Rebeca Wong

Sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP) versus dynapenia as a risk factor for mortality in the elderly

BackgroundSarcopenia, defined as low muscle mass (LMM), and dynapenia have been associated with adverse outcomes in elderly.ObjectiveContrast the association of sarcopenia versus dynapenia with incidence of disability.DesignA four-year prospective study (2006–2010).SettingSão Paulo, Brazil.Participants478 individuals aged 60 and older from the Saúde, Bem-Estar e Envelhecimento (SABE) study who were non-disabled at baseline.MeasurementsSarcopenia, measured according to the European Working Group on Sarcopenia in Older People (EWGSOP), includes: LMM assessed by skeletal muscle mass index ≤8.90kg/m2 (men) and ≤6.37kg/m2 (women); low muscle strength (LMS) assessed by handgrip strength <30kg (men) and <20kg (women); and low physical performance (LPP) assessed by gait speed ≤0.8m/s. Diagnosis of sarcopenia required LMM plus LMS or LPP. Dynapenia was defined as handgrip strength <30kg (men) and <20kg (women). Covariates included socio-demographic and behavioral variables, medical conditions, hospitalization, depressive symptoms, cognition, perception of vision, hearing and body mass index.OutcomesDisability in mobility or instrumental activities of daily living (IADL) or disability in activities of daily living (ADL) and IADL.ResultsThe incidence density of mobility or IADL disability was 43.4/1000 person/year and 22.6/1000 person/year for IADL and ADL disability. There was no significant difference in incidence density according sarcopenia or dynapenia status. After controlling for all covariates, sarcopenia was associated with mobility or IADL disability (relative risk ratio = 2.23, 95%Confidence Interval: 1.03–4.85). Dynapenia was not associated with disability.ConclusionsSarcopenia according to the EWGSOP definition can be used in clinical practice as a screening tool for early functional decline (mobility or IADL disability).

Survey Data for the Study of Aging in Latin America and the Caribbean: Selected Studies

The article summarizes three of the data collection studies that can assist researchers in examining population aging processes in the Latin America and Caribbean region with an emphasis on cross-national comparisons, including the population of Mexican immigrants in the United States. These are the Survey on Health and Wellbeing of Elders conducted in seven urban centers of the region, the national Mexican Health and Aging Study, and the Hispanic Established Populations for Epidemiologic Studies of the Elderly in the United States. The article describes the studies and marks them as informative, comprehensive, and still underanalyzed in particular for the purpose of cross-national analyses of aging among Latin American and Caribbean populations.

Household income and health care expenditures in Mexico

The purpose of this paper is to examine the determinants of household health expenditures in Mexico. Our analysis involves the estimation of household monetary health care expenditures, using the economic and demographic characteristics of the household as covariates. We pay particular attention to the impact of household income on health expenditures, estimating the elasticity of health care expenditures with respect to income for different income groups and according to health insurance status. For the empirical analysis, we use the Mexican National Survey of Income and Expenditures of 1989. Our principle findings show that monetary health expenditures by Mexican households are sensitive to changes in household income levels and that the group which is most responsive to changes in income levels in the lower-income uninsured group. This suggests that in times of economic crisis, these households reduce cash expenditures on health care by proportionately more than higher-income and insured households.

Adultos mayores mexicanos en contexto socioeconómico amplio: salud y envejecimiento

OBJETIVO: Describir el Estudio Nacional sobre Salud y Envejecimiento en Mexico (ENASEM), conocido tambien por su nombre en ingles: Mexican Health and Aging Study (MHAS). MATERIAL Y METODOS: Se hace una descripcion del diseno del estudio, su trabajo de campo y contenido tematico, sus alcances y potencial analitico. Se presentan resultados descriptivos acerca de temas selectos. Este es un estudio prospectivo de panel sobre personas de 50 anos de edad o mas en 2000. RESULTADOS: En la encuesta inicial, realizada en 2001 con representatividad nacional y en areas urbanas y rurales, se entrevisto aproximadamente a 15 200 personas. La encuesta de seguimiento realizada en 2003 recontacto exitosamente a mas de 90% de los individuos entrevistados en la encuesta inicial y se realizaron 546 entrevistas sobre personas fallecidas entre 2001 y 2003. Se presentan resultados descriptivos de caracteristicas demograficas, de salud, estilo de vida, apoyo institucional, pensiones, empleo, ayudas familiares y cambios en la salud a dos anos. CONCLUSIONES: Los adultos mayores en Mexico presentan gran heterogeneidad, la cual se ilustra en forma concisa y breve en los resultados presentados. El estudio y las bases de datos derivadas tienen un gran potencial analitico para explorar multiples dimensiones de la salud en adultos mayores.

Comorbidity and Disability in Elderly Mexican and Mexican American Adults Findings From Mexico and the Southwestern United States

This article aims to compare the effects of morbid and comorbid medical conditions on disability in elderly Mexican and Mexican American adults. Data from the 2001 Mexican Health and Aging Study (N = 4,872) and 1993 to 1994 Hispanic Established Population for Epidemiologic Studies of the Elderly (N = 3,050) were analyzed. Prevalence of medical conditions and disability in activities of daily living were calculated and logistic models were used to test associations. Prevalence of disability in older Mexicans was 16.3% while it was slightly lower in Mexican Americans (13.1%). Prevalence of arthritis, cancer, diabetes, heart attack, and stroke were substantially higher in Mexican Americans than in older adults living in Mexico. Diabetes, stroke, and heart attack were comorbid conditions that raised the likelihood of disability in both populations among subjects with other medical conditions. Despite differences in prevalence, the associations of morbidity and comorbidity with disability had similar magnitudes in both populations.

The Tide to Come Elderly Health in Latin America and the Caribbean

This article introduces a conjecture and reviews partial evidence about peculiarities in the aging of populations in Latin America and the Caribbean (LAC) that may impact future elderly health status. Using Survey on Health and Well-Being of Elders data (SABE; n = 10,902), the authors estimated effects of early childhood conditions on adult diabetes and heart disease. Using Waaler-type surfaces, the authors obtained expected mortality risks for SABE and also U.S. elderly (Health and Retirement System, n = 12,527). Expected mortality risks using Waaler-type surfaces among elderly in LAC reflected excesses supporting our conjecture. There was partial evidence of a relation between various indicators of early childhood nutritional status (knee height, waist-to-hip ratio) and diabetes and even stronger evidence of a relation between rheumatic fever and adult heart disease. There is some evidence, albeit weak, to suggest that the conjecture regarding elderly health status’ connection to early conditions has some merit.

Health care utilization among older mexicans: health and socioeconomic inequalities

OBJECTIVE To examine the determinants of the utilization of health care services among the population of older adults in Mexico. Three types of health care services are analyzed: preventive care, visits to the doctor, and hospitalizations. MATERIAL AND METHODS Data was used from the 2001 Mexican Health and Aging Study (MHAS/ENASEM) and estimates were made using multivariate probit regression methods. RESULTS Socioeconomic factors, health conditions reported by the individuals, and the availability of health insurance are significant determinants of the differential use of services by older adults. CONCLUSION Specific health conditions are important determinants of use of the various types of health care services. For all three types, however, the availability of health insurance is an enabling factor of health care use. Older age is associated with greater propensity to use health care services but its effect is small when controlling for health conditions.

Cohort Profile: The Mexican Health and Aging Study (MHAS)

The Mexican Health and Aging Study (MHAS) was designed to prospectively evaluate the impact of disease on the health, function and mortality of adults over the age of 50 in both urban and rural areas of Mexico. The overall goal of the study is to examine the ageing process and its disease and disability burden in a large representative panel of older Mexicans, using a wide socioeconomic perspective. The study protocols and survey instruments are highly comparable to the U.S. Health and Retirement Study (HRS).The MHAS 2001 baseline is a nationally and urban-rural representative survey of individuals born in 1951 or earlier. Three waves of data have been collected so far: baseline in 2001 and follow-ups in 2003 and 2012. In 2012, the study added a representative sample of the population from the 1952-62 birth cohorts. A fourth wave will be collected in 2015.The data files and documentation are available free of charge at the study website [www.MHASweb.org] in English and [www.ENASEM.org] in Spanish.

Household catastrophic health expenditures: A comparative analysis of twelve Latin American and Caribbean Countries

OBJECTIVE Compare patterns of catastrophic health expenditures in 12 countries in Latin America and the Caribbean. MATERIAL AND METHODS Prevalence of catastrophic expenses was estimated uniformly at the household level using household surveys. Two types of prevalence indicators were used based on out-of-pocket health expense: a) relative to an international poverty line, and b) relative to the households ability to pay net of their food basket. Ratios of catastrophic expenditures were estimated across subgroups defined by economic and social variables. RESULTS The percent of households with catastrophic health expenditures ranged from 1 to 25% in the twelve countries. In general, rural residence, lowest quintile of income, presence of older adults, and lack of health insurance in the household are associated with higher propensity of catastrophic health expenditures. However, there is vast heterogeneity by country. CONCLUSIONS Cross national studies may serve to examine how health systems contribute to the social protection of Latin American households.

Wealth in middle and old age in Mexico: The role of international migration

This article examines the impact that past migration to the U.S. has on the current economic well-being of individuals in middle or old age who have returned to Mexico. A priori, the net effect of U.S. migration on wealth among return migrants is difficult to predict; there are counteracting factors that can affect wealth positively or negatively. Using data from the Mexican Health and Aging Study 2001 and correcting for selection factors, the long-term effect of U.S. migration for return migrants was found consistently positive in terms of their accumulated personal wealth at middle and old age. This article speculates about the possible mechanisms that can explain this apparent advantage.