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Socioeconomic determinants of chronic health diseases among older Indian adults: a nationally representative cross-sectional multilevel study.

ABSTRACT: OBJECTIVE:Study uses multilevel modelling to examine the effect of individual, household and contextual characteristics on chronic diseases among older Indian adults. DESIGN:Nationally representative cross-sectional study. PARTICIPANTS:Data from the nationally representative, India Human Development Survey conducted in 2011-2012 was used in this study. The survey asked information related to the diagnosed chronic illnesses such as cataract, tuberculosis, hypertension, heart disease and others. The sample size of this study comprised 39?493 individuals who belonged to the age group 50 years and above. MEASURES:Self-reported diagnosed chronic illness. METHOD:Considering the hierarchal structure of the data multilevel logistic regression analysis was applied to attain the study objective. RESULTS:Older adults aged 80 years and older were found with three times more chances (OR: 3.99, 95%?CI 2.91 to 5.48) of suffering from a chronic ailment than 50-54 years old. Lifestyle risk factors such as alcohol and tobacco (smoked and smokeless) consumption were noted to be significantly associated with the presence of chronic illness whereas older adults who have never consumed smokeless tobacco stood 20% fewer chances (OR: 0.80, 95%?CI 0.68 to 0.94) of having any chronic illness. Contextual level variables such as older adults residing in the rural areas were found with 17% fewer chances (OR: 0.83, 95%?CI 0.70 to 0.97) of suffering from a chronic illness. CONCLUSION:Even after controlling for various characteristics at the individual, household and contextual levels, significant variations in chronic illness remain unexplained at the community and state level, respectively. The findings of this study could effectively be utilised to consider more contextual variables to examine the chronic health status among the growing older population of India.

SUBMITTER: Singh PK

PROVIDER: S-EPMC6731792 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

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Socioeconomic determinants of chronic health diseases among older Indian adults: a nationally representative cross-sectional multilevel study.

Singh Prashant Kumar PK Singh Lucky L Dubey Ritam R Singh Shalini S Mehrotra Ravi R

BMJ open 20190906 9

<h4>Objective</h4>Study uses multilevel modelling to examine the effect of individual, household and contextual characteristics on chronic diseases among older Indian adults.<h4>Design</h4>Nationally representative cross-sectional study.<h4>Participants</h4>Data from the nationally representative, India Human Development Survey conducted in 2011-2012 was used in this study. The survey asked information related to the diagnosed chronic illnesses such as cataract, tuberculosis, hypertension, heart ...[more]

PMID: 31494603

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Project description:BackgroundLess educational training is consistently associated with incident dementia among older adults, but associations between income and financial strain with incident dementia have not been well tested in national samples. This is an important gap because, like education, financial resources are potentially modifiable by policy change and strengthening the social safety net. This study tested whether financial resources (income and financial strain) predict six-year incident dementia independent of education and occupation.MethodsThe National Health and Aging Trends Study is a prospective cohort study that recruited a nationally representative sample of U.S. Medicare beneficiaries aged ?65?years. Incident dementia (2013 to 2018) was classified based on diagnosis, cognitive test scores or proxy-reported changes among participants dementia-free in 2012 (n?=?3785). Baseline socioeconomic measures included income to poverty ratio (analyzed separately for those <?500% vs. ?500% poverty threshold), financial strain, education and history of professional occupation. Discrete time survival analysis applied survey weights to account for study design and nonresponse. Coefficients were standardized to compare the strength of associations across the four socioeconomic measures.ResultsAdjusting for socioeconomic measures, demographic characteristics, home ownership, retirement, chronic conditions, smoking, BMI and depressive symptoms, higher income (hazard OR?=?0.84, 95% CI: 0.74, 0.95 among those <?500% poverty) and higher education (hOR?=?0.73, 95% CI: 0.65, 0.83) were associated with lower odds, and financial strain with higher odds (hOR?=?1.20, 95% CI: 1.09, 1.31), of incident dementia.ConclusionLow income and greater financial strain predict incident dementia among older adults and associations are comparable to those of low education among U.S. older adults. Interventions to mitigate financial strain through improving access to economic opportunity and strengthening safety net programs and improving access to them in low income groups may complement other ongoing efforts to prevent dementia.

Project description:BACKGROUND: Several healthful dietary patterns appear to be effective at lowering blood pressure and preventing hypertension. However, the relationship between dietary patterns and hypertension among a representative Chinese population sample is unclear. METHODS: A nationally representative sample of 23 671 participants aged 18-59 years were recruited by the 2002 China National Nutrition and Health Survey. All participants had their blood pressure measured with standardized mercury sphygmomanometers. Hypertension was defined as systolic blood pressure ?140 mmHg and/or diastolic blood pressure ?90 mmHg. We conducted factor analysis using dietary information from a validated food frequency questionnaire to derive dietary patterns. Information of participants on physical activities, education level, annual household income, smoking status and family history of hypertension was collected by interviewer-administrated questionnaires. RESULTS: Three major dietary patterns, defined as 'Western', 'traditional northern', and 'traditional southern', were identified. Participants with the highest quartile for the score of the Western pattern had significantly higher blood pressure comparing with counterparts in the lowest quartile. In contrast, participants in the top quartile for the score of the traditional southern pattern presented significantly lower blood pressure comparing with counterparts in the lowest quartile. In multivariate analyses the traditional northern pattern score was associated with an odds ratio (OR) of 1.30 (95% confidence interval (CI) 1.11-1.53, P for trend = 0.0001) comparing with the lowest quartile. The OR for the top quartile of score for the traditional southern pattern was 0.73 (95% CI, 0.59-0.89, P for trend = 0.0040) compared with the lowest quartile of traditional southern pattern score. However, the significant association between the traditional northern pattern and prevalence of hypertension disappeared after further adjusting for body mass index (BMI) (P for trend = 0.3), whereas the association between the traditional southern pattern and prevalence of hypertension persisted after further adjusting for BMI (P for trend = 0.01). CONCLUSIONS: We observed a positive relationship between the traditional northern pattern and hypertension that was mediated through differences in BMI. In addition, the traditional southern pattern was significantly associated with lower odds of presenting with hypertension.

Dataset Information

Socioeconomic determinants of chronic health diseases among older Indian adults: a nationally representative cross-sectional multilevel study.

Publications

Socioeconomic determinants of chronic health diseases among older Indian adults: a nationally representative cross-sectional multilevel study.

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