Inequalities in basic activities of daily living among older adults: ELSI-Brazil, 2015

Andrade, Fabíola Bof de; Duarte, Yeda Aparecida de Oliveira; Souza Junior, Paulo Roberto Borges de; Torres, Juliana Lustosa; Lima-Costa, Maria Fernanda; Andrade, Flavia Cristina Drumond

doi:10.11606/S1518-8787.2018052000617

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Sumário

Supplement ELSI-Brazil, Original Article • Rev. Saúde Pública 52 (Suppl 2) • 2018 • https://doi.org/10.11606/S1518-8787.2018052000617 copy

Inequalities in basic activities of daily living among older adults: ELSI-Brazil, 2015

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To evaluate the magnitude of wealth-related inequalities in basic activities of daily living among community-dwelling Brazilian older adults and to determine the contribution of demographic, socioeconomic, and health conditions to the inequality.

METHODS

We used data from the 2015 Brazilian Longitudinal Study of Aging (ELSI-Brazil) with a nationally representative sample of adults aged 50 years or older. We assessed wealth-related inequalities in basic activities of daily living by the concentration index. Concentration index was decomposed to determine the contribution of demographic, health, and socioeconomic factors to wealth-related inequalities in basic activities of daily living.

RESULTS

The prevalence of disability in the sample was 15.7% (95%CI 14.9–17.6). The concentration index was -0.145 (95%CI -0.194– -0.097), which indicates that disability is concentrated in the poorest individuals in Brazil. Inequalities in basic activities of daily living disability are primarily explained by socioeconomic status (wealth and own education) not by demographic or health factors.

CONCLUSIONS

There are avoidable wealth-related inequities for those with a disability in Brazil. The strong contribution of the socioeconomic status highlights the need for new public health policies that promote equity, universality, and integrality, in addition to the expansion of home nursing public services.

Aged; Activities of Daily Living; Disabled Persons; Socioeconomic Factors; Health Inequalities

Variable	Total	No BADL	BADL	p
Unweighted sample size	8,642	7,175	1,467
Age
50–59	48.4	50.0	39.8	< 0.0001
60–69	29.6	30.2	26.7
≥ 70	21.9	19.8	33.5
Sex				0.1120
Female	46.5	47.0	43.6
Male	53.5	53.0	56.4
Own education (years of schooling)				< 0.0001
0–3	32.3	29.9	45.2
4–7	31.1	31.0	31.7
8–11	28.0	29.5	19.7
≥ 12	8.7	9.6	3.4
Parental education				< 0.0001
No formal education	49.8	48.2	58.6
Incomplete primary school	22.2	22.4	21.6
Complete primary school or more	28.0	29.5	19.7
Wealth quintile				< 0.0001
1 (poorest)	19.8	18.9	24.2
2	20.0	19.0	25.1
3	19.7	19.4	21.3
4	20.3	20.7	18.2
5 (wealthiest)	20.3	22.0	11.3
Number of health conditions				< 0.0001
0–1	63.9	68.2	41.1
≥ 2	36.1	31.8	58.9

Variable	Disability

	CCI	%	CI
Age (years)
50–59 (reference)
60–69	0.000	-0.1	-0.005
≥ 70	-0.006	4.2	-0.095
Female	0.000	-0.3	-0.032

(1) Total demographic factors	-0.006	3.8

Number of health conditions
0–1 (reference)
≥ 2	0.003	-2.0	0.010

(2) Total health factors	0.003	-2.0

(3) Total demographic and health (1) + (2)	-0.003	1.8

Wealth
1 – poorest (reference)
2	-0.002	1.4	-0.405
3	0.000	-0.1	-0.009
4	-0.010	7.1	0.391
5 – wealthiest	-0.064	43.9	0.797
Parental education
No formal education (reference)
Incomplete primary school	0.000	0.1	0.023
Complete primary school or more	-0.007	5.1	0.304
Own education (years)
0–3 (reference)
4–7	0.003	-1.9	-0.043
8–11	-0.026	17.9	0.272
≥ 12	-0.027	18.7	0.581

(4) Total SES	-0.134	92.2

(5) Total (3) + (4)	-0.137	94.0

(6) Error	-0.009	6.0

(7) Total CI (5) + (6)		100	-0.145
95%CI			(-0.194– -0.097)

HI (7) - (3)			-0.143
95%CI			(-0.189– -0.097)

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E-mail: revsp@usp.br

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[1] Correspondence: Fabíola Bof de Andrade. Av. Augusto de Lima, 1715 Barro Preto 30190-002 Belo Horizonte, MG, Brasil E-mail: fabiola.andrade@minas.fiocruz.br