Social determinants of death among the elderly: a
               systematic literature review

We searched articles published in Portuguese, English and Spanish language periodicals from January 1^st 2007 to December 31^st 2009, by means of Lilacs and Pubmed databases. Twenty cohort studies were identified, having most of them been developed in European, North-American and Asian countries.

RESULTS:

The articles analysed provided determinant social factors significantly associated with the elderly mortality: urban/rural and intercontinental variation, be part of ethnic minorities, financial stress, living conditions, schooling, social participation, gender and race discrimination, smoking, alcoholism, physical activities, instrumental activities of daily living, leisure, marital status, equality and healthy lifestyle.

CONCLUSION:

Mortality amongst the elderly is influenced by social determinants in many levels of reach, from determinants linked to lifestyle to socioeconomic macro-determinants. The actions on these determinants must be guided by the intersectorial perspective and regarded as a priority in the health sector, seeking to provide extended longevity with good quality of life for the population.

Aged; Mortality; Socioeconomic factors; Social conditions; Social determinants of health; Review

Author (year of publication)	Country	NOS Score	Age range	Sample	Social determinants analyzed
Bowling e Grundy (2009)²⁸	England	7	65 and over	1,384	Social participation
Johnson e Langford (2009)²⁹	England	8	65 and over	2,225	Smoking, alcohol, possession of property
Khaw et al. (2008)³⁰	United Kingdom	6	45 to 79	20,244	Healthy behavior
Sampson et al. (2009)³¹	United Kingdom	8	75 and over	10,720	Social engagement
Happonen et al. (2008)³²	Finland	7	70 and over	817	Daily consumption of coffee
Cesari et al. (2008)³³	Italy	7	80 and over	335	Physical functions: ADL, IADL
Landi et al. (2008)³⁴	Italy	7	80 and over	248	Physical activity
Scafato et al. (2008)³⁵	Italy	8	65 to 84	5,376	Marital status and cohabitation status
Agahi e Parker (2008)³⁶	Sweden	7	65 to 95	1,246	Leisure activities
Byberg et al. (2009)³⁷	Sweden	7	50 to 82	2,205	Physical activity
Hult et al. (2009)³⁸	Sweden	7	65 to 72	24,369	Retirement Age
Baker et al. (2008)³⁹	United States	7	65 and over	3,260	Health education
Barnes et al. (2008⁾⁴⁰	United States	7	65 and over	4,154	Perceived discrimination
Szanton et al. (2008)⁴¹	United States	7	70 to 79	728	Financial hardship/stress
Fujisawa et al. (2008)⁴²	Japan	7	80 and over	690	Smoking
Tamakoshi et al. (2009)⁴³	Japan	7	40 and over	62,106	Healthy lifestyle factors
Yorifuji et al. (2009)⁴⁴	Japan	7	65 to 84	13,444	Air pollution
Jaffe et al. (2009)⁴⁵	Israel	7	45 to 89	134,555	Continent of origin, years of education, number of bedrooms, parity
Fantahun et al. (2009)⁴⁶	Ethiopia	6	65 and over	2,231	Urban and rural environment, literacy status and widowhood
Jatrana e Blakely (2008)⁴⁷	New Zealand	7	65 and over	1,3 million	Ethnic disparity

Study	Social determinant	Category	RR/HR (CI)
Yorifuji et al. (2009)	Air pollution: level of NO₂	Increase of 10 mg/m³ in the NO₂ level	HR = 1.02 (0.96 – 1.08)
Fantahun et al. (2009)	Urban and rural environment	Urban environment	HR = 1
		Rural environment	HR = 1.52 (1.41 – 1.64)
		Rural environment - Men	HR = 1.21 (1.07 – 1.37)
		Rural environment - Woman	HR = 1.68 (1.55 – 1.83)
Jaffe et al. (2009)	Continent of origin	Europe	HR = 1
		African - Men	HR = 1.20 (1.11 – 1.28)
		African - Women	HR = 1.10 (0.98 – 1.24)
		Asian - Men	HR = 0.94 (0.88 – 1.00)
		Asian - Women	HR = 0.87 (0.78 – 0.96)
Jatrana, Blakely (2008)	Ethnic disparity	Non-Maori, non-Pacific and non-Asian	RR = 1
		Maori - men	RR = 1.51 (1.40 – 1.63)
		Maori - women	RR = 1.78 (1.64 – 1.93)
		Pacific - men	RR = 1.41 (1.24 – 1.60)
		Pacific - women	RR =1.37 (1.20 – 1.57)
		Asian - men	RR = 0.60 (0.52 – 0.70)
		Asian - Women	RR = 0.76 (0.66 – 0.88)
Szanton et al. (2008)	Financial hardship/stress	For each unit of increase in financial stress	HR = 1.59 (1.16 – 2.16)

Study	Social determinant	Category	RR/HR (CI)*
Johnson, Langford (2009)	Possession of property	Own property	HR = 1
		Rented property	HR = 1.22 (1.07 – 1.39)
		Rented property - men	HR = 1.16 (0.96 – 1.41)
		Rented property - women	HR = 1.29 (1.08 – 1.54)
Jaffe et al. (2009)	Number of bedrooms	4.5 and more	HR = 1
		3.5 to 4 - men	HR = 1.13 (1.02 – 1.25)
		3.5 to 4 - women	HR = 1.20 (1.00 – 1.43)
		3 - men	HR = 1.22 (1.10 – 1.34)
		3 - women	HR = 1.18 (0.99 – 1.40)
		1-2.5 - men	HR = 1.34 (1.22 – 1.48)
		1-2.5 - women	HR = 1.35 (1.13 – 1.60)
	Years of study	13 and over	HR = 1
		9 and 12 - men	HR = 1.14 (1.08 – 1.21)
		9-12 - women	HR = 1.18 (1.07 – 1.30)
		0-8 - men	HR = 1.33 (1.25 – 1.40)
		0-8 - women	HR = 1.51 (1.37 – 1.66)
Fantahun et al. (2009)	Literacy	Literate	HR = 1
		Illiterate	HR = 1.84 (1.55 – 2.20)
		Illiterate - men	HR = 2.26 (1.86 – 2.73)
		Illiterate - women	HR = 1.28 (0.99 – 1.64)
Baker et al. (2008)	Health education	Appropriate	HR = 1
		Marginal	HR = 1.08 (0.85 – 1.36)
		Inappropriate	HR = 1.27 (1.03 – 1.57)
Hult et al. (2009)	Retirement Age	60 and over vs. 59 and under	HR = 1.02 (0.78 – 1.34)
Bowling, Grundy (2009)	Social participation
	Artistic activities	No	HR = 1
	Artistic activities	Yes	HR = 0.85 (0.75 – 0.97)
	Visiting friends or family	No	HR = 1
	Visiting friends or family	Yes	HR = 0.85 (0.75 – 0.97)
	Social activities (club, church, bar)	No	HR = 1
	Social activities (club, church, bar)	Yes	HR = 0.87 (0.77 – 0.88)
Sampson et al. (2009)	Social engagement	High	HR = 1
		Medium	HR = 1.09 (1.02 – 1.16)
		Low	HR = 1.17 (1.05 – 1.29)
Barnes et al. (2008)	Discrimination (race and gender)	Never	HR = 1
		Always or sometimes	HR = 1.05 (1.01 – 1.09)
		Always or sometimes – black	HR = 1.03 (0.99 – 1.07)
		Always or sometimes – white	HR = 1.12 (1.04 – 1.20)

Study	Social determinant	Category	RR/HR (CI/p-value)*
Fujisawa et al. (2008)	Smoking	Non-smoker	HR = 1
		Current smoker – men	HR = 2.3 (1.0 – 5.2)
		Current smoker – women	HR = 4.2 (1.9 – 9.5)
Johnson, Langford (2009)	Smoking	Non-smoker	HR = 1
		Frequent smoker – men	HR = 1.64 (1.30 – 2.06)
		Frequent smoker – women	HR = 1.98 (1.07 – 1.13)
	Alcohol	Insignificant consumption	HR = 1
		Moderate consumption – men	HR = 0.80 (0.66 – 0.98)
		Moderate consumption - women	HR = 0.74 (0.61 – 0.98)
		Heavy consumption – men	HR = 1.00 (0.77 – 1.32)
		Heavy consumption – women	HR = 0.55 (0.35 – 0.87)
Landi et al. (2008)	Physical activity	Sedentary	HR = 1
Landi et al. (2008)	Physical activity	Active	HR = 0.36 (0.12 – 0.98)
Byberg et al. (2009)	Physical activity	High	HR = 1
		Medium	HR = 1.14 (1.01 – 1.28)
		Low	HR = 1.13 (0.96 – 1.33)
Cesari et al. (2008)	Physical function: IADL **	Totally dependent	HR = 1
Cesari et al. (2008)	Physical function: IADL **	Totally independent	HR = 0.70 (0.50 – 0.99)
Agahi, Parker (2008)	Leisure activities	6 activities or more	HR = 1
		1 activity	HR = 2.2 (p < 0.001)
		2 activities	HR = 1.8 (p < 0.001)
		3 activities	HR = 1.5 (p < 0.01)
		4 activities	HR = 1.4 (p < 0.05)
		5 activities	HR = 1.3
Tamakoshi et al. (2009)	6 healthy life factors	0 to 2 factors	HR = 1
		3 factors – men	HR = 0.79 (0.73 – 0.85)
		3 factors – women	HR = 0.83 (0.73 – 0.95)
		4 factors – men	HR = 0.71 (0.65 – 0.77)
		4 factors – women	HR = 0.74 (0.65 – 0.84)
		5 factors – men	HR = 0.56 (0.49 – 0.63)
		5 factors – women	HR = 0.59 (0.51 – 0.68)
		6 factors – men	HR = 0.40 (0.28 – 0.55)
		6 factors – women	HR = 0.52 (0.40 – 0.67)
Khaw et al. (2008)	Healthy behavior	4 behaviors	HR = 1
		3 behaviors	HR = 1.51 (1.29 – 1.77)
		2 behaviors	HR = 2.06 (1.75 – 2.41)
		1 behavior	HR = 2.68 (2.22 – 3.23)
		No behavior	HR = 3.58 (2.51 – 5.11)
Fantahun et al. (2009)	Widowhood	Not a widower	HR = 1
		Widowed - men	HR = 2.02 (1.59 – 2.57)
		Widowed - women	HR = 1.23 (1.04 – 1.46)
Scafato et al. (2008)	Marital status	Married	HR = 1
		Unmarried - men	HR = 1.25 (1.03 – 1.52)
		Unmarried - women	HR = 0.98 (0.76 – 1.25)
	Cohabitation status	Doesn’t live alone	HR = 1
		Lives alone – men	HR = 1.42 (1.05 – 1.92)
		Lives alone – women	HR = 1.05 (0.81 – 1.35)
Jaffe et al. (2009)	Parity	2 children	HR = 1
		Childless - men	HR = 1.14 (1.02 – 1.22)
		Childless - women	HR = 1.25 (1.11 – 1.41)
		1 child - men	HR = 1.11 (1.05 – 1.18)
		1 child - women	HR = 1.19 (1.09 – 1.30)
		3-4 children - men	HR = 0.97 (0.92 – 1.03)
		3-4 children - women	HR = 0.96 (0.88 – 1.04)
		5-7 children - men	HR = 1.11 (1.03 – 1.20)
		5-7 children - women	HR = 0.97 (0.85 – 1.11)

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[1] Corresponding author: Vanessa de Lima Silva. Avenida Moraes Rego, s/n, Cidade Universitária , CEP: 50670-420, Recife, PE, Brasil. E-mail: vanelima@gmail.com