Risk of all-cause mortality and its association with health status in a cohort of community-dwelling older people: FIBRA study

Francisco, Priscila Maria Stolses Bergamo; Assumpção, Daniela de; Borim, Flávia Silva Arbex; Yassuda, Monica Sanches; Neri, Anita Liberalesso

doi:10.1590/1413-812320212612.32922020

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FREE THEMES • Ciênc. saúde coletiva 26 (12) • Dec 2021 • https://doi.org/10.1590/1413-812320212612.32922020 copy

Risk of all-cause mortality and its association with health status in a cohort of community-dwelling older people: FIBRA study

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Abstract

This article aims to estimate the risk of death according to sociodemographic characteristics, chronic diseases, frailty, functional capacity, and social participation in older people as well as determine the median time of death in relation to health status and social participation. A retrospective longitudinal study was conducted with older people (≥65 years) in 2008-09 and 2016-17 in the city of Campinas and the subdistrict of Ermelino Matarazzo in the city of São Paulo. Face-to-face interviews were conducted at community centers and the participants’ homes. The cumulative incidence of death was estimated and associations with the predictor variables were analyzed using Poisson multiple regression. The Kaplan-Meier method and the log-rank test were also used. Among the 741 individuals located at follow-up, 192 had deceased. The incidence of death was higher among those who reported having heart disease and those who were dependent on others regarding the performance of instrumental activities of daily living. The incidence of death was lower among women, individuals in the highest income stratum, and those who performed three or more activities related to social inclusion. No differences in median survival times were found. Predictors of mortality can contribute to broadening knowledge on the singularities of the aging process.

Key words:
Mortality; Aged; Frailty; Activities of daily living; Social participation

Variables		Follow-up		Lost to follow-up		p- value*
Variables		n=751	%	n=543	%
Sex
	Male	242	32.7	160	29.5	0.223
	Female	499	67.3	383	70.5
Age group (years)
	65 to 69	241	32.5	214	39.4	0.011
	70 to 74	234	31.6	173	31.9
	75 or more	266	35.9	156	28.7
Schooling (years)
	0	140	18.9	93	17.2	0.069
	1 to 4	430	58.1	293	54.2
	5 or more	170	23.0	155	28.6
Family income (quartiles)#
	1st quartile	188	29.6	121	25.8	0.208
	2nd quartile	138	21.7	119	25.4
	3rd quartile	177	27.9	118	25.2
	4th quartile	132	20.8	110	23.5
Medical diagnosis of disease
	Hypertension	381	64.7	257	63.9	0.807
	Arthritis/arthrosis/rheumatism	237	40.2	170	42.3	0.519
	Heart disease	149	25.3	101	25.1	0.921
	Diabetes mellitus	135	22.9	90	22.4	0.844
	Lung disease	68	11.6	37	9.2	0.236
	Cancer	57	9.7	28	7.0	0.134
	Stroke	52	8.8	28	6.9	0.285
Frailty
	Non-frail	223	30.1	163	30.0	0.857
	Pre-frail	429	57.9	320	58.9
	Frail	89	12.0	60	11.1
Performance on activities of daily living
	Dependent on IADL (partial/total)	176	30.2	120	29.7	0.856
Indicator of social involvement (number of AADL)
	0 to 1	140	24.1	79	19.7	0.005
	2	196	33,7	111	27,7
	3 ou mais	245	42,2	211	52,6

Variáveis		Number of deaths	Incidence of mortality %	Crude RR (95%CI)	Adjusted RR** (95%CI)
Sex			0.011*
	Male	77	31.8	1	1
	Female	115	23.0	0.72 (0.54-0.96)	0.72 (0.54-0.96)
Age group (years)			<0.001*
	65 to 69	46	19.1	1	1
	70 to 74	45	19.2	1.00 (0.67-1.52)	0.96 (0.63-1.44)
	75 or more	101	38.0	1.99 (1.40-2.82)	1.85 (1.30-2.63)
Schooling (years)			0.002*
	0	52	37.1	1	1
	1 to 4	105	24.4	0.66 (0.47-0.92)	0.72 (0.52-1.01)
	5 or more	35	20.6	0.55 (0.36-0.85)	0.64 (0.41-0.98)
Family income (quartiles)#			0.020*
	1st quartile	57	30.3	1	1
	2nd quartile	32	23.2	0.76 (0.50-1.18)	0.81 (0.52-1.25)
	3rd quartile	44	24.9	0.82 (0.55-1.21)	0.93 (0.62-1.40)
	4th quartile	20	15.1	0.50 (0.30-0.83)	0.60 (0.35-1.04)
Medical diagnosis of disease
	Hypertension		0.996*
	Hypertension	88	23.1	1.00 (0.70-1.42)	1.07 (0.75-1.52)
	Arthritis/arthrosis/rheumatism		0.006*
	Arthritis/arthrosis/rheumatism	41	17.3	0.64 (0.44-0.92)	0.71 (0.49-1.04)
	Heart disease		0.008*
	Heart disease	46	30.9	1.52 (1.07-2.17)	1.58 (1.11-2.26)
	Diabetes mellitus		0.373*
	Diabetes mellitus	35	25.9	1.16 (0.79-1.71)	1.16 (0.79-1.71)
	Lung disease		0.099*
	Lung disease	21	30.9	1.41 (0.88-2.24)	1.37 (0.86-2.19)
	Cancer		0.957*
	Cancer	13	22.8	0.99 (0.56-1.75)	1.00 (0.56-1.78)
	Stroke		0.998*
	Stroke		23.1	1.00 (0.55-1.81)	0.95 (0.52-1.72)
Frailty			<0.001*
	Non-frail	39	17.5	1	1
	Pre-frail	119	27.7	1.59 (1.10-2.28)	1.53 (1.06-2.20)
	Frail	34	38.2	2.18 (1.38-3.46)	1.74 (1.09-2.79)
Instrumental activities of daily living			<0.001*
	Independent	74	18.2	1	1
	Dependent (partial or total)	60	34.1	1.87 (1.33-2.63)	1.61 (1.13-2.29)
Indicator of social involvement			<0.001*
	0 to 1	45	33.8	1	1
	2	52	39.1	0.82 (0.55-1.23)	0.83 (0.56-1.24)
	3 or 4	36	27.1	0.46 (0.29-0.71)	0.51 (0.33-0.79)

Variables		1^st step*	p-value	2^nd step*	p-value
Variables		Adjusted RR (95%CI)	p-value	Adjusted RR (95%CI)	p-value
Sex
	Male	1		1
	Female	0.69 (0.50-0.96)	0.028	0.64 (0.43-0.95)	0.027
Age group (years)
	65 to 69	1		1
	70 to 74	1.08 (0.69-1.70)	0.729	1.01 (0.59-1.74)	0.958
	75 or more	2.06 (1.39-3.06)	< 0.001	1.94 (1.20-3.12)	0.007
Family income (quartiles)#
	1st quartile	1		1
	2nd quartile	0.76 (0.49-1.18)	0.222	0.88 (0.53-1.46)	0.620
	3rd quartile	0.84 (0.57-1.26)	0.411	0.87 (0.52-1.45)	0.598
	4th quartile	0.50 (0.30-0.83)	0.007	0.51 (0.27-0.96)	0.037
Heart disease
	No			1
	Yes			1.55 (1.03-2.34)	0.036
Instrumental activities of daily living
	Independent			1
	Dependent (partial or total)			1.66 (1.11-2.47)	0.013
Indicator of social involvement (number of AADL)
	0 to 1			1
	2			0.91 (0.58-1.43)	0.690
	3 or more			0.53 (0.32-0.87)	0.013

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[1] Collaborations

PMSB Francisco guided the study proposal, analysis, data interpretation, text writing and final critical review. D Assumpção performed the analysis, data interpretation, text writing and final critical review. FSA Borim contributed to the literature review and critical review of the final version of the article. MS Yassuda participated in the data collection and critical review of the final version of the article. AL Neri carried out the conception of the FIBRA Study, data collection and critical review of the final version.