Perianayagam Arokiasamy

Data Resource Profile: The World Health Organization Study on global AGEing and adult health (SAGE)

Population ageing is rapidly becoming a global issue and will have a major impact on health policies and programmes. The World Health Organizations Study on global AGEing and adult health (SAGE) aims to address the gap in reliable data and scientific knowledge on ageing and health in low- and middle-income countries. SAGE is a longitudinal study with nationally representative samples of persons aged 50+ years in China, Ghana, India, Mexico, Russia and South Africa, with a smaller sample of adults aged 18-49 years in each country for comparisons. Instruments are compatible with other large high-income country longitudinal ageing studies. Wave 1 was conducted during 2007-2010 and included a total of 34 124 respondents aged 50+ and 8340 aged 18-49. In four countries, a subsample consisting of 8160 respondents participated in Wave 1 and the 2002/04 World Health Survey (referred to as SAGE Wave 0). Wave 2 data collection will start in 2012/13, following up all Wave 1 respondents. Wave 3 is planned for 2014/15. SAGE is committed to the public release of study instruments, protocols and meta- and micro-data: access is provided upon completion of a Users Agreement available through WHOs SAGE website (www.who.int/healthinfo/systems/sage) and WHOs archive using the National Data Archive application (http://apps.who.int/healthinfo/systems/surveydata).

Factors affecting quality of life in lower limb amputees

Background: Quality of life (QoL) is increasingly being recognized as an important outcome for rehabilitation programs, and has mainly been used to compare the efficacy of interventions or to compare amputees with other diseased populations. There is relatively a limited number of studies primarily focusing on analyzing the multitude of factors influencing QoL in amputees. Objectives: To identify important background and amputation related factors which affect quality of life (QoL) in lower limb amputees, and to compare QoL profile of amputees’ to that of general population. Study design: Cross-sectional. Methods: Lower limb amputees 18 years and above from a rehabilitation centre, a limb-fitting centre and four limb-fitting camps were interviewed (n = 605). Structured questionnaires included patient background and amputation characteristics, and the MOS short-form health survey (SF-36) for assessing QoL. The SF-36 was administered to a general adult population using purposive sampling (n = 184). Results: SF-36 PCS and MCS scores were found to be significantly lower for amputees when compared to those for the general population. In this study, employment status, use of an assistive device, use of a prosthesis, comorbidities, phantom-limb pain and residual stump pain were found to predict both PCS and MCS scores significantly, and explained 47.8% and 29.7% of variance respectively. Age and time since amputation accounted for an additional 3% of variance in PCS scores. Conclusions: The abovementioned factors should be addressed in order to ensure holistic reintegration and participation, and to enable the amputees to regain or maintain QoL. Prospective longitudinal studies are recommended to systematically study the change in QoL over time and to assess its determinants. Clinical relevance Proper appraisal of abovementioned factors in the rehabilitation programme would assist in establishing a treatment protocol, which would adequately address QoL in amputees.

The impact of multimorbidity on adult physical and mental health in low- and middle-income countries: what does the study on global ageing and adult health (SAGE) reveal?

BackgroundChronic diseases contribute a large share of disease burden in low- and middle-income countries (LMICs). Chronic diseases have a tendency to occur simultaneously and where there are two or more such conditions, this is termed as ‘multimorbidity’. Multimorbidity is associated with adverse health outcomes, but limited research has been undertaken in LMICs. Therefore, this study examines the prevalence and correlates of multimorbidity as well as the associations between multimorbidity and self-rated health, activities of daily living (ADLs), quality of life, and depression across six LMICs.MethodsData was obtained from the WHO’s Study on global AGEing and adult health (SAGE) Wave-1 (2007/10). This was a cross-sectional population based survey performed in LMICs, namely China, Ghana, India, Mexico, Russia, and South Africa, including 42,236 adults aged 18 years and older. Multimorbidity was measured as the simultaneous presence of two or more of eight chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, and vision impairment. Associations with four health outcomes were examined, namely ADL limitation, self-rated health, depression, and a quality of life index. Random-intercept multilevel regression models were used on pooled data from the six countries.ResultsThe prevalence of morbidity and multimorbidity was 54.2 % and 21.9 %, respectively, in the pooled sample of six countries. Russia had the highest prevalence of multimorbidity (34.7 %) whereas China had the lowest (20.3 %). The likelihood of multimorbidity was higher in older age groups and was lower in those with higher socioeconomic status. In the pooled sample, the prevalence of 1+ ADL limitation was 14 %, depression 5.7 %, self-rated poor health 11.6 %, and mean quality of life score was 54.4. Substantial cross-country variations were seen in the four health outcome measures. The prevalence of 1+ ADL limitation, poor self-rated health, and depression increased whereas quality of life declined markedly with an increase in number of diseases.ConclusionsFindings highlight the challenge of multimorbidity in LMICs, particularly among the lower socioeconomic groups, and the pressing need for reorientation of health care resources considering the distribution of multimorbidity and its adverse effect on health outcomes.

Socio-economic inequalities in child survival in India: A decomposition analysis

This paper provides a first time assessment of the decomposed contributions of socio-economic determinants of under2 child mortality in India and its states using the recent National Family Health Survey (NFHS-3, 2005-06) data. In the first stage analysis, concentration indices of under2 mortality were generated as measures of socio-economic inequalities. The concentration indices were then decomposed into their determining factors. Decomposition results reveal that poor household economic status (46%), mothers illiteracy (35%) and rural residence (15%) contribute to 96% of total socio-economic inequalities in child survival at the national level. The contribution of economic status is relatively smaller in 5 states that are advanced in health transition. The varying pattern of evidence across the states from decomposition analysis suggests the need for unique health intervention strategies for different states in accordance with the evidence of major contributions to total child health inequalities arising from poverty, illiteracy and rural residence.

Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE)

BackgroundIn 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over. Falls are becoming a major public health problem in low- and middle-income countries (LMICs) where populations are ageing rapidly.MethodsNationally representative standardized data collected from adults aged 50 years and over participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, the Russian Federation and South Africa are analysed. The aims are to identify the prevalence of, and risk factors for, past-year fall-related injury and to assess associations between fall-related injury and disability. Regression methods are used to identify risk factors and association between fall-related injury and disability. Disability was measured using the WHO Disability Assessment Schedule Version 2.0 (WHODAS 2.0).ResultsThe prevalence of past-year fall-related injuries ranged from 6.6 % in India to 1.0 % in South Africa and was 4.0 % across the pooled countries. The proportion of all past-year injuries that were fall-related ranged from 73.3 % in the Russian Federation to 44.4 % in Ghana. Across the six countries this was 65.7 %. In the multivariable logistic regression, the odds of past-year fall-related injury were significantly higher for: women (OR: 1.27; 95 % CI: 0.99,1.62); respondents who lived in rural areas (OR: 1.36; 95 % CI: 1.06,1.75); those with depression (OR: 1.43; 95 % CI: 1.01,2.02); respondents who reported severe or extreme problems sleeping (OR: 1.54; 95 % CI: 1.15,2.08); and those who reported two or more (compared with no) chronic conditions (OR: 2.15; 95 % CI: 1.45,3.19). Poor cognition was also a significant risk factor for fall-related injury.The association between fall-related injury and the WHODAS measure of disability was highly significant (P<0.0001) with some attenuation after adjusting for confounders. Reporting two or more chronic conditions (compared with none) was significantly associated with disability (P<0.0001).ConclusionsThe findings provide a platform for improving understanding of risk factors for falls in older adults in this group of LMICs. Clinicians and public health professionals in these countries must be made aware of the extent of this problem and the need to implement policies to reduce the risk of falls in older adults.

Risk Factors and Disability Associated with Low Back Pain in Older Adults in Low- and Middle-Income Countries. Results from the WHO Study on Global AGEing and Adult Health (SAGE)

Background Back pain is a common disabling chronic condition that burdens individuals, families and societies. Epidemiological evidence, mainly from high-income countries, shows positive association between back pain prevalence and older age. There is an urgent need for accurate epidemiological data on back pain in adult populations in low- and middle-income countries (LMICs) where populations are ageing rapidly. The objectives of this study are to: measure the prevalence of back pain; identify risk factors and determinants associated with back pain, and describe association between back pain and disability in adults aged 50 years and older, in six LMICs from different regions of the world. The findings provide insights into country-level differences in self-reported back pain and disability in a group of socially, culturally, economically and geographically diverse LMICs. Methods Standardized national survey data collected from adults (50 years and older) participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) were analysed. The weighted sample (n = 30, 146) comprised respondents in China, Ghana, India, Mexico, South Africa and the Russian Federation. Multivariable regressions describe factors associated with back pain prevalence and intensity, and back pain as a determinant of disability. Results Prevalence was highest in the Russian Federation (56%) and lowest in China (22%). In the pooled multi-country analyses, female sex, lower education, lower wealth and multiple chronic morbidities were significant in association with past-month back pain (p<0.01). About 8% of respondents reported that they experienced intense back pain in the previous month. Conclusions Evidence on back pain and its impact on disability is needed in developing countries so that governments can invest in cost-effective education and rehabilitation to reduce the growing social and economic burden imposed by this disabling condition.

Determinants of Gender Differences in Self-Rated Health Among Older Population: Evidence From India

The purpose of this study is to examine gender difference in self-rated health among older population in India. Data from the 60th round of National Sample Survey Organization on 34,831 older persons are used. The present study measured self-rated health categorized as “poor” and “good.” We used bivariate and binary logistic regression model to investigate differences and factors that best explain and predict the self-rated health among older persons. Results show that poor self-rated health was more common among women than men. Furthermore, the poor self-rated health was higher among Muslims, Scheduled Castes, and women residing in rural areas. Findings suggest a clear need for gender-sensitive health interventions.

Chronic noncommunicable diseases in 6 low- and middle-income countries: Findings from wave 1 of the world health organization's Study on Global Ageing and Adult Health (SAGE)

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organizations Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems.

Understanding epidemiological transition in India.

Background Omrans theory explains changing disease patterns over time predominantly from infectious to chronic noncommunicable diseases (NCDs). Indias epidemiological transition is characterized by dual burden of diseases. Kumar addressed low mortality and high morbidity in Kerala, which seems also to be true for India as a country in the current demographic scenario. Methods NSS data (1986–1987, 1995–1996, 2004) and aggregated data on causes of death provided by Registrar General India (RGI) were used to examine the structural changes in morbidity and causes of death. A zero-inflated poisson (ZIP) regression model and a beta-binomial model were used to corroborate the mounting age pattern of morbidity. Measures, namely the 25th and 75th percentiles of age-at-death and modal age-at-death, were used to examine the advances in mortality transition. Objective This study addressed the advances in epidemiological transition via exploring the structural changes in pattern of diseases and progress in mortality transition. Results The burden of NCDs has been increasing in old age without replacing the burden of communicable diseases. The manifold rise of chronic diseases in recent decades justifies the death toll and is responsible for transformation in the age pattern of morbidity. Over time, deaths have been concentrated near the modal age-at-death. Modal age-at-death increased linearly by 5 years for females (r 2=0.9515) and males (r 2=0.9020). Significant increase in modal age-at-death ascertained the dominance of old age mortality over the childhood/adult age mortality. Conclusions India experiences a dual burden of diseases associated with a remarkable transformation in the age pattern of morbidity and mortality, contemporaneous with structural changes in disease patterns. Continued progress in the pattern of diseases and mortality transition, accompanied by a linear rise in e x , unravels a compelling variation in advances found so far in epidemiological transition witnessed by the developed nations, with similar matrices for India.Background Omrans theory explains changing disease patterns over time predominantly from infectious to chronic noncommunicable diseases (NCDs). Indias epidemiological transition is characterized by dual burden of diseases. Kumar addressed low mortality and high morbidity in Kerala, which seems also to be true for India as a country in the current demographic scenario. Methods NSS data (1986-1987, 1995-1996, 2004) and aggregated data on causes of death provided by Registrar General India (RGI) were used to examine the structural changes in morbidity and causes of death. A zero-inflated poisson (ZIP) regression model and a beta-binomial model were used to corroborate the mounting age pattern of morbidity. Measures, namely the 25th and 75th percentiles of age-at-death and modal age-at-death, were used to examine the advances in mortality transition. Objective This study addressed the advances in epidemiological transition via exploring the structural changes in pattern of diseases and progress in mortality transition. Results The burden of NCDs has been increasing in old age without replacing the burden of communicable diseases. The manifold rise of chronic diseases in recent decades justifies the death toll and is responsible for transformation in the age pattern of morbidity. Over time, deaths have been concentrated near the modal age-at-death. Modal age-at-death increased linearly by 5 years for females (r 2=0.9515) and males (r 2=0.9020). Significant increase in modal age-at-death ascertained the dominance of old age mortality over the childhood/adult age mortality. Conclusions India experiences a dual burden of diseases associated with a remarkable transformation in the age pattern of morbidity and mortality, contemporaneous with structural changes in disease patterns. Continued progress in the pattern of diseases and mortality transition, accompanied by a linear rise in e x , unravels a compelling variation in advances found so far in epidemiological transition witnessed by the developed nations, with similar matrices for India.

Prevalence of Loss of All Teeth (Edentulism) and Associated Factors in Older Adults in China, Ghana, India, Mexico, Russia and South Africa †

Little information exists about the loss of all one’s teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO’s) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%–21.7%) than China, Ghana, and South Africa (3.0%–9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.