Society. Available: http://www.hsph.harvard.edu/pgda/WorkingPapers/2012/PGDA_WP_89.pdf. Accessed 31 March 2013.
Štítky
Interné lekárstvoČlánok vyšiel v časopise
PLOS Medicine
2013 Číslo 5
- Statiny indukovaná myopatie: Jak na diferenciální diagnostiku?
- MUDr. Dana Vondráčková: Hepatopatie sú pri liečbe metamizolom väčším strašiakom ako agranulocytóza
- Vztah mezi statiny a rizikem vzniku nádorových onemocnění − metaanalýza
- Nech brouka žít… Ať žije astma!
- Parazitičtí červi v terapii Crohnovy choroby a dalších zánětlivých autoimunitních onemocnění
Najčítanejšie v tomto čísle
- Gene Expression Classification of Colon Cancer into Molecular Subtypes: Characterization, Validation, and Prognostic Value
- Domestic Violence and Perinatal Mental Disorders: A Systematic Review and Meta-Analysis
- Intimate Partner Violence and Incident Depressive Symptoms and Suicide Attempts: A Systematic Review of Longitudinal Studies
- Measuring Coverage in MNCH: Challenges in Monitoring the Proportion of Young Children with Pneumonia Who Receive Antibiotic Treatment