Publications by authors named "Maria Fernanda Lima-Costa"

237 Publications

[Seroprevalence and factors associated with chronic infections among community-dwelling elderly individuals].

Cien Saude Colet 2021 15;26(suppl 3):5109-5121. Epub 2021 Nov 15.

Grupo Integrado de Pesquisas em Biomarcadores, Instituto René Rachou, Fiocruz Minas. Belo Horizonte MG Brasil.

Chronic infections can contribute to the aging process, but this issue is less studied in Latin America. The aim was to assess the prevalence and factors associated with cytomegalovirus (CMV), Herpes Simplex 1 (HSV-1), Chlamydia pneumoniae and Helicobacter pylori among the elderly. A total of 1,320 individuals participated from the baseline of the Elderly Cohort of Bambuí. IgG antibodies against infections and explanatory variables (sociodemographic factors, health behaviors and health conditions) were evaluated. Poisson regression models with robust variance were used. Seroprevalence rates were 99.4% for CMV, 96.7% for HSV-1, 56% for C. pneumoniae and 70.5% for H. pylori. Elderly men, women, smokers, diabetics, the disabled and those with high levels of IL-6 had a higher prevalence of CMV. HSV-1 was less frequent among women. The prevalence of C. pneumoniae was higher at ages >75 and among diabetics; it was lower among women and individuals with less schooling. H. pylori was less frequent among women and those with detectable levels of IL-1β, but more common among smokers. The findings show a high prevalence of chronic infection and a different epidemiologic profile for each pathogen, making it possible to detect groups that are vulnerable to these infections.
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http://dx.doi.org/10.1590/1413-812320212611.3.37062019DOI Listing
November 2021

Alcohol consumption among older adults: Findings from the ELSI-Brazil study.

Int J Geriatr Psychiatry 2021 Nov 11. Epub 2021 Nov 11.

Health Technology Assessment Unit, International Research Institute, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil.

Objectives: This study estimates the national prevalence of drinking patterns (current, heavy, and binge) and the associated factors, among older Brazilians.

Design: Cross-sectional study using survey data from ELSI-Brazil (2015-2016).

Setting/participants: A total of 7839 adults aged 50 years or older.

Measurements: Respondents were asked about alcohol drinking. Alcohol consumption status was categorized as current drinkers (last month), heavy drinkers (≥7 drinks/week for females and ≥14 drinks/week for males), and binge drinkers (≥4 drinks on one occasion for females and ≥5 drinks on one occasion for males). Covariates included sociodemographic characteristics, tobacco smoking, depression, and number of chronic diseases.

Results: Of the 7839 participants, 29.4% were current drinkers, 5.1% were heavy drinkers, and 10.3% reported binge drinking. In the ≥60 years old age group, the prevalence of current drinking was 23.8%, 3.9% were heavy drinkers, and 6.7% reported binge drinking. All drinking patterns had similar associated factors: being male, being younger, having higher education, tobacco smoking, and falls. In addition, the greater the number of chronic conditions, the lower the prevalence of current drinking and binge drinking.

Conclusion: Heavy drinking and binge drinking are often reported by older Brazilians, particularly among males, those with higher education and in the younger age groups. These behaviors can negatively affect the health of older adults. It is, therefore, important to identify the problems related to alcohol consumption among older adults to minimize the risks and harms.
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http://dx.doi.org/10.1002/gps.5655DOI Listing
November 2021

Chlamydia pneumoniae and Helicobacter pylori infections and immunological profile of community-dwelling older adults.

Exp Gerontol 2021 Dec 9;156:111589. Epub 2021 Oct 9.

Instituto René Rachou, Fundação Oswaldo Cruz, Fiocruz Minas, Núcleo de Estudos em Saúde Pública e Envelhecimento, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais, Escola de Enfermagem, Departamento de Gestão em Saúde, Belo Horizonte, MG, Brazil. Electronic address:

Chronic bacterial infections are associated with changes in the immunosenescence process and immunological biomarkers can assist in monitoring these changes. The identification of this immunological profile is important because Chlamydia pneumoniae (C. pneumoniae) and Helicobacter pylori (H. pylori) infections are important factors of morbidity and mortality among the older adults. This study aimed to identify changes in the immunological profile in the presence of C. pneumoniae and H. pylori infections among community-dwelling older adults. This is a cross-sectional study that used data from 1432 participants from the Bambuí Cohort Study of Aging, Minas Gerais, Brazil. The presence of immunoglobulin G (IgG) for C. pneumoniae and H. pylori was considered a dependent variable and assessed in the participants' serum using the enzyme-linked immunosorbent assay (ELISA). In assessing the immunological profile, the following inflammatory markers were considered: CXCL8, CXCL9, CXCL10, CCL2, CCL5, IL-1β, IL-6, IL-10, IL-12, TNF, and CRP. Associations were assessed by logistic regression, estimating odds ratios and confidence intervals (95%) using the Stata® V.13.1 software. The seroprevalence of anti-C. pneumoniae and anti-H. pylori antibodies was 55.9% and 70.3%, respectively. While high levels of anti-C. pneumoniae antibodies were associated with higher concentrations of CXCL10 and IL-10, higher levels of IL-1β and IL-6 were inversely associated with the titration of anti-H. pylori antibodies. The results characterize immunological profiles associated with these chronic infections and reinforce the potential effects of biomarkers on infections by these bacteria and on the immunosenescence process.
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http://dx.doi.org/10.1016/j.exger.2021.111589DOI Listing
December 2021

[Frailty in elderly individuals and perception of problems in indicators of attributes of primary healthcare: results of the ELSI-Brasil].

Cad Saude Publica 2021;37(9):e00255420. Epub 2021 Sep 22.

Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.

This study aimed to examine the association between frailty syndrome and the perception of problems in indicators of attributes in primary healthcare (PHC) among elderly Brazilians. This was a cross-sectional study with 5,432 participants 60 years or older in the first wave of the Brazilian Longitudinal Study of Aging (ELSI-Brasil), conducted in 2015 and 2016. Frailty, the independent variable, was defined according to the theoretical framework of the frailty phenotype, and the indicators of problems in PHC attributes, the dependent variables, were obtained from questions related to health services use. Access, longitudinal care, coordination, comprehensiveness, family orientation, and cultural adequacy were the target attributes. For the data analysis, logistic regression models were used, adjusted for predisposing, enabling, and need factors for use of health services. Among the participants, 55.1% were females, 57.9% were 60 to 69 years of age, and 51.8% reported multimorbidity. Frail and pre-frail elders accounted for 13.4% and 54.5% of the sample, respectively. Multivariate analyses showed that frail elders (compared to robust elders) showed higher odds of reporting problems with access (OR = 1.45; 95%CI: 1.08-1.93), longitudinal care (OR = 1.54; 95%CI: 1.19-2.00), and comprehensive care (OR = 1.45; 95%CI: 1.14-1.85), in addition to more problems with attributes of PHC (OR = 1.38; 95%CI: 1.05-1.82, for 5 or more). The study suggests the occurrence of inequities in the care provided by Brazilian PHC for frail elders, particularly in the attributes of access, longitudinal care, and comprehensiveness.
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http://dx.doi.org/10.1590/0102-311X00255420DOI Listing
October 2021

Gene Variants Associated With a Higher Risk for Alcohol Dependence in Multiethnic Populations.

Front Psychiatry 2021 31;12:665257. Epub 2021 May 31.

Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.

Genetics influence the vulnerability to alcohol use disorders, and among the implicated genes, three previous studies have provided evidences for the involvement of in alcohol dependence (AD). expression is broadly dysregulated in postmortem brain from AD humans, as well as in the brain of mice with alcohol dependent-like behaviors and in a zebrafish model of alcohol preference. The aim of the present study was to evaluate the association of variants in the gene with AD in multiethnic populations from South and North America. Alcohol-screening questionnaires [such as CAGE and Alcohol Use Disorders Identification Test (AUDIT)] were used to determine individual risk of AD. Multivariate logistic regression analyses were done in three independent populations (898 individuals from Bambuí, Brazil; 3,015 individuals from Pelotas, Brazil; and 1,316 from the United States). Linkage disequilibrium and conditional analyses, as well as functional analyses, were also conducted. Four variants were significantly associated with AD in our discovery cohort (Bambuí): rs4768231, rs4767971, rs7307310, and rs1465527. Two of these variants (rs4768231 and rs4767971) were replicated in both Pelotas and US cohorts. The consistent association signal (at the locus) found in populations with different genetic backgrounds reinforces the relevance of our findings. Taken together, these results support the notion that genetic variants in the locus are risk factors for AD in humans.
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http://dx.doi.org/10.3389/fpsyt.2021.665257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202767PMC
May 2021

[Predisposition to severe forms of COVID-19 and adherence to preventive measures: the role of social support].

Cien Saude Colet 2021 May;26(5):1863-1872

Programa de Pós-Graduação em Saúde Pública, Universidade Federal de Minas Gerais. Av. Professor Alfredo Balena 190, Santa Efigênia. 30130-100. Belo Horizonte MG Brasil.

This study sought to assess the adherence to preventive measures among the elderly more prone to severe forms of COVID-19, and the association and interaction with social support. It is a cross-sectional study conducted with a sample of 3,477 participants of the telephone survey of the Brazilian Longitudinal Study of Aging (ELSI-COVID-19 initiative), who reported going out of the home in the past week. The adherence was based on the frequency of leaving the house, the need to venture outside the home, use of masks, and sanitization of hands. Statistical analysis was based on the Poisson model with robust variance. Predisposing factors for severe forms of COVID-19 included age ≥65 years, hypertension, diabetes, and obesity. Social support included living arrangements and social distancing during the pandemic. Approximately 46% of the participants showed higher adherence, which was positively associated with the number of predisposing factors for severe forms of COVID-19. Social support was not associated with adherence, nor was this association modified after adjustments. The conclusion drawn is that higher adherence is concentrated among the elderly with greater predisposition to severe forms of COVID-19, irrespective of social support, albeit preventive measures should be adopted by all.
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http://dx.doi.org/10.1590/1413-81232021265.00822021DOI Listing
May 2021

Loneliness and social disconnectedness in the time of pandemic period among Brazilians: evidence from the ELSI COVID-19 initiative.

Aging Ment Health 2021 May 10:1-7. Epub 2021 May 10.

Graduate Program in Public Health, Faculty of Medicine, Observatory for Urban Health in Belo Horizonte, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

This study aimed at estimating the pre-pandemic and pandemic prevalence of loneliness and investigating the association of loneliness with social disconnectedness during social distancing strategies in the time of the COVID-19 pandemic period. We used data from the ELSI COVID-19 initiative with participants from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which comprised 4,431 participants aged 50 years and over. Loneliness (hardly ever/some of the time/often) was assessed by the question "In the past 30 days, how often did you feel alone/lonely?". Social disconnectedness included information on social contacts through virtual talking (i.e. telephone, Skype, WhatsApp, or social media) and outside-home meetings with people living in another household. Covariates included sociodemographic and health related characteristics. Multinomial logistic regression models were used to estimate odds ratios (OR) with their 95% confidence interval (CI). The overall prevalence of loneliness during the pandemic was 23.9% (95% CI 20.7-27.5); lower than in the pre-pandemic period (32.8%; 95% CI 28.6-37.4). In the pandemic period, 20.1% (95% CI 16.9-23.6) reported some of the time feeling lonely and 3.9% (95% CI 3.1-4.8) reported often feeling lonely. In the fully adjusted model, virtual talking disconnectedness (OR=1.67; 95% CI 1.09-2.56) was positively associated with some of the time feeling lonely and outside-home disconnectedness (OR=0.33; 95% CI 0.18-0.60) was negatively associated with often feeling lonely. Individuals with virtual talking disconnectedness and without outside-home disconnectedness are at higher risk of loneliness during the time of COVID-19 pandemic. Stimulating virtual talking connectedness might have the potential to diminish loneliness despite steep outside-home disconnectedness.
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http://dx.doi.org/10.1080/13607863.2021.1913479DOI Listing
May 2021

External validation of the estimate of prevalence of smokers in small areas by Vigitel, in Belo Horizonte, Minas Gerais, Brazil.

Rev Bras Epidemiol 2021 16;24(suppl 1):e210002. Epub 2021 Apr 16.

Center of Studies in Public Health and Aging, René Rachou Institute, Fiocruz Minas - Belo Horizonte (MG), Brazil.

Objective: The study aimed to validate the estimates of adult smokers determined by Vigitel for small areas, defined by the Health Vulnerability Index (IVS).

Methods: The database of the Health Survey of the Metropolitan Region of Belo Horizonte (RMBH) carried out in 2010 and the data from Vigitel in the period from 2010 to 2013 were used to obtain estimates of adult smokers by IVS. With Vigitel, the estimate of smokers by IVS was obtained by the indirect estimation method in small areas. The prevalence of adult smokers was compared, considering RMBH as the gold standard. The t test was used to evaluate the difference between the means and the Pearson correlation, with a significance level of 5%.

Results: When stratifying by IVS in the household survey, the prevalence of adult smokers ranged from 13.39% (95%CI 11.88 - 14.91) for residents in a low-risk area to 22.9% (95%CI 12.33 - 33.48) among residents in a very high-risk area. With Vigitel, according to IVS, the prevalence of adult smokers ranged from 11.98% (95%CI 10.75 - 13.21) for residents in the low-risk area to 22.31% (95%CI 18.25 - 26.1) in very high-risk areas. The prevalence was similar between the two surveys, showing good Pearson correlation (r = 0.93).

Conclusion: The study points out that the estimates of smokers were similar in both surveys, showing the external validity of Vigitel. There was a gradient in prevalence, with progressive increase, identifying a higher proportion of smokers in high-risk areas.
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http://dx.doi.org/10.1590/1980-549720210002.supl.1DOI Listing
April 2021

Differences in disability and nutritional status among older Brazilian and English adults: the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and English Longitudinal Study of Aging (ELSA) cohorts.

Am J Clin Nutr 2021 08;114(2):422-428

Department of Social and Preventive Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Background: Brazil and England are 2 countries at different stages in their demographic, epidemiological, and nutritional transitions and with distinct socioeconomic and politic contexts, but with similar universal health systems. We aimed to examine disability and its association with objective anthropometric indicators of nutritional status, including BMI, waist circumference, and waist-to-height ratio, comparing older Brazilian and English adults.

Methods: We used cross-sectional data from 2 nationally representative aging studies. For Brazil, we included 9412 participants who participated in the baseline (2015-2016) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The English data were from 8024 participants of the wave 6 (2012-2013) of the English Longitudinal Study of Aging (ELSA). Disability was defined as difficulty to perform at least 1 activity of daily living. We used logistic regression models to examine the association between anthropometric indicators and disability, adjusted for sociodemographic and health-related characteristics, considering the interaction term between each anthropometric indicator and country.

Results: All health-related characteristics were worse in Brazil than England, although the prevalence of disability was similar among Brazilian (17.85%) and English (16.27%) older adults. Fully adjusted models showed statistically significant interaction terms between country and anthropometric indicators. The strength of the associations in Brazil was weaker compared with England. All anthropometric indicators were positively associated with disability: elevated BMI, in Brazil (OR: 1.27; 95% CI: 1.06, 1.51) and in England (OR: 1.80; 95% CI: 1.51, 2.14); elevated waist circumference, in Brazil (OR: 1.21; 95% CI: 1.02, 1.44) and in England (OR: 1.90; 95% CI: 1.51, 2.37); and elevated waist-to-height ratio, in Brazil (OR: 1.20; 95% CI: 0.96, 1.52) and in England (OR: 1.83; 95% CI: 1.37, 2.44).

Conclusions: Elevated BMI and waist circumference increased the odds of disability in both populations. However, these associations were stronger in England than in Brazil.
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http://dx.doi.org/10.1093/ajcn/nqab060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436132PMC
August 2021

Cytomegalovirus and herpes simplex type 1 infections and immunological profile of community-dwelling older adults.

Exp Gerontol 2021 07 31;149:111337. Epub 2021 Mar 31.

Instituto René Rachou, Oswaldo Cruz Foundation (Fiocruz) Fiocruz Minas, Health Studies Center, Public Health and Aging, Belo Horizonte, Minas Gerais, Brazil; Federal University of Minas Gerais, Nursing School, Department of Health Management, Belo Horizonte, Minas Gerais, Brazil. Electronic address:

Chronic infections, such as cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV-1), contribute to the inflammation process among older adults and are associated with the immunosenescence process. The aim was to identify the immunological profile associated with CMV and HSV-1 infections among older adults. This is a cross-sectional study, carried out with 1492 participants from the Bambuí Cohort Study of Aging - Minas Gerais, Brazil. For analysis purposes, we considered the presence of immunoglobulin G (IgG) for CMV and HSV-1 in the participants' serum, assessed by the enzyme-linked immunosorbent assay (ELISA); outcomes were defined by titration above the median (>160 UR/mL for HSV-1 and >399.5 U/mL for CMV). In order to assess the immunological profile, the following biomarkers were considered: IL-1beta, IL-10, IL-12, TNF, CXCL8, CXCL9, CXCL10, CCL2, CCL5, IL-6 and CRP; the first four being categorized as detectable levels or not, and the others using the Classification and Regression Tree (CART) method. The analysis was adjusted for sociodemographic variables, health behaviors and health conditions. The seroprevalence of anti CMV and anti HSV-1 antibodies was 99.4% and 97.0%, respectively. Higher concentrations of CXCL8 and CCL5 chemokines were associated with lower antibody titers for CMV, and higher concentrations of CXCL9, IL-6 and CRP were associated with higher levels of antibodies to CMV. Moreover, intermediate levels of CXCL10 were also associated with higher levels of antibodies to CMV. In HSV-1 infection, intermediate levels of CXCL9, CCL5 and IL-6 were less likely to have higher antibody titers for this infection. On the other hand, higher levels of CXCL10 and CRP were positively associated with higher antibody titers for HSV-1. The results describe important immunological changes and reinforce the potential effect of CMV and HSV-1 on the immunosenescence process.
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http://dx.doi.org/10.1016/j.exger.2021.111337DOI Listing
July 2021

Admixture/fine-mapping in Brazilians reveals a West African associated potential regulatory variant (rs114066381) with a strong female-specific effect on body mass and fat mass indexes.

Int J Obes (Lond) 2021 05 26;45(5):1017-1029. Epub 2021 Feb 26.

Cancer Biology Division, Ponce Research Institute, Ponce Health Sciences University, Ponce, Puerto Rico.

Background/objectives: Admixed populations are a resource to study the global genetic architecture of complex phenotypes, which is critical, considering that non-European populations are severely underrepresented in genomic studies. Here, we study the genetic architecture of BMI in children, young adults, and elderly individuals from the admixed population of Brazil.

Subjects/methods: Leveraging admixture in Brazilians, whose chromosomes are mosaics of fragments of Native American, European, and African origins, we used genome-wide data to perform admixture mapping/fine-mapping of body mass index (BMI) in three Brazilian population-based cohorts from Northeast (Salvador), Southeast (Bambuí), and South (Pelotas).

Results: We found significant associations with African-associated alleles in children from Salvador (PALD1 and ZMIZ1 genes), and in young adults from Pelotas (NOD2 and MTUS2 genes). More importantly, in Pelotas, rs114066381, mapped in a potential regulatory region, is significantly associated only in females (p = 2.76e-06). This variant is rare in Europeans but with frequencies of ~3% in West Africa and has a strong female-specific effect (95% CI: 2.32-5.65 kg/m per each A allele). We confirmed this sex-specific association and replicated its strong effect for an adjusted fat mass index in the same Pelotas cohort, and for BMI in another Brazilian cohort from São Paulo (Southeast Brazil). A meta-analysis confirmed the significant association. Remarkably, we observed that while the frequency of rs114066381-A allele ranges from 0.8 to 2.1% in the studied populations, it attains ~9% among women with morbid obesity from Pelotas, São Paulo, and Bambuí. The effect size of rs114066381 is at least five times higher than the FTO SNPs rs9939609 and rs1558902, already emblematic for their high effects.

Conclusions: We identified six candidate SNPs associated with BMI. rs114066381 stands out for its high effect that was replicated and its high frequency in women with morbid obesity. We demonstrate how admixed populations are a source of new relevant phenotype-associated genetic variants.
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http://dx.doi.org/10.1038/s41366-021-00761-1DOI Listing
May 2021

Trans-ethnic meta-analysis identifies new loci associated with longitudinal blood pressure traits.

Sci Rep 2021 02 18;11(1):4075. Epub 2021 Feb 18.

Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, 20892, USA.

Genome-wide association studies (GWAS) have identified thousands of genetic loci associated with cross-sectional blood pressure (BP) traits; however, GWAS based on longitudinal BP have been underexplored. We performed ethnic-specific and trans-ethnic GWAS meta-analysis using longitudinal and cross-sectional BP data of 33,720 individuals from five cohorts in the US and one in Brazil. In addition to identifying several known loci, we identified thirteen novel loci with nine based on longitudinal and four on cross-sectional BP traits. Most of the novel loci were ethnic- or study-specific, with the majority identified in African Americans (AA). Four of these discoveries showed additional evidence of association in independent datasets, including an intergenic variant (rs4060030, p = 7.3 × 10) with reported regulatory function. We observed a high correlation between the meta-analysis results for baseline and longitudinal average BP (rho = 0.48). BP trajectory results were more correlated with those of average BP (rho = 0.35) than baseline BP(rho = 0.18). Heritability estimates trended higher for longitudinal traits than for cross-sectional traits, providing evidence for different genetic architectures. Furthermore, the longitudinal data identified up to 20% more BP known associations than did cross-sectional data. Our analyses of longitudinal BP data in diverse ethnic groups identified novel BP loci associated with BP trajectory, indicating a need for further longitudinal GWAS on BP and other age-related traits.
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http://dx.doi.org/10.1038/s41598-021-83450-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7893038PMC
February 2021

[The prevalence of severe falls and associated factors among elderly Brazilians: Results of the 2013 National Health Survey].

Cien Saude Colet 2021 Jan 7;26(1):185-196. Epub 2019 Mar 7.

Núcleo de Estudos em Saúde Pública e Envelhecimento, Instituto René Rachou, Fiocruz Minas. Belo Horizonte MG Brasil.

The scope of this study was to estimate the prevalence and factors associated with severe falls among elderly Brazilians. It included a transversal study of 10,537 elderly individuals who participated in the National Health Survey (2013). The dependent variable was a report of severe falls in the past year. The independent variables comprised, hierarchically, socio-demographic factors, behavior, health status and functional capacity. Logistic regression was used to obtain the odds ratio (OR) and the confidence interval (95%CI), using the 13.1 Stata program. The prevalence of severe falls was 7.5% (95%CI: 6.7-8.3) and the highest odds were among women (OR: 1.35; 95%CI: 1.03-1.77), 70 to 79 years of age (OR: 1.47; 95%CI: 1.12-1.95) and 80 years and above (OR: 2.00; 95%CI: 1.46-2.74), living without a spouse/partner (OR: 1.37; 95%CI: 1.08-1.74), sedentary in leisure time (OR: 1.55; 95%CI: 1.06-2.26), having multimorbities (OR: 1.54; 95%CI: 1.19-2.00), sleeping difficulties (OR: 2.18; 95%CI: 1.65-2.88), limitations in daily activities (OR: 2.25; 95%CI 1.63 -3.10) and use of a walking aid (OR: 1.89; 95%CI: 1.30-2.73). The prevalence of severe falls was high and multifactorial, enabling the identification of profiles of greater vulnerability, which should be considered in public policies for specific interventions.
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http://dx.doi.org/10.1590/1413-81232020261.30542018DOI Listing
January 2021

Association between "a body shape index" and mortality: Bambuí Cohort Study of Aging, Brazil.

Cad Saude Publica 2021 11;37(1):e00016020. Epub 2021 Jan 11.

Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.

This article aims to evaluate the joint and separate association between abdominal and general adiposity indicators and mortality. Data was collected from 1,366 older adults in the Bambuí Cohort Study of Aging with complete information for all variables of interest. The outcome variable was all-cause time until death; exposure variables were a body shape index (ABSI), waist circumference (WC), waist-to-height ratio (WHtR) and body mass index (BMI), assessed at the beginning of the study, and at the 3rd, 5th and 11th year of follow-up. Association between the quartiles of anthropometric indicators and mortality was calculated using an extended Cox proportional hazards model and adjusted for socioeconomic and behavioral confounding factors. Older adults in the 4th ABSI quartile had a higher risk of mortality regardless of BMI (1.27; 95%CI: 1.01-1.58), but this association was not observed in sensitivity analyses. Older adults in the 2nd, 3rd and 4th BMI quartiles had a lower risk of mortality, even when adjusted for WC or ABSI. WC and WHtR showed no association consistent with all-cause mortality after adjustment for confounding factors. Considering the loss of significance in the sensitivity analyses, ABSI's predictive capacity for mortality is still weak. Thus, adopting ABSI in clinical practice or in epidemiological surveys, in conjunction or replacing BMI and WC, requires more in-depth studies.
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http://dx.doi.org/10.1590/0102-311X00016020DOI Listing
April 2021

Frailty Modifies the Association of Hypertension With Cognition in Older Adults: Evidence From the ELSI-Brazil.

J Gerontol A Biol Sci Med Sci 2021 05;76(6):1134-1143

Laboratorio de Investigacao Medica em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Brazil.

Background: The relationship between hypertension and cognition in later life is controversial. We investigated whether the association of hypertension with cognition differs in older adults according to the frailty status using cross-sectional data from the Brazilian Longitudinal Study of Aging, a nationally representative sample of adults aged ≥50 years.

Method: Hypertension was defined by a medical diagnosis or measured blood pressure ≥140/90 mm Hg. Frailty status was assessed using the Cardiovascular Health Study criteria. We estimated the association of hypertension and systolic and diastolic blood pressure with global cognition, orientation, memory, and verbal fluency z-scores, using multiple linear regression models. We also investigated interactions between hypertension and frailty on cognitive performance and impairment.

Results: We evaluated 8609 participants (mean age = 61.9 ± 9.6 years, 53% women). Participants with hypertension (59% of adults aged 50-64 and 77% of those aged ≥65 years) had poorer scores for global cognitive performance than those without hypertension, especially among adults aged 50-64 years (β = -0.09; 95% confidence interval = -0.15, -0.04; p = .001). However, frailty modified the associations of hypertension with cognitive performance and impairment in those aged ≥65 years (p-values for interaction = .01 and .02, respectively). Among nonfrail older adults, hypertension was associated with cognitive impairment. In contrast, among frail older adults, hypertension was related to better global and memory cognitive z-scores.

Conclusions: Hypertension was associated with worse cognitive performance. Among older adults, hypertension was related to cognitive impairment only in nonfrail participants. Frailty evaluation may help clinicians offer personalized hypertension management in older adults.
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http://dx.doi.org/10.1093/gerona/glaa303DOI Listing
May 2021

Lifestyle factors and multimorbidity among older adults (ELSI-Brazil).

Eur J Ageing 2020 Dec 14;17(4):521-529. Epub 2020 Feb 14.

Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, MG Brazil.

The objective of the study was to evaluate the association between unhealthy lifestyle factors (individual and combined) and multimorbidity stratified by sex, in a national sample representative of Brazilians aged 50 years or older. Data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil) baseline, conducted in 2015-2016, were used. Multimorbidity was defined by the existence of two or more of the 19 chronic diseases. Four unhealthy lifestyle factors were considered: (1) at-risk alcohol consumption, (2) current or past smoking, (3) insufficient physical activity and (4) below-recommended consumption of fruits and vegetables. The association between unhealthy lifestyle factors, individual and combined, was assessed by logistic regression. Among the 7918 study participants, the prevalence of multimorbidity was 75.8% (95% CI 73.7-77.7) among women and 58.7% (95% CI 56.0-61.3) among men. Among women, none of the analyzed behaviors presented an independent and statistically significant association ( < 0.05) with multimorbidity. Among men, at-risk alcohol consumption was associated with lower odds of multimorbidity. On the other hand, current or past smoking and insufficient physical activity were associated with greater odds of this condition. In addition, the presence of three or four unhealthy lifestyle factors was associated with greater odds of multimorbidity among men. The results reinforce the need for interventions to promote healthy behaviors among older men with two or more chronic diseases. In addition, it is evident that the health services need to act in an attempt to modify unhealthy behaviors after medical diagnosis of chronic diseases to reduce the risk of future complications.
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http://dx.doi.org/10.1007/s10433-020-00560-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752941PMC
December 2020

Catastrophic health expenditure and multimorbidity among older adults in Brazil.

Rev Saude Publica 2020 14;54:125. Epub 2020 Dec 14.

Fundação Oswaldo Cruz. Instituto René Rachou. Programa de Pós-Graduação em Saúde Coletiva. Belo Horizonte, Minas Gerais, Brasil.

Objective: To estimate the relation between catastrophic health expenditure (CHE) and multimorbidity in a national representative sample of the Brazilian population aged 50 year or older.

Methods: This study used data from 8,347 participants of the Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI - Brazilian Longitudinal Study of Aging) conducted in 2015-2016. The dependent variable was CHE, defined by the ratio between the health expenses of the adult aged 50 years or older and the household income. The variable of interest was multimorbidity (two or more chronic diseases) and the variable used for stratification was the wealth score. The main analyses were based on multivariate logistic regression.

Results: The prevalence of CHE was 17.9% and 7.5%, for expenditures corresponding to 10 and 25% of the household income, respectively. The prevalence of multimorbidity was 63.2%. Multimorbidity showed positive and independent associations with CHE (OR = 1.95, 95%CI 1.67-2.28, and OR = 1.40, 95%CI 1.11-1.76 for expenditures corresponding to 10% and 25%, respectively). Expenditures associated with multimorbidity were higher among those with lower wealth scores.

Conclusions: The results draw attention to the need for an integrated approach of multimorbidity in health services, in order to avoid CHE, particularly among older adults with worse socioeconomic conditions.
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http://dx.doi.org/10.11606/s1518-8787.2020054002285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7703545PMC
January 2021

Difficulty in performing activities of daily living and the need for help in older adults: evidence on social distancing models from the ELSI-COVID-19 initiative.

Cad Saude Publica 2020;36(suppl 3):e00213520. Epub 2020 Dec 18.

Programa de Pós-graduação em Fisioterapia, Universidade Federal de São Carlos, São Carlos, Brasil.

To analyze whether the older adults with difficulty or need of help to perform basic or instrumentals activities of daily living are more socially distanced in times of COVID-19. A total of 4,035 older adults participated in the telephone interviews from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Difficulty, need and receiving help were classified into: (1) independents; (2) had difficulty without need for care; (3) had difficulty, needed and have received care from someone within their household; (4) had difficulty, needed and have received care from someone outside their household; and (5) had difficulty and needed care but did not receive it. Social distancing was categorized as follows: did not leave their houses in the last 7 days, left their houses for essential activities and went out for non-essential activities. Multinomial regression model adjusted for age, sex, schooling and great geographical region was performed. Older adults who had difficulty, needed and have received help from within their homes (odds ratio - OR = 2.34 95%CI: 1.25-4.39) or from outside their homes (OR = 3.94; 95%CI: 2.24-6.92) were more socially distanced. Age increased the odds of not going out (OR = 1.06; 95%CI: 1.03-1.09) while be men reduced it (OR = 0.48; 95%CI: 0.33-0.70). Living in the South of Brazil has increased the odds of the respondents going out for essential activities (OR = 1.77; 95%CI: 1.01-3.10). Older adults who had difficulty, needed and have received help from within or outside their homes did not leave their homes in the last 7 days. Even with social distancing, these older adults can not have their exposure to COVID-19 reduced, weakening the theory of selective social distancing.
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http://dx.doi.org/10.1590/0102-311X00213520DOI Listing
December 2020

Poor sleep quality and oral health among older Brazilian adults.

Oral Dis 2020 Nov 26. Epub 2020 Nov 26.

Department of Epidemiology & Public Health, University College London, London, UK.

Objectives: This study evaluates the association between normative and subjective oral health measures and poor self-reported sleep quality among community-dwelling older adults in Brazil.

Methods: This was a cross-sectional study with data from the Brazilian Longitudinal Study of Aging. The dependent variable was the poor sleep quality. Independent variables of interest included number of teeth and self-reported impact of oral health on eating/chewing and on maintaining emotional stability.

Results: Poor sleep quality was reported by 17.8 (95% CI 16.6; 19.2) of the participants, 29% of the participants were edentulous, and 30% had 20 or more teeth. Impacts of oral health on eating and maintaining emotional stability was found among 33.3% and 20% of the older adults, respectively. After adjusting for all oral health measures and covariates, the magnitude of the associations between the number of teeth and sleep quality was attenuated. Sleep quality was related to oral health impacts on eating (OR 1.19 [95% CI 1.00; 1.41]) and on emotional stability (OR 1.51 [95% CI 1.21; 1.87]).

Conclusions: This study found an association between oral health and sleep quality emphasizing the importance of oral health to general health.
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http://dx.doi.org/10.1111/odi.13734DOI Listing
November 2020

Multimorbidity and population at risk for severe COVID-19 in the Brazilian Longitudinal Study of Aging.

Cad Saude Publica 2020 20;36(12):e00129620. Epub 2020 Nov 20.

Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brasil.

This study aimed to measure the occurrence of multimorbidity and to estimate the number of individuals in the Brazilian population 50 years or older at risk for severe COVID-19. This was a cross-sectional nationwide study based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, with 9,412 individuals 50 years or older. Multimorbidity was defined as ≥ 2 chronic conditions based on a list of 15 diseases considered risk conditions for severe COVID-19. The analyses included calculation of prevalence and estimation of the absolute number of persons in the population at risk. Self-rated health status, frailty, and basic activities of daily living were used as markers of health status. Sex, age, region of the country, and schooling were used as covariables. Some 80% of the sample had at least one of the target conditions, which represents some 34 million individuals. Multimorbidity was reported by 52% of the study population, with higher proportions in the Central, Southeast, and South of Brazil. Cardiovascular diseases and obesity were the most frequent chronic conditions. An estimated 2.4 million Brazilians are at serious health risk. The results revealed inequalities according to schooling. The number of persons 50 years or older who presented risk conditions for severe COVID-19 is high both in absolute and relative terms. The estimate is important for planning strategies to monitor persons with chronic conditions and for preventive strategies to deal with the novel coronavirus.
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http://dx.doi.org/10.1590/0102-311X00129620DOI Listing
December 2020

[Determinants of paid work among older Brazilians using structural equation modeling: evidence from the ELSI-Brazil study].

Cad Saude Publica 2020 23;36(11):e00194619. Epub 2020 Nov 23.

Programa de Pós-graduação em Saúde Púbica, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.

This study aimed to develop a conceptual model and to explore direct and indirect associations between paid work and life-course factors in a representative national sample of the Brazilian population 50 years and older. The analysis was based on 8,903 participants in the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil). The exposure variables were sociodemographic, health, work, and social interaction variables. Based on a structural equation model, paid work showed total association with lifetime social status in women (standardized coefficient - SC = 0.489) and direct association with capacity for work in men (SC = 0.527). For women alone, an indirect and negative association was observed with lifetime intense physical effort at work, via retirement (SC = -0.156). Men with paid work were more prone to social participation, measured by belonging to groups or associations (SC = 0.209). Among women, this participation was through interaction with family and friends (SC = 0.047), via capacity for work. For both men and women, lifetime health status showed an indirect and positive association (SC = 0.298 men; SC = 0.142 women) with paid work, via capacity for work. All the above-mentioned factors showed a significant association with paid work. The study's results showed that participation in the work market occurs by different mechanisms for men and women, principally considering the factors related to work and social interaction.
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http://dx.doi.org/10.1590/0102-311X00194619DOI Listing
March 2021

Protective behaviors for COVID-19 among Brazilian adults and elderly living with multimorbidity: the ELSI-COVID-19 initiative.

Cad Saude Publica 2020 13;36Suppl 3(Suppl 3):e00196120. Epub 2020 Nov 13.

Departamento de Enfermagem, Universidade Federal de Pelotas, Pelotas, Brasil.

To measure the occurrence of protective behaviors for COVID-19 and sociodemographic factors according to the occurrence of multimorbidity in the Brazilian population aged 50 or over was the objective of this study. We used data from telephone surveys among participants of ELSI-Brazil (Brazilian Longitudinal Study of Aging), conducted between May and June 2020. The use of non-pharmacological prevention measures for COVID-19, reasons for leaving home according to the presence of multimorbidity and sociodemographic variables were evaluated. among 6,149 individuals. Multimorbidity was more frequent in females, married, aged 50-59 years and residents of the urban area. Most of the population left home between once and twice in the last week, increasing according to the number of morbidities (22.3% no morbidities and 38% with multimorbidity). Leaving home every day was less common among individuals with multimorbidity (10.3%) and 9.3% left home in the last week to access health care. Hand hygiene (> 98%) and always wearing a mask when leaving home (> 96%) were almost universal habits. Greater adherence to social isolation was observed among women with multimorbidity when compared to men (PR = 1.49, 95%CI: 1.23-1.79). This adherence increased proportionally with age and inversely with the level of education. The protective behavior in people with multimorbidity seems to be greater in relation to the others, although issues related to social isolation and health care deserve to be highlighted. These findings can be useful in customizing strategies for coping with the current pandemic.
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http://dx.doi.org/10.1590/0102-311X00196120DOI Listing
November 2020

Health behaviours and the adoption of individual protection measures during the new coronavirus pandemic: the ELSI-COVID-19 initiative.

Cad Saude Publica 2020 13;36Suppl 3(Suppl 3):e00195420. Epub 2020 Nov 13.

Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.

The objective of this study was to evaluate whether healthy behaviours determine the adoption of individual protective measures to fight COVID-19. The data were obtained from the ELSI-COVID-19 initiative, a telephone survey conducted among participants in the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which includes a national sample representative of the population aged 50 years or older. The outcomes evaluated were three protective measures (not having left home in the past week, wearing a mask when leaving home, and sanitizing hands when returning home), and the explanatory variables were health behaviours (smoking, alcohol consumption, consumption of fruits and vegetables, and physical activity). The associations were evaluated by logistic models, considering adjustments for potential confounding factors. A total of 5,827 individuals participated in the analysis; 32.2% did not leave home in the last week, and among those who left home, 97.5% used a face mask, and 97.3% sanitized their hands when they returned home. The practice of physical activity at the recommended levels was associated with a lower chance of not leaving home in the previous week. Ex-smokers were more likely to use a mask, and those who practised physical activity were less likely to adopt this protective measure. Individuals with low-risk alcohol consumption had a higher chance of sanitizing their hands. Actions aimed at increasing the adoption of protective measures to fight the new coronavirus should consider the existence of vulnerable groups, which can be identified by the distribution of other health behaviours in the population.
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http://dx.doi.org/10.1590/0102-311X00195420DOI Listing
November 2020

Relationship between work before the epidemic and having gone out to work during the epidemic among participants in the Brazilian Longitudinal Study of Aging: results of the ELSI-COVID-19 initiative.

Cad Saude Publica 2020 13;36Suppl 3(Suppl 3):e00193320. Epub 2020 Nov 13.

Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.

The objective of this study was to examine the prevalence of going out to work during the COVID-19 epidemic, and the factors associated with this, among adults aged 50 years and over who were in paid employment before its onset. We used data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted through face-to-face interviews between August 2019 and March 2020 (before the onset of the epidemic), in a representative national sample of adults aged 50 and over, and data obtained through telephone interviews carried out among the same participants (ELSI-COVID-19 initiative), conducted between May 26 and June 8, 2020 (during the epidemic). The analyses were based on odds ratios (OR) estimated by logistic regression. The participants' mean age was 59.9 years (SD = 6.5). The prevalence of going out to work in the previous seven days was 38.4% (95%CI: 31.3-46.1), 50.2% among men and 25.1% among women (formal work, self-employment, and informal work). The results showed that among men, the likelihood of going out to work was lower among those aged 60 to 69 years compared to those aged 50 to 59 years (OR = 0.27; 95%CI: 0.15-0.48). Among women, the likelihood was lower among those who were self-employed (OR = 0.28; 95%CI: 0.12-0.64) or in informal employment before the epidemic (OR = 0.25; 95%CI: 0.09-0.69), compared to those in formal employment. One of the hypotheses to explain this association is that women in informal employment were more likely to be dismissed, and that self-employed women have stopped working during the epidemic.
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http://dx.doi.org/10.1590/0102-311X00193320DOI Listing
November 2020

Prevalence and characteristics of Brazilians aged 50 and over that received a doctor's diagnosis of COVID-19: the ELSI-COVID-19 initiative.

Cad Saude Publica 2020 13;36Suppl 3(Suppl 3):e00190320. Epub 2020 Nov 13.

Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brasil.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused over half a million deaths worldwide. Brazil has been particularly impacted, registering more than 1.3 million infections and 57,000 deaths by late June 2020. Aggregate numbers of cases are essential in modeling the epidemic and planning responses; however, more detailed analysis of risk factors associated with SARS-CoV-2 infection are needed. Our study provides an initial examination of characteristics associated with receiving a doctor's diagnosis of COVID-19 among a nationally representative sample of Brazilians aged 50 and over. Data are derived from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) and a telephone follow-up survey to ELSI-Brazil participants, known as the ELSI-COVID-19 initiative. The telephone survey was conducted between 26 May and 8 June 2020. Results show that about 2.4% (n = 70) of the sample reported being told by a doctor they had COVID-19, however, only about half of these individuals (n = 37) reported receiving a diagnostic confirmation from viral testing (RT-PCR). Demographic factors (aged 50-60 years), socioeconomic factors (lower household income), health-related factors (obesity, three or more chronic conditions), and geography (living in the Northern region of the country) were positively associated with reporting a COVID-19 diagnosis. Despite the descriptive and preliminary nature of these findings, results reported here suggest the need for more targeted approaches to enhance personal protection and provide greater viral testing options, especially for older, sicker and more vulnerable adults in Brazil.
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http://dx.doi.org/10.1590/0102-311X00190320DOI Listing
November 2020

Universal Health Coverage: Are Older Adults Being Left Behind? Evidence From Aging Cohorts In Twenty-Three Countries.

Health Aff (Millwood) 2020 11;39(11):1951-1960

Maria Fernanda Lima-Costa is a professor in the Rene Rachou Research Institute, Fundação Oswaldo Cruz, and the Public Health Postgraduate Program at the Federal University of Minas Gerais, in Belo Horizonte, Brazil.

Countries around the world have committed to achieving universal health coverage as part of the Sustainable Development Goals agreed upon by all United Nations members, intended to be achieved by 2030. But important population groups such as older adults are rarely examined as part of Sustainable Development Goals monitoring and evaluation efforts. This study uses recent (2014-16) high-quality, individual-level data from several aging cohorts representing more than 100,000 adults ages fifty and older in twenty-three high- and middle-income countries. After individual characteristics and health needs were controlled for, national rates varied up to tenfold for poor access (no doctor visit) and threefold for potential overutilization (fifteen or more doctor visits and multiple hospitalizations) in the past year. Catastrophic expenditures (25 percent or more of household income spent out of pocket on health care) averaged 9 percent, with the highest rates observed in middle-income countries and among sicker populations in some high-income countries. Strengthening universal health coverage for older adults will require greater tailoring and targeting of benefits to meet this population's health needs while protecting them from catastrophic health expenditures.
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http://dx.doi.org/10.1377/hlthaff.2019.01570DOI Listing
November 2020

Life-course risk factors are associated with activity of daily living disability in older adults.

Eur J Public Health 2021 07;31(3):520-527

Fundação Oswaldo Cruz, Instituto de Pesquisas René Rachou, Belo Horizonte, Brazil.

Background: Multiple risk factors accumulate over the life-course and contribute to higher rates of disability at older ages. This study investigates whether three life-course risk factors (low educational attainment, poor health in childhood and multimorbidity) are associated with increased risk of disability [defined as any limitation in basic activities of daily living (BADL)] in older adults and whether this relationship is moderated by the national socioeconomic context, measured by the Human Development Index (HDI).

Methods: Data include 100 062 adults (aged 50 and over) participating in longitudinal studies of aging conducted in 19 countries. Analyses include multivariable Poisson models with robust standard errors to assess the associations between HDI, life-course risk factors and other individual-level control variables (sex and age) with any BADL disability.

Results: In country-specific analyses, both educational attainment and multimorbidity are independently associated with disability in nearly every country. The interaction between these risk factors further increases the magnitude of this association. In pooled regression analyses, the relationship between life-course risk factors and disability is moderated by a country's HDI. For individuals with all three life-course risk factors, the predicted probability of disability ranged from 36.7% in the lowest HDI country to 21.8% in the highest HDI country.

Conclusions: Social and health system policies directed toward reducing the development of life-course risk factors are essential to reduce disability in all countries, but are even more urgently needed in those with lower levels of socioeconomic development.
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http://dx.doi.org/10.1093/eurpub/ckaa156DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8485733PMC
July 2021

Perceived Neighborhood and Walking Among Older Brazilian Adults Living in Urban Areas: A National Study (ELSI-Brazil).

J Aging Phys Act 2020 10 22;29(3):431-441. Epub 2020 Oct 22.

The study goal was to examine the association between perceived neighborhood characteristics and walking in urban older adults in Brazil. A cross-sectional study including 4,027 older adults from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) was performed. Walking was measured using the International Physical Activity Questionnaire. Neighborhood characteristics were questions about physical disorder, noise pollution, safety, violence, social cohesion, services, concerns with community mobility, and pleasantness. Multinomial logistic regression was used. Concern about taking the bus, subway, or train was inversely associated with walking for men. Violence (victim of theft, robbery, or had home broken into) and social cohesion (trust in neighbors) were positively and inversely associated with walking for women, respectively. A significant interaction term between social cohesion and number of chronic diseases was observed for women. These findings demonstrate the need for sex-specific interventions and policies to increase the walking levels among older Brazilian adults.
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http://dx.doi.org/10.1123/japa.2020-0227DOI Listing
October 2020

Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: the ELSI-COVID-19 initiative.

Cad Saude Publica 2020 12;36Suppl 3(Suppl 3):e00193920. Epub 2020 Oct 12.

University of California, Los Angeles, U.S.A.

The aim of the study was to examine the prevalence of social distancing, the use of face masks and hand washing when leaving home among Brazilian adults aged 50 or over. Data from 6,149 telephone interviews were used, conducted between May 26 and June 8, 2020 among participants in the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Social distancing was defined by not having left home in the last seven days. Only 32.8% of study participants did not leave home during the period considered, 36.3% left between one and two times, 15.2% between three and five times and 15.7% left every day. The main reasons for leaving home were to buy medicine or food (74.2%), to work (25.1%), to pay bills (24.5%), for health care (10.5%), to exercise (6.2%), and to meet family or friends (8.8%). Among those who left home, 97.3% always wore face masks and 97.3% always performed hand washing. Women left home less often than men. Men left home more often to work and exercise while women left home more often to seek healthcare. Men (odds ratio - OR = 1.84), those with higher education (OR = 1.48 and 1.95 for 5-8 and 9 years, respectively) and urban residents (OR = 1.54) left home more frequently to perform essential activities, regardless of age or other characteristics. Results show low adherence to social distancing, but high prevalence in the reported use of face masks and hand washing.
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http://dx.doi.org/10.1590/0102-311X00193920DOI Listing
October 2020
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