Contribution of chronic diseases to the prevalence of disability in basic and instrumental activities of daily living in elderly Brazilians: the <i>National Health Survey</i> (2013)

Costa Filho, Antônio Macêdo; Mambrini, Juliana Vaz de Melo; Malta, Deborah Carvalho; Lima-Costa, Maria Fernanda; Peixoto, Sérgio Viana

doi:10.1590/0102-311X00204016

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ARTICLE • Cad. Saúde Pública 34 (1) • 2018 • https://doi.org/10.1590/0102-311X00204016 copy

Contribution of chronic diseases to the prevalence of disability in basic and instrumental activities of daily living in elderly Brazilians: the National Health Survey (2013)

Contribuição das doenças crônicas na prevalência da incapacidade para as atividades básicas e instrumentais de vida diária entre idosos brasileiros: Pesquisa Nacional de Saúde (2013)

Contribución de enfermedades crónicas a la prevalencia de incapacidad en actividades básicas e instrumentales de la vida diaria entre ancianos brasileños: Encuesta Nacional de Salud (2013)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

This study’s objective was to assess the contribution of selected chronic diseases to the prevalence of disability in elderly Brazilians, based on data from the National Health Survey (PNS 2013). Disability was defined as some degree of difficulty in performing ten activities, considering three levels: (i) without disability; (ii) disabled only in some instrumental activity of daily living (IADL); and (iii) disabled in some basic activity of daily living (BADL). The multinomial additive hazards model was the attribution method used to assess the contribution of each self-reported chronic condition (hypertension, diabetes, arthritis, stroke, depression, heart disease, and lung disease) to the prevalence of disability in this population, stratified by sex and age bracket (60 to 74 years and 75 or older). Study participants included 10,537 elderly Brazilians with a mean age of 70.0 years (SD = 7.9 years) and predominance of women (57.4%). Prevalence rates for disability in at least one IADL and at least one BADL were 14% (95%CI: 12.9; 15.1) and 14.9% (95%CI: 13.8; 16.1), respectively. In general, the contribution of chronic diseases to prevalence of disability was greater in younger elderly (60 to 74 years) and in the group with greatest severity (disabled in BADL), highlighting the relevance of stroke and arthritis in men, and arthritis, hypertension, and diabetes in women. This knowledge can help orient health services to target specific groups, considering age, sex, and current illnesses, aimed at preventing disability in the elderly.

Keywords:
Disabled Persons; Chronic Disease; Aging

Variables	Total (%)	95%CI	60-74 years		75+ years
Variables	Total (%)	95%CI	%	95%CI	%	95%CI
Men
Disability
With disability	74.9	72.4; 77.2	81.3	78.6; 83.8	55.5	49.7; 60.1
Disabled in IADL	11.4	9.8; 13.3	8.3	6.7; 10.1	21.0	16.9; 25.7
Disabled in BADL	13.6	11.9; 15.6	10.4	8.5; 12.6	23.5	19.4; 28.3
Chronic diseases
Arthritis	10.1	8.3; 12.2	9.7	7.7; 12.1	11.2	8.0; 15.4
Hypertension	47.6	44.7; 50.5	46.3	42.9; 49.6	51.4	46.0; 56.8
Diabetes	17.3	15.1; 19.7	17.0	14.4; 19.9	18.2	14.3; 22.8
Stroke	6.3	5.0; 7.8	5.1	3.8; 6.9	9.8	7.0; 13.5
Depression	4.9	3.7; 6.6	5.4	3.8; 7.6	3.5	2.0; 5.9
Lung disease	4.2	3.1; 5.6	3.9	2.7; 5.7	4.8	3.0; 7.7
Heart disease	13.1	11.0; 15.6	12.2	9.9; 15.0	16.0	12.0; 20.1
Women
Disability
With disability	68.1	66.2; 70.1	77.5	75.4; 79.5	41.2	37.3; 45.3
Disabled in IADL	15.9	14.4; 17.5	11.2	9.7; 12.9	29.5	25.7; 33.4
Disabled in BADL	15.9	14.5; 17.5	11.2	9.8; 12.8	29.3	25.9; 33.0
Chronic diseases
Arthritis	22.1	20.4; 24.0	20.9	19.0; 23.0	25.6	22.1; 29.4
Hypertension	55.8	53.5; 58.1	54.1	51.5; 56.8	60.6	56.3; 64.7
Diabetes	20.4	18.7; 22.2	19.7	17.8; 21.7	22.3	19.0; 26.0
Stroke	4.2	3.5; 5.1	3.7	2.9; 4.7	5.9	4.5; 7.8
Depression	13.6	12.0; 15.3	14.9	13.0; 16.9	9.9	7.6; 12.7
Lung disease	3.6	2.8; 4.5	3.4	2.5; 4.7	3.9	2.7; 5.6
Heart disease	10.9	9.7; 12.4	10.3	8.8; 12.1	12.8	10.5; 15.4

Variables	Prevalence of disability (%)
	60-74 years				75+ years
	IADL	95%CI	BADL	95%CI	IADL	95%CI	BADL	95%CI
Men
Arthritis	11.9	6.6; 20.4	27.0	17.0; 40.0	21.8	12.0; 36.3	35.6	22.4; 51.6
Hypertension	9.2	7.0; 12.0	13.1	10.1; 16.9	22.1	16.6; 28.7	23.9	18.2; 30.8
Diabetes	10.2	6.6; 15.4	12.3	8.5; 17.5	16.1	9.6; 25.7	31.6	21.7; 43.5
Stroke	16.8	8.1; 31.7	46.6	32.6; 61.1	19.5	10.5; 33.3	70.2	55.6; 81.5
Depression	8.4	4.0; 16.5	26.3	12.9; 46.3	25.1	10.2; 49.7	21.8	8.1; 46.7
Lung disease	11.5	3.5; 32.2	30.6	14.4; 53.6	16.5	7.3; 33.2	40.4	21.3; 63.0
Heart disease	13.1	7.9; 21.1	15.9	10.0; 24.2	25.2	15.9; 37.4	29.6	18.5; 43.8
Women
Arthritis	10.8	8.4; 13.8	18.9	15.2; 23.3	27.2	21.2; 34.0	40.7	33.0; 49.0
Hypertension	12.5	10.6; 14.8	14.7	12.4; 17.2	29.6	25.2; 34.4	30.4	26.0; 35.1
Diabetes	12.2	9.5; 15.5	18.1	14.2; 22.9	29.8	22.4; 38.5	37.9	29.1; 47.4
Stroke	15.3	8.9; 25.1	34.6	23.5; 47.8	24.8	15.0; 38.3	59.2	45.6; 71.5
Depression	17.2	12.2; 23.7	14.3	10.2; 19.6	37.0	24.8; 51.0	35.8	25.2; 48.0
Lung disease	17.2	8.9; 30.7	12.9	6.2; 25.1	26.1	13.8; 43.8	44.2	27.0; 62.9
Heart disease	20.8	15.0; 28.0	19.3	14.1; 25.9	31.8	23.3; 41.6	43.3	33.7; 53.4

Chronic diseases	Disability in IADL				Disability in BADL
	Coefficient	95%CI	Relative contribution (%)		Coefficient	95%CI	Relative contribution (%)
	Coefficient	95%CI	60-74 years	75+ years			60-74 years	75+ years
Men
Background	-	-	75.77	87.14	-	-	46.51	57.87
Arthritis	0.04 *	0.01; 0.07	3.81	1.96	0.20 *	0.18; 0.23	14.38	8.50
Hypertension	0.01	-0.01; 0.01	6.09	3.02	0.01	-0.04; 0.03	4.78	2.59
Diabetes	-0.002	-0.01; 0.02	-0.52	-0.22	0.03 *	0.01; 0.04	5.03	2.90
Stroke	0.18 *	0.15; 0.22	5.59	3.07	0.81 *	0.79; 1.05	20.49	22.62
Depression	0.01	-0.04; 0.04	0.95	0.33	0.01 *	0.00; 0.08	0.71	0.23
Lung disease	-0.03	-0.06; 0.07	-1.20	-0.64	0.15*	0.01; 0.21	4.46	3.05
Heart disease	0.07	-0.01; 0.10	9.5	5.31	0.04	-0.01; 0.08	3.60	2.22
Women
Background	-	-	73.17	90.79	-	-	27.26	69.86
Arthritis	-0.01	-0.03; 0.02	-2.35	-0.95	0.11 *	0.09; 0.14	17.51	7.31
Hypertension	0.01 *	0.01; 0.02	6.56	2.72	0.05 *	0.05; 0.06	20.10	7.58
Diabetes	0.01	-0.01; 0.00	1.45	0.57	0.09 *	0.07; 0.15	13.77	5.15
Stroke	0.07 *	0.01; 0.17	1.47	0.67	0.42 *	0.35; 0.51	8.73	5.43
Depression	0.08 *	0.01; 0.12	8.92	2.01	0.04	-0.00; 0.04	4.33	0.90
Lung disease	0.05	-0.01; 0.06	1.42	0.45	0.01	-0.11; 0.17	0.30	0.12
Heart disease	0.13 *	0.06; 0.16	9.34	3.71	0.13 *	0.08; 0.14	7.96	3.60

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[1] * Correspondence S. V. Peixoto Instituto René Rachou, Fundação Oswaldo Cruz. Av. Augusto de Lima 1715, Belo Horizonte, MG 30190-002, Brasil. sergio@cpqrr.fiocruz.br