Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China: A Population-Based Cohort Study
The vital status of 12,373 people aged 65 years and over was determined 3â€“5 years after baseline survey in sites in Latin America, India, and China. Crude and standardised mortality rates are reported, standardized mortality ratios comparing mortality experience with that in the United States, and estimated associations with socioeconomic factors using Coxâ€™s proportional hazards regression. Cause-specific mortality fractions were estimated using the InterVA algorithm. Crude mortality rates varied from 27.3 to 70.0 per 1,000 person-years, a 3-fold variation persisting after standardisation for demographic and economic factors. Compared with the US, mortality was much higher in urban India and rural China, much lower in Peru, Venezuela, and urban Mexico, and similar in other sites. Mortality rates were higher among men, and increased with age. Adjusting for these effects, it was found that education, occupational attainment, assets, and pension receipt were all inversely associated with mortality, and food insecurity positively associated. Mutually adjusted, only education remained protective (pooled hazard ratio 0.93, 95% CI 0.89â€“0.98). Most deaths occurred at home, but, except in India, most individuals received medical attention during their final illness. Chronic diseases were the main causes of death, together with tuberculosis and liver disease, with stroke the leading cause in nearly all sites. [Plos Research article]. URL:[http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001179].
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