Aïda Solé-Auró

Health of Immigrants in European countries

The health of older immigrants can have important consequences for needed social support and demands placed on health systems. This paper examines health differences between immigrants and the native-born populations aged 50 years and older in 11 European countries. We examine differences in functional ability, disability, disease presence, and behavioral risk factors for immigrants and nonimmigrants using data from the Survey of Health, Aging and Retirement in Europe (SHARE) database. Among the 11 European countries, migrants generally have worse health than the native population. In these countries, there is a little evidence of the “healthy migrant” at ages 50 years and over. In general, it appears that growing numbers of immigrants may portend more health problems in the population in subsequent years.

Health care utilization among immigrants and native-born populations in 11 European countries. Results from the Survey of Health, Ageing and Retirement in Europe

Objective: This study examines health care utilization of immigrants relative to the native-born populations aged 50 years and older in eleven European countries. Methods. We analyzed data from the Survey of Health Aging and Retirement in Europe (SHARE) from 2004 for a sample of 27,444 individuals in 11 European countries. Negative Binomial regression was conducted to examine the difference in number of doctor visits, visits to General Practitioners (GPs), and hospital stays between immigrants and the native-born individuals. Results: We find evidence those immigrants above age 50 use health services on average more than the native-born populations with the same characteristics. Our models show immigrants have between 6% and 27% more expected visits to the doctor, GP or hospital stays when compared to native-born populations in a number of European countries. Discussion: Elderly immigrant populations might be using health services more intensively due to cultural reasons.

Who cares? A comparison of informal and formal care provision in Spain, England and the USA

ABSTRACT This paper investigates the prevalence of incapacity in performing daily activities and the associations between household composition and availability of family members and receipt of care among older adults with functioning problems in Spain, England and the United States of America (USA). We examine how living arrangements, marital status, child availability, limitations in functioning ability, age and gender affect the probability of receiving formal care and informal care from household members and from others in three countries with different family structures, living arrangements and policies supporting care of the incapacitated. Data sources include the 2006 Survey of Health, Ageing and Retirement in Europe for Spain, the third wave of the English Longitudinal Study of Ageing (2006), and the eighth wave of the USA Health and Retirement Study (2006). Logistic and multinomial logistic regressions are used to estimate the probability of receiving care and the sources of care among persons age 50 and older. The percentage of people with functional limitations receiving care is higher in Spain. More care comes from outside the household in the USA and England than in Spain. The use of formal care among the incapacitated is lowest in the USA and highest in Spain.

Educational differentials in disability vary across and within welfare regimes: a comparison of 26 European countries in 2009

Background Social differentials in disability prevalence exist in all European countries, but their scale varies markedly. To improve understanding of this variation, the article focuses on each end of the social gradient. It compares the extent of the higher disability prevalence in low social groups (referred to as disability disadvantage) and of the lower prevalence in high social groups (disability advantage); country-specific advantages/disadvantages are discussed regarding the possible influence of welfare regimes. Methods Cross-sectional disability prevalence is measured by longstanding health-related activity limitation (AL) in the 2009 European Statistics on Income and Living Conditions (EU-SILC) across 26 countries classified into four welfare regime groups. Logistic models adjusted by country, age and sex (in all 30–79 years and in three age-bands) measured the country-specific ORs across education, representing the AL-disadvantage of low-educated and AL-advantage of high-educated groups relative to middle-educated groups. Results The relative AL-disadvantage of the low-educated groups was small in Sweden (eg, 1.2 (1.0–1.4)), Finland, Romania, Bulgaria and Spain (youngest age-band), but was large in the Czech Republic (eg, 1.9 (1.7–2.2)), Denmark, Belgium, Italy and Hungary. The high-educated groups had a small relative AL-advantage in Denmark (eg, 0.9 (0.8–1.1)), but a large AL-advantage in Lithuania (eg, 0.5 (0.4–0.6)), half of the Baltic and Eastern European countries, Norway and Germany (youngest age-band). There were notable differences within welfare regime groups. Conclusions The country-specific disability advantages/disadvantages across educational groups identified here could help to identify determining factors and the efficiency of national policies implemented to tackle social differentials in health.

Disease Incidence and Mortality Among Older Americans and Europeans

Recent research has shown a widening gap in life expectancy at age 50 between the United States and Europe as well as large differences in the prevalence of diseases at older ages. Little is known about the processes determining international differences in the prevalence of chronic diseases. Higher prevalence of disease could result from either higher incidence or longer disease-specific survival. This article uses comparable longitudinal data from 2004 and 2006 for populations aged 50 to 79 from the United States and from a selected group of European countries to examine age-specific differences in prevalence and incidence of heart disease, stroke, lung disease, diabetes, hypertension, and cancer as well as mortality associated with each disease. Not surprisingly, we find that Americans have higher disease prevalence. For heart disease, diabetes, and cancer, incidence is lower in Europe when we control for sociodemographic and health behavior differences in risk, and these differences explain much of the prevalence gap at older ages. On the other hand, incidence is higher in Europe for lung disease and not different between Europe and the United States for hypertension and stroke. Our findings do not suggest a survival advantage conditional on disease in Europe compared with the United States. Therefore, the origin of the higher disease prevalence at older ages in the United States is to be found in higher prevalence earlier in the life course and, for some conditions, higher incidence between ages 50 and 79.

Educational attainment, gender and health inequalities among older adults in Catalonia (Spain).

BackgroundHealth expectancies vary worldwide according to socioeconomic status (SES), with health disadvantages being evident among lower SES groups. Using educational attainment as a proxy of SES, we seek to identify trends in SES differentials in health by gender, with a particular focus on individuals with low educational attainment in the adult Catalan population (Spain) aged 55 or older.MethodsUsing cross-sectional data for 1994 and 2010-2014 drawn from the Catalan Health Survey, we examined three health indicators to document social health inequalities: self-perceived health, functional limitations, and restrictions on activities of daily living (ADL). We applied logistic models for each indicator, controlling for sociodemographic characteristics, health coverage and health behaviours.ResultsAmong the less-educated, females presented a greater improvement in their self-perceived health over time than did their male counterparts, there being no significant variations among the medium/high educated. Regardless of education, males showed an increase in the prevalence of functional problems (as did the women, but the increase was not statistically significant). Both genders presented a higher prevalence of limitations when performing ADL in the second time period. The gender health gap was reduced slightly both for the low and the medium/high educated, expect in the case of ADL restrictions. Health and functioning differences by education level persisted, but showed significant signs of reduction.ConclusionsLess-educated females constitute the most disadvantaged group in terms of health and personal autonomy, though there are encouraging signs that the gap is closing both in terms of gender and level of education. Health policymakers need to devote particular attention to the aging population with low SES, especially to women. Public programmes promoting greater protection and equity, while fostering preventive and healthy practices, need to target the most underprivileged.

The Oldest Old Health in Europe and the United States

Increasing longevity is one of the primary drivers of population aging. As life expectancy increases, more people will survive to the oldest ages. People who have reached 80 years of age live longer now than they did in the past. Health plays an important role on understanding how long and well you will live. We investigate the health and survival of the oldest old across 13 industrialized countries using nationally representative cross-national samples of older Europeans and Americans. Countries with the longest life expectancy at age 80 are not the countries where survival to age 80 was high nor are they the countries with better health after age 80. For instance, southern Europeans of very old age tend to have a higher life expectancy than northern Europeans in this age group, but they have more functioning problems. Characteristics of those over age 80 differ markedly by country in ways that affect health in later life, e.g. in gender, marital status, education and health behaviors.

Economic Hardship and Educational Differentials in Disability in 26 European Countries.

Objective: The objective of this article is to study to what extent European variations in differentials in disability by education level are associated to variation in poverty. Method: Using the European Statistics on Income and Living Conditions (EU-SILC) for 26 countries, we measure the prevalence of activity limitation (AL) and the rate of economic hardship (EH) by level of education. We measure the increased AL prevalence (disadvantage) of the low-educated relative to the middle-educated and the reduced AL prevalence (advantage) of the high-educated groups, controlling or not for EH. Results: The rate of EH and the extent of the AL-advantage/disadvantage vary substantially across Europe. EH contributes to the AL-advantage/disadvantage but to different extent depending on its level across educational groups. Discussion: Associations between poverty, education, and disability are complex. In general, large EH goes along with increased disability differentials. Actions to reduce poverty are needed in Europe to reduce the levels and differentials in disability.

Risk of dependence associated with health, social support, and lifestyle

OBJECTIVE To analyze the prevalence of individuals at risk of dependence and its associated factors. METHODS The study was based on data from the Catalan Health Survey, Spain conducted in 2010 and 2011. Logistic regression models from a random sample of 3,842 individuals aged ≥ 15 years were used to classify individuals according to the state of their personal autonomy. Predictive models were proposed to identify indicators that helped distinguish dependent individuals from those at risk of dependence. Variables on health status, social support, and lifestyles were considered. RESULTS We found that 18.6% of the population presented a risk of dependence, especially after age 65. Compared with this group, individuals who reported dependence (11.0%) had difficulties performing activities of daily living and had to receive support to perform them. Habits such as smoking, excessive alcohol consumption, and being sedentary were associated with a higher probability of dependence, particularly for women. CONCLUSIONS Difficulties in carrying out activities of daily living precede the onset of dependence. Preserving personal autonomy and function without receiving support appear to be a preventive factor. Adopting an active and healthy lifestyle helps reduce the risk of dependence.

Feeling good in old age: factors explaining health-related quality of life

BackgroundSustained growth in longevity raises questions as to why some individuals report a good quality of life in older ages, while others seem to suffer more markedly the effects of natural deterioration. Health-related quality of life (HRQL) is mediated by several easily measurable factors, including socio-demographics, morbidity, functional status and lifestyles. This study seeks to further our knowledge of these factors in order to outline a profile of the population at greater risk of poor ageing, and to identify those attributes that might be modified during younger stages of the life course.MethodsWe use nationally representative data for Catalonia (Spain) to explain the HRQL of the population aged 80-plus. Cross-sectional data from 2011 to 2016 were provided by an official face-to-face survey. HRQL was measured using EQ-VAS – the EuroQol-5D visual analogue scale – which summarizes current self-perceived health. Multivariate linear regression was used to identify variables influencing the EQ-VAS score.ResultsSociodemographic factors, including being older, female, poorly educated and belonging to a low social class, were related with poor HRQL at advanced ages. The presence of severe mobility problems, pain/discomfort, and anxiety/depression were highly correlated to the HRQL of the elderly, while problems of self-care and with usual activities had a weaker association.ConclusionsEncouraging the young to stay in education, as well as to adopt healthier lifestyles across the lifespan, might ensure better HRQL when individuals reach old age. More multidisciplinary research is required to understand the multifaceted nature of quality of life in the oldest-old population.