Juliana Vaz de Melo Mambrini

Genomic ancestry, Self-rated health and its association with mortality in an admixed population: 10 year follow-up of the Bambui-Epigen (Brazil) cohort study of ageing

Background Self-rated health (SRH) has strong predictive value for mortality in different contexts and cultures, but there is inconsistent evidence on ethnoracial disparities in SRH in Latin America, possibly due to the complexity surrounding ethnoracial self-classification. Materials/Methods We used 370,539 Single Nucleotide Polymorphisms (SNPs) to examine the association between individual genomic proportions of African, European and Native American ancestry, and ethnoracial self-classification, with baseline and 10-year SRH trajectories in 1,311 community dwelling older Brazilians. We also examined whether genomic ancestry and ethnoracial self-classification affect the predictive value of SRH for subsequent mortality. Results European ancestry predominated among participants, followed by African and Native American (median = 84.0%, 9.6% and 5.3%, respectively); the prevalence of Non-White (Mixed and Black) was 39.8%. Persons at higher levels of African and Native American genomic ancestry, and those self-identified as Non-White, were more likely to report poor health than other groups, even after controlling for socioeconomic conditions and an array of self-reported and objective physical health measures. Increased risks for mortality associated with worse SRH trajectories were strong and remarkably similar (hazard ratio ~3) across all genomic ancestry and ethno-racial groups. Conclusions Our results demonstrated for the first time that higher levels of African and Native American genomic ancestry—and the inverse for European ancestry—were strongly correlated with worse SRH in a Latin American admixed population. Both genomic ancestry and ethnoracial self-classification did not modify the strong association between baseline SRH or SRH trajectory, and subsequent mortality.

Physical activity and all-cause mortality among older Brazilian adults: 11-year follow-up of the Bambuí Health and Aging Study

Objective To investigate the association between physical activity (eg, energy expenditure) and survival over 11 years of follow-up in a large representative community sample of older Brazilian adults with a low level of education. Furthermore, we assessed sex as a potential effect modifier of this association. Materials and methods A population-based prospective cohort study was conducted on all the ≥60-year-old residents in Bambuí city (Brazil). A total of 1,606 subjects (92.2% of the population) enrolled, and 1,378 (85.8%) were included in this study. Type, frequency, and duration of physical activity were assessed in the baseline survey questionnaire, and the metabolic equivalent task tertiles were estimated. The follow-up time was 11 years (1997–2007), and the end point was mortality. Deaths were reported by next of kin during the annual follow-up interview and ascertained through the Brazilian System of Information on Mortality, Brazilian Ministry of Health. Hazard ratios (95% confidence intervals [CIs]) were estimated by Cox proportional-hazard models, and potential confounders were considered. Results A statistically significant interaction (P<0.03) was found between sex and energy expenditure. Among older men, increases in levels of physical activity were associated with reduced mortality risk. The hazard ratios were 0.59 (95% CI 0.43–0.81) and 0.47 (95% CI 0.34–0.66) for the second and third tertiles, respectively. Among older women, there was no significant association between physical activity and mortality. Conclusion It was possible to observe the effect of physical activity in reducing mortality risk, and there was a significant interaction between sex and energy expenditure, which should be considered in the analysis of this association in different populations.

Mortality risk attributable to smoking, hypertension and diabetes among English and Brazilian older adults (The ELSA and Bambui cohort ageing studies).

Background: The main aim of this study was to quantify and compare 6-year mortality risk attributable to smoking, hypertension and diabetes among English and Brazilian older adults. This study represents a rare opportunity to approach the subject in two different social and economic contexts. Methods: Data from the data from the English Longitudinal Study of Ageing (ELSA) and the Bambuí Cohort Study of Ageing (Brazil) were used. Deaths in both cohorts were identified through mortality registers. Risk factors considered in this study were baseline smoking, hypertension and diabetes mellitus. Both age–sex adjusted hazard ratios and population attributable risks (PAR) of all-cause mortality and their 95% confidence intervals for the association between risk factors and mortality were estimated using Cox proportional hazards models. Results: Participants were 3205 English and 1382 Brazilians aged 60 years and over. First, Brazilians showed much higher absolute risk of mortality than English and this finding was consistent in all age, independently of sex. Second, as a rule, hazard ratios for mortality to smoking, hypertension and diabetes showed more similarities than differences between these two populations. Third, there was strong difference among English and Brazilians on attributable deaths to hypertension. Conclusions: The findings indicate that, despite of being in more recent transitions, the attributable deaths to one or more risk factors was twofold among Brazilians relative to the English. These findings call attention for the challenge imposed to health systems to prevent and treat non-communicable diseases, particularly in populations with low socioeconomic level.

Components of the metabolic syndrome and depressive symptoms in community-dwelling older people: the Bambuí Cohort Aging Study

Objective: To investigate the moderating effect of an increasing number of clustered metabolic syndrome (MetS) components on the association between MetS and depressive symptoms in a population-based cohort of older adults in Brazil. Methods: This analysis used data from the Bambuí Cohort Aging Study. Participants in this cross-sectional study comprised 1,469 community-dwelling older people aged ≥ 60 years. Analyses were performed to assess both the association between depressive symptoms and each individual MetS component and the association between depressive symptoms and clustering of an increasing number of MetS components. Results: High triglyceride level was the individual component that showed the strongest association with depressive symptoms (odds ratio [OR]: 1.47; 95% confidence intervals [95%CI] 1.19-1.81; p < 0.0001). Only the presence of three MetS components was associated with depressive symptoms (OR = 1.53; 95%CI 1.05-2.23; p = 0.025). No graded association was detected between increasing number of clustered MetS components and depressive symptoms. Conclusions: Increasing the number of MetS components did not impact the association with depressive symptoms. The association between high triglyceride level and depressive symptoms highlights the relevance of lipid metabolism abnormalities for the emergence of depressive symptoms in older adults.

Aspectos sociodemográficos e de saúde associados ao trabalho remunerado em adultos (50-69 anos) na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

Foram examinados os fatores associados ao trabalho remunerado em uma amostra probabilistica de 3.320 individuos (50-69 anos de idade), residentes na Regiao Metropolitana de Belo Horizonte, Minas Gerais, Brasil. A prevalencia do trabalho remunerado foi de 62,8% entre homens e 35,8% entre mulheres. Em ambos os generos, o trabalho remunerado apresentou associacao positiva com o nivel de escolaridade e negativa com a autoavaliacao da saude. A propensao de ter trabalho remunerado foi maior entre mulheres sem conjuge e aquelas que conheciam alguem que havia sido discriminado no ambiente de trabalho. Entre os homens, a prevalencia do trabalho remunerado caiu de 67,2%, entre aqueles com ≥ 8 anos de escolaridade e que avaliaram melhor a sua saude, para 37,8% entre aqueles com escolaridade mais baixa e que avaliaram a sua saude como ruim (RP = 0,56; IC95%: 0,37-0,87). Entre as mulheres, a prevalencia correspondente caiu de 42,1% para 3,6% (RP = 0,09; IC95%: 0,03-0,26). A propensao de ter trabalho remunerado entre mulheres com baixa escolaridade e pior avaliacao da saude foi dez vezes menor do que entre seus equivalentes homens.Factors associated with paid work were examined in a probabilistic sample of 3,320 adults (50-69 years) in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. Prevalence of paid work was 62.8% in men and 35.8% in women. For both men and women, paid work was positively associated with schooling and negatively associated with self-rated health. The probability of having paid work was higher for single women and those who knew someone that had suffered discrimination at the workplace. For men, prevalence of paid work varied from 67.2% in those with ≥ 8 years of schooling and better self-rated health, as compared to 37.8% in those with less schooling and poor self-rated health (PR = 0.56; 95%CI: 0.37-0.87). In women, the corresponding prevalence rates were 42.1% and 3.6% (PR = 0.09; 95%CI: 0.03-0.26). For women with little schooling and poor self-rated health, the likelihood of having paid work was ten times lower than for their male counterparts.

Performance of primary dental care services: an ecological study in a large Brazilian city.

This study explored the association between area-level primary dental care performance and area-level demographics, dental treatment need, and health care service indicators. An ecological cross-sectional study was performed in Belo Horizonte, Brazil, in 2010. The 142 primary health care (PHC) units were grouped based on the following variables: access to individual dental treatment, frequency of dental emergencies, and frequency of individual preventive procedures. The independent variables analyzed were demographic variables, dental treatment need, and health care service indicators. The data were obtained from the information systems of the Brazilian Ministry of Health and the city of Belo Horizonte. We explored the associations between membership in a specific PHC cluster type and the independent variables using multinomial logistic regression with a significance level of 5%. Variables such as the high/very high vulnerability of population, rate of completed treatment, and rate of referrals of users to secondary care were independently associated with the clusters (P < 0.05). The performance of primary dental care services was associated with patient demographics, dental treatment need, and referrals. The results of this study have implications for the planning of public policies.

Immune senescence and biomarkers profile of Bambuí aged population-based cohort

&NA; During immunosenescence many proinflammatory markers such as cytokines and chemokines are increased. This process called by Franceschi and colleagues as inflammaging is associated with chronic inflammation and the ethiology and pathophysiolgy of many ageing diseases as Alzheimers and atherosclerosis. The knowledge of immune profile during ageing may provide some interventions that would improve the immune function in elderly and quality of life for old people. However, the identification of a group of potential biomarkers to monitor the ageing process is very difficult. In addition, most of the evidence evaluating immune biomarkers profile is based on data from older Caucasian adults. To our knowledge, no previous Latin American old population‐based cohort has evaluated immunological parameters along the ageing process. The present work evaluated CXCL8, CXCL9, CXCL10, CCL2, CCL5, IL‐1, IL‐6, IL‐12, TNF and IL‐10 serum levels in 1494 older adults aged 60 to 95 from a population based ageing cohort in Brazil. Our data suggest that there is an increased positive predicted probability of participants to be a high producer of IL‐6, CXCL8 and CXCL9. Moreover, results did not differ between men and women, except for CXCL10 that increased only in men. Results were not different in the adjusted model by many potential confounders, including African genomic ancestry. Together, these findings add novel insights about the immunologic aspects of ageing supported by a large population‐based cohort study that provides evidences that corroborate with the inflammaging proposal and subsidize the establishment of biomarkers for monitoring the health status of aged population. HighlightsImmunological biomarkers are evaluated in a population‐based cohort of aged adults in Brazil.There is a positive predicted probability of high producers of IL‐6/CXCL8/CXCL9 along ageing.Shift from macro biomarker networks towards micro‐arrangements occur earlier in women.

Cuidado informal e remunerado aos idosos no Brasil (Pesquisa Nacional de Saúde, 2013)

OBJETIVO Descrever a prevalencia e fatores sociodemograficos associados a ajuda informal e remunerada a idosos com limitacoes funcionais. METODOS Dos 23.815 participantes com 60 anos ou mais da Pesquisa Nacional de Saude, 5.978 declararam necessitar de ajuda para realizar atividades da vida diaria e foram incluidos nesta analise. A variavel dependente foi a fonte de […]ABSTRACT OBJECTIVE To describe the prevalence and sociodemographic factors associated with informal and paid care for Brazilian older adults with functional limitations. METHODS Of the 23,815 participants of the National Health Survey aged 60 or older, 5,978 reported needing help to perform activities of daily living and were included in this analysis. The dependent variable was the source of care, categorized as exclusively informal (unpaid), exclusively formal (paid), mixed or none. The socio-demographic variables were age (60-64, 65-74, ≥ 75 years old), gender and number of residents in the household (1, 2, ≥ 3). The multivariate analysis was based on binomial and multinomial logistic regressions. RESULTS Informal care predominated (81.8%), followed by paid (5.8%) or mixed (6.8%) and no care (5.7%). The receipt of care from any source increased gradually with the number of residents in a same household, regardless of age and gender (OR = 4.85 and 9.74 for 2 and ≥ 3, respectively). Age was positively associated with receiving any care while the male gender showed a negative association. The number of residents in the household showed the strongest association with informal care (OR = 10.94 for ≥ 3 residents), compared with paid (OR = 5.48) and mixed (OR = 4.16) care. CONCLUSIONS Informal care is the main source of help for community-dwelling older adults with functional limitations. In a context of rapid population aging and decline in family size, the results reinforce the need for policies to support long-term care for older Brazilians.

Uso de serviços de saúde por idosos brasileiros com e sem limitação funcional

OBJETIVO Analisar o uso de servicos de saude e a qualidade da atencao medica recebida por idosos brasileiros com e sem limitacao funcional. METODOS As analises principais foram baseadas em amostra nacional representativa de 23.815 participantes da Pesquisa Nacional de Saude com 60 anos ou mais. A limitacao funcional foi definida pela dificuldade para realizar […]ABSTRACT OBJECTIVE To analyze the use of health services and the quality of medical care received by Brazilian older adults with and without functional limitation. METHODS The main analyses were based on a national sample representing 23,815 participants of the National Survey on Health (PNS) aged 60 years or older. Functional limitation was defined by the difficulty to perform at least one out of ten basic or instrumental activities of daily living. Potential confounding variables included predisposing and enabling factors of the use of health services. RESULTS The prevalence of functional limitation was 30.1% (95%CI 29.2–31.4). The number of doctor visits and hospitalizations in the past 12 months showed statistically significant associations with functional limitation, both for users of the public system (OR = 2.48 [95%CI 2.13–2.88] for three or more doctor visits and OR = 2.58 [95%CI 2.15–3.09] for one or more hospitalizations) and of the private system (OR = 2.56 [95%CI 1.50–4.36] and OR = 2.22 [95%CI 1.64–3.00], respectively). The propensity to use basic health units was higher among users of the private system with functional limitations (OR = 2.01 [95%CI 1.12–3.59]). Only two out of seven indicators of the quality of medical care received were associated with functional limitation, in the perception of users of public and private systems. The public system users with functional limitations did worse evaluation of the freedom for choosing the doctor and waiting time for an appointment, when compared with users of the same system without these limitations (OR = 0.81 [95%CI 0.67–0.99] and OR = 0.76 [95%CI 0.62–0.93], respectively). CONCLUSIONS Older adults with functional limitations use more health services in comparison with those without such limitations. The magnitude of the association between functional limitation and number of doctor visits and hospitalizations was similar in the public and private health systems.

Health literacy and warfarin therapy at two anticoagulation clinics in Brazil

Objective Health literacy has been related to health-related conditions and health outcomes. Studies examining the association of health literacy and anticoagulation have had variable results. We sought to investigate the relations of health literacy and percentage of time in therapeutic range (TTR) in a vulnerable Brazilian cohort at two hospital-based anticoagulation clinics. Methods We measured health literacy with the Short Assessment of Health Literacy for Portuguese-speaking Adults (SAHLPA-18) in 2015–2016. We identified the demographic and clinical characteristics associated with health literacy and related health literacy to TTR. Results We enrolled 422 adults prescribed chronic warfarin therapy in our observational study (median age 62.1 years; 58.8% women; monthly income