Home-based gait speed and the association with sociodemographic and anthropometric variables: A national study (ELSI-Brazil).

OBJECTIVES: To investigate home-based gait speed performance for men and women stratified by age group and its associations with sociodemographic and anthropometric variables. METHODS: Data from the 2nd wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2019-2021) were used. Gait speed was tested twice at home over 3.0 meters at usual pace. Associations of sociodemographic and anthropometric variables with gait speed were evaluated using gamma regression. RESULTS: Median gait speed value reduced with increasing age in both sexes [men: 0.70 m/s (50-59 years) to 0.53 m/s (≥80 years); women: 0.68 m/s (50-59 years) to 0.48 m/s (≥80 years)] and was significantly lower in women than men in the age groups of 60-69 and 70-79 years. Age group and education among men and age group, education, and waist circumference among women were significantly associated with gait speed. CONCLUSIONS: Our findings may be helpful as reference values to identify mobility limitation among older Brazilians.

Loneliness and social disconnectedness in the time of pandemic period among Brazilians: evidence from the ELSI COVID-19 initiative.

Objectives: This study aimed at estimating the pre-pandemic and pandemic prevalence of loneliness and investigating the association of loneliness with social disconnectedness during social distancing strategies in the time of the COVID-19 pandemic period.Methods: We used data from the ELSI COVID-19 initiative with participants from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), which comprised 4,431 participants aged 50 years and over. Loneliness (hardly ever/some of the time/often) was assessed by the question "In the past 30 days, how often did you feel alone/lonely?". Social disconnectedness included information on social contacts through virtual talking (i.e. telephone, Skype, WhatsApp, or social media) and outside-home meetings with people living in another household. Covariates included sociodemographic and health related characteristics. Multinomial logistic regression models were used to estimate odds ratios (OR) with their 95% confidence interval (CI).Results: The overall prevalence of loneliness during the pandemic was 23.9% (95% CI 20.7-27.5); lower than in the pre-pandemic period (32.8%; 95% CI 28.6-37.4). In the pandemic period, 20.1% (95% CI 16.9-23.6) reported some of the time feeling lonely and 3.9% (95% CI 3.1-4.8) reported often feeling lonely. In the fully adjusted model, virtual talking disconnectedness (OR=1.67; 95% CI 1.09-2.56) was positively associated with some of the time feeling lonely and outside-home disconnectedness (OR=0.33; 95% CI 0.18-0.60) was negatively associated with often feeling lonely.Conclusion: Individuals with virtual talking disconnectedness and without outside-home disconnectedness are at higher risk of loneliness during the time of COVID-19 pandemic. Stimulating virtual talking connectedness might have the potential to diminish loneliness despite steep outside-home disconnectedness.

Perceived Neighborhood and Walking Among Older Brazilian Adults Living in Urban Areas: A National Study (ELSI-Brazil).

The study goal was to examine the association between perceived neighborhood characteristics and walking in urban older adults in Brazil. A cross-sectional study including 4,027 older adults from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) was performed. Walking was measured using the International Physical Activity Questionnaire. Neighborhood characteristics were questions about physical disorder, noise pollution, safety, violence, social cohesion, services, concerns with community mobility, and pleasantness. Multinomial logistic regression was used. Concern about taking the bus, subway, or train was inversely associated with walking for men. Violence (victim of theft, robbery, or had home broken into) and social cohesion (trust in neighbors) were positively and inversely associated with walking for women, respectively. A significant interaction term between social cohesion and number of chronic diseases was observed for women. These findings demonstrate the need for sex-specific interventions and policies to increase the walking levels among older Brazilian adults.

Who are the sexual and gender minorities who frequently interact with children and their association with healthcare. / Quem são as minorias sexuais e de gênero que convivem frequentemente com filhos(as) e sua associação a cuidados em saúde.

This study aimed to examine the sociodemographic profile of sexual and gender minorities who regularly interact with children and investigate whether such frequent interactions are associated with healthcare factors. This cross-sectional study utilized data from the LGBT+ Health Survey in Brazil, conducted online and anonymously from August to November 2020 with 958 participants. Regular interaction with children was defined as living with children or engaging in bi-weekly face-to-face meetings with children residing in different households. Healthcare factors encompass having a professional or reference service, feeling comfortable in discussing personal issues, and receiving worse quality medical or hospital care. The statistical analysis used the Poisson regression with robust variance. The prevalence of interaction with children was 5.3%. We observed a statistically higher prevalence among cisgender women (13.4%) and Black/brown and other non-white people (7.9%) after adjusting for age. The results showed a positive association only between regular interaction with children and worse-quality medical or hospital care received (PR=6.00; 95%CI 1.22-29.67). These findings highlight a persistent stigma and prejudice within healthcare services.

Objetivou-se analisar as características sociodemográficas das minorias sexuais e de gênero que convivem frequentemente com filhos(as) e verificar se existe associação entre convívio frequente com filhos(as) e os cuidados em saúde. Trata-se de um estudo transversal com dados do inquérito de saúde LGBT+, realizado no Brasil em 2020 (agosto-novembro) de forma on-line e anônima, totalizado 958 participantes. O convívio frequente com filhos(as) foi avaliado pela moradia com filhos(as) ou encontros presenciais quinzenais com filhos(as) que moram em outro domicílio. Os cuidados em saúde incluíram ter um profissional ou serviço de referência, sentir-se à vontade para contar seus problemas e receber tratamento médico ou hospitalar de pior qualidade. A regressão de Poisson com variância robusta foi usada na análise estatística. A prevalência de convívio com filhos(as) foi de 5,3%. Após o ajuste por idade, verificou-se uma prevalência estatisticamente maior em mulheres cisgênero (13,4%) e entre pretos/pardos e outras raças/cores não brancas (7,9%). Observou-se que o convívio frequente com filhos(as) foi positivamente associado apenas a receber tratamento médico ou hospitalar de pior qualidade (RP=6,00; IC95% 1,22-29,67). Esses achados destacam que ainda há estigma/preconceito nos serviços de saúde.

[Sociodemographic characteristics associated with underweight and overweight in adults aged 50 years and over (ELSI-Brasil): differences between sexes]. / Características sociodemográficas associadas ao baixo peso e ao excesso de peso em adultos com 50 anos ou mais (ELSI-Brasil): diferenças entre sexos.

The objective were to describe the prevalence of underweight and overweight, assessed by body mass index (BMI), stratified by sex and age group, and to analyze the sociodemographic characteristics associated with BMI in older women and men. This is a cross-sectional analysis of 8,974 participants aged ≥ 50 years from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brasil, 2015-2016). BMI was classified as underweight, eutrophy, and overweight according to the participant's age. A multinomial logistic regression model was used, considering the sociodemographic characteristics of women and men. The results showed a higher prevalence of overweight in women compared to men (64.1% vs. 57.3%). In both sexes, the prevalence of underweight was higher in the longest-lived individuals, while overweight was lower. In women, the chance of underweight was higher than the chance of eutrophy in those who were single/widowed/divorced (OR = 1.95; 95%CI: 1.42-2.66) and in those living in rural areas (OR = 1.58; 95%CI: 1.01-2.49), while the chance of being overweight was lower than the chance of being eutrophy in those living in rural areas (OR = 0.78; 95%CI: 0.62-0.97) and in all geographic macro-regions related to the South Region. For men, the chance of being overweight was lower than the chance of being eutrophy among single/widowed/divorced individuals (OR = 0.58; 95%CI: 0.48-0.69). The richest had a lower chance of being underweight (OR = 0.59; 95%CI: 0.38-0.90), as well as a higher chance of being overweight (OR = 1.52; 95%CI: 1.20-1.92). In conclusion, the sociodemographic characteristics associated with BMI differed between the sexes.

Os objetivos foram descrever a prevalência de baixo peso e excesso de peso, avaliados pelo índice de massa corporal (IMC), estratificada por sexo e faixa etária, e analisar as características sociodemográficas associadas ao IMC em mulheres e homens mais velhos. Trata-se de uma análise transversal de 8.974 participantes com ≥ 50 anos da linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil, 2015-16). O IMC foi classificado em baixo peso, eutrofia e excesso de peso de acordo com a idade do participante. Foi utilizado modelo de regressão logística multinominal, considerando-se as características sociodemográficas de mulheres e homens. Os resultados evidenciaram maior prevalência de excesso de peso nas mulheres em comparação aos homens (64,1% vs. 57,3%). Em ambos os sexos, a prevalência de baixo peso foi maior nos mais longevos, enquanto que o excesso de peso foi menor. Nas mulheres, a chance de baixo peso foi maior do que a chance de eutrofia naquelas solteiras/viúvas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) e nas residentes na área rural (OR = 1,58; IC95%: 1,01-2,49), ao passo que a chance de excesso de peso foi menor do que a chance de eutrofia nas residentes na área rural (OR = 0,78; IC95%: 0,62-0,97) e em todas as macrorregiões geográficas relativas à Região Sul. Para os homens, a chance de excesso de peso foi menor do que a chance de eutrofia entre solteiros/viúvos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Os mais ricos apresentaram menor chance de baixo peso (OR = 0,59; IC95%: 0,38-0,90), bem como maior chance de excesso de peso (OR = 1,52; IC95%: 1,20-1,92). Em conclusão, as características sociodemográficas associadas ao IMC diferiram entre os sexos.

Los objetivos fueron describir la prevalencia de bajo peso y sobrepeso, evaluados a través del índice de masa corporal (IMC), estratificada por sexo y grupo de edad, y analizar las características sociodemográficas asociadas al IMC en mujeres y hombres mayores. Se trata de un análisis transversal de 8.974 participantes con ≥ 50 años de la línea de base del Estudio Longitudinal Brasileño sobre el Envejecimiento (ELSI-Brasil, 2015-2016). Se clasificó el IMC en bajo peso, eutrofia y sobrepeso conforme la edad del participante. Se utilizó el modelo de regresión logística multinomial, teniendo en cuenta las características sociodemográficas de mujeres y hombres. Los resultados evidenciaron una prevalencia más alta de sobrepeso en las mujeres en comparación con los hombres (64,1% vs. 57,3%). En ambos sexos, la prevalencia de bajo peso fue más alta en los grupos de mayor edad, mientras que la prevalencia del sobrepeso fue menor. La chance de bajo peso fue más alta que la chance de eutrofia en las mujeres solteras/viudas/divorciadas (OR = 1,95; IC95%: 1,42-2,66) y en las que viven en el área rural (OR = 1,58; IC95%: 1,01-2,49), mientras que la chance de sobrepeso fue menor que la chance de eutrofia en las que viven en el área rural (OR = 0,78; IC95%: 0,62-0,97) y en todas las macrorregiones geográficas relacionadas a la región Sur. La chance de sobrepeso fue menor que la chance de eutrofia entre los hombres solteros/viudos/divorciados (OR = 0,58; IC95%: 0,48-0,69). Los más ricos presentaron una chance menor de bajo peso (OR = 0,59; IC95%: 0,38-0,90), así como una chance más alta de sobrepeso (OR = 1,52; IC95%: 1,20-1,92). En conclusión, las características sociodemográficas asociadas al IMC difirieron entre los sexos.

Age at natural menopause and its associated characteristics among Brazilian women: cross-sectional results from ELSI-Brazil.

OBJECTIVES: This study aimed to determine the median age at natural menopause and analyze lifestyle, anthropometric, and dietary characteristics associated with the age at natural menopause among Brazilian women. METHODS: This cross-sectional study involved 2,731 women 50 years and over, drawn from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil, 2015/16). Nonparametric Kaplan-Meier cumulative survivorship estimates were used to assess the median timing of natural menopause. Cox proportional hazards regression models were employed to estimate the associations between age at natural menopause and exposure variables. RESULTS: The overall median age at natural menopause was 50 years. In the adjusted Cox model, current smoking (hazard ratio [HR], 1.11; 95% CI, 1.01-1.23) and underweight (HR, 1.34; 95% CI, 1.12-1.61) were associated with earlier natural menopause. Conversely, performing recommended levels of physical activity in the last week (HR, 0.88; 95% CI, 0.80-0.97), being overweight (HR 0.86; 95% CI, 0.74-0.99), and adhering to two or three healthy eating markers (HR, 0.80; 95% CI, 0.66-0.97; HR, 0.76; 95% CI, 0.61-0.94, respectively) were associated with later age at natural menopause. Binge drinking and waist circumference were not associated with age at natural menopause. CONCLUSIONS: Lifestyle, anthropometric, and dietary characteristics are significant factors that affect the age at natural menopause. Our findings can contribute to public policies targeted at Brazilian women's health.

[Differences between men and women in the prevalence of frailty and associated factors among older adults: evidence from ELSI-Brazil]. / Diferenças entre homens e mulheres na prevalência da fragilidade e fatores associados entre adultos mais velhos: evidências do ELSI-Brasil.

Based on a national representative sample of the population aged 50 years or older, this study aimed to estimate the prevalence of frailty among men and women, identify associated sociodemographic and health factors, and estimate the population attributable fraction. Data from the second wave (2019-2021) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) were used. Frailty was classified based on the number of positive items among unintentional weight loss, exhaustion, low level of physical activity, slow gait, and weakness. The main analyses were based on multinomial logistic regression stratified by sex. The prevalence of frailty was lower in men (8.6%; 95%CI: 6.9; 10.7) than in women (11.9%; 95%CI: 9.6; 14.8), with the most frequent item being the low level of physical activity in both. Age and schooling level were the sociodemographic factors associated with pre-frailty and fragility among men and women. The population attributable fraction was different for frailty between genders. In men, the highest population attributable fraction was due to not having a partner (23.5%; 95%CI: 7.7; 39.2) and low schooling level (18.2%; 95%CI: 6.6; 29,7). In women, higher population attributable fraction values were due to memory deficit (17.1%; 95%CI: 7.6; 26.6), vision deficit (13.4%; 95%CI: 5.1; 21.7), and diabetes mellitus (11.4%; 95%CI: 4.6; 18,1). Similar population attributable fraction levels were observed for heart disease (8.9%; 95%CI: 3.8; 14.1 in women and 8.8%; 95%CI: 2.0; 15.6 in men). Strategies aimed at physical activity have the potential to prevent frailty in both men and women, and the prevention of chronic conditions is more important in women.

Este trabalho, baseado em amostra nacional representativa da população com 50 anos ou mais, objetivou estimar a prevalência da fragilidade entre homens e mulheres, identificar fatores sociodemográficos e de saúde associados e estimar a fração atribuível populacional. Foram utilizados dados da segunda onda (2019-2021) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). A fragilidade foi classificada pelo número de itens positivos entre perda de peso não intencional, exaustão, baixo nível de atividade física, lentidão da marcha e fraqueza. As análises principais foram baseadas na regressão logística multinomial estratificada por sexo. A prevalência da fragilidade foi menor nos homens (8,6%; IC95%: 6,9; 10,7) do que nas mulheres (11,9%; IC95%: 9,6; 14,8), sendo o item mais frequente o baixo nível de atividade física em ambos. A idade e a escolaridade foram os fatores sociodemográficos associados à pré-fragilidade e à fragilidade entre homens e mulheres. Houve diferença da fração atribuível populacional para fragilidade entre os sexos. Nos homens, a maior fração atribuível populacional foi para não ter companheiro (23,5%; IC95%: 7,7; 39,2) e escolaridade baixa (18,2%; IC95%: 6,6; 29,7). Nas mulheres, maiores frações atribuíveis populacionais foram para déficit de memória (17,1%; IC95%: 7,6; 26,6), déficit da visão (13,4%; IC95%: 5,1; 21,7) e diabetes mellitus (11,4%; IC95%: 4,6; 18,1). Observou-se fração atribuível populacional semelhante para doença cardíaca (8,9%; IC95%: 3,8; 14,1, em mulheres; e 8,8%; IC95%: 2,0; 15,6, em homens). Estratégias voltadas para a prática de atividade física têm o potencial de prevenir a fragilidade em ambos os sexos, enquanto a prevenção de condições crônicas é mais importante nas mulheres.

Este estudio tuvo por objetivo estimar, utilizando una muestra nacional representativa de la población de 50 años o más, la prevalencia de la fragilidad entre hombres y mujeres, identificar los factores sociodemográficos y de salud asociados, y calcular la fracción atribuible a la población. Se utilizaron datos de la 2ª ola (2019-2021) del Estudio Longitudinal de Salud de los Ancianos Brasileños (ELSI-Brasil). La fragilidad se clasificó por el número de elementos positivos entre pérdida de peso no intencional, agotamiento, bajo nivel de actividad física, marcha lenta y debilidad. Los principales análisis se basaron en la regresión logística multinomial estratificada por sexo. La prevalencia de fragilidad fue menor en los hombres (8,6%; IC95%: 6,9; 10,7) que en las mujeres (11,9%; IC95%: 9,6; 14,8), y como ítem más frecuente el bajo nivel de actividad física en ambos. La edad y el nivel educativo fueron los factores sociodemográficos asociados a la pre-fragilidad y la fragilidad entre hombres y mujeres. Hubo una diferencia en fracción atribuible a la población para la fragilidad entre los sexos. Entre los hombres, la fracción atribuible a la población más elevada fue no tener pareja (23,5%; IC95%: 7,7; 39,2) y bajo nivel educativo (18,2%; IC95%: 6,6; 29,7). Entre las mujeres, las fracción atribuible a la población más elevadas fueron déficit de memoria (17,1%; IC95%: 7,6; 26,6), déficit de visión (13,4%; IC95%: 5,1; 21,7) y diabetes mellitus (11,4%; IC95%: 4,6; 18,1). Se observaron fracción atribuible a la población similares para enfermedades cardíacas (8,9%; IC95%: 3,8; 14,1 en mujeres, y 8,8%; IC95%: 2,0; 15,6 en hombres). Las estrategias dirigidas a la actividad física tienen el potencial de prevenir la fragilidad en ambos sexos, mientras que la prevención de enfermedades crónicas es más necesaria en las mujeres.

Food consumption is associated with frailty in edentulous older adults: evidence from the ELSI-Brazil study.

This cross-sectional study aimed to evaluate the association between food consumption (meat, fish, and fruits and vegetables), anthropometric indicators (body mass index, waist circumference, and waist-to-height ratio), and frailty; and to verify whether these associations vary with edentulism. We used data from 8,629 participants of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) (2015-16). Frailty was defined by unintentional weight loss, weakness, slow walking speed, exhaustion, and low physical activity. Statistical analyses included multinomial logistic regression. Of the participants, 9% were frail and 54% pre-frail. Non-regular meat consumption was positively associated with pre-frailty and frailty. Non-regular fish consumption, and underweight were associated only with frailty. Models with interactions reveled a marginal interaction between meat consumption and edentulism (p-value = 0.051). After stratification, non-regular meat consumption remained associated with frailty only in edentulous individuals (OR = 1.97; 95%CI 1.27-3.04). Our results highlight the importance of nutritional assessment, oral health, and public health-promoting policies to avoid, delay and/or reverse frailty in older adults.

Urban-rural differences in food consumption and environment and anthropometric parameters of older adults: results from ELSI-Brazil. / Diferenças urbano-rurais relativas ao consumo e ambiente alimentar e aos parâmetros antropométricos de adultos mais velhos: resultados do ELSI-Brasil.

This study aimed to identify dietary and anthropometric differences in older Brazilian adults (≥ 50 years old) living in urban-rural areas. This is a cross-sectional study with data from the second wave (9,949 participants) of the Brazilian Longitudinal Study of Aging (ELSI-Brazil) from 2019-2021. Weekly dietary intake of fruit/vegetables, beans, and fish; self-perception of salt consumption; food environment (availability of fruit/vegetables in the neighborhood and self-production of food); and objective anthropometric parameters (body mass index [BMI] and waist circumference [WC]) were evaluated. Analyses were adjusted for schooling level. Compared to urban areas, rural areas show lower consumption of fruit/vegetables five days or more per week (74.6% vs. 86.4%) and greater adequate salt intake (96.8% vs. 92.1%) - differences we observed for men and women. Rural areas showed lower high WC (61.9% vs. 68%), significant only for men. Considering food environment, rural areas had lower fruit and vegetable availability in the neighborhood (41.2% vs. 88.3%) and higher self-production of food (38.2% vs. 13.2%). We observed a lower consumption of fruit/vegetables five days or more per week in rural areas with fruit/vegetable availability in the neighborhood and no self-production of food. Urban and rural areas show food and nutritional diversity. Incentives for fruit or vegetable consumption among residents in urban areas should consider the greater availability of these foods in their neighborhood, whereas, in rural areas, self-production of food should be encouraged. Adequate salt intake and ideal WC maintenance should be reinforced in urban areas.

Objetivou-se identificar diferenças alimentares e antropométricas entre adultos mais velhos brasileiros (≥ 50 anos) residentes em áreas urbano-rurais. Trata-se de um estudo transversal com dados da segunda onda (9.949 participantes) do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), de 2019-2021. Foram avaliados: consumo alimentar semanal de fruta/hortaliça, feijão e peixe; autopercepção do consumo de sal; ambiente alimentar (disponibilidade de fruta/hortaliça na vizinhança e produção própria de alimentos); e parâmetros antropométricos objetivos (índice de massa corporal [IMC] e circunferência da cintura [CC]). As análises foram ajustadas por escolaridade. Em comparação com as áreas urbanas, observaram-se nas rurais: menor consumo de fruta/hortaliça em cinco dias da semana ou mais (74,6% vs. 86,4%) e maior consumo adequado de sal (96,8% vs. 92,1%) - diferenças observadas para homens e mulheres. A CC elevada foi menor nas áreas rurais (61,9% vs. 68%), sendo significativa somente para homens. Houve menor disponibilidade de fruta/hortaliça na vizinhança (41,2% vs. 88,3%) e maior produção própria de alimentos (38,2% vs. 13,2%) nas áreas rurais. O consumo de fruta/hortaliça em cinco dias da semana ou mais foi menor nas áreas rurais quando houve disponibilidade de fruta/hortaliça na vizinhança e ausência de produção própria de alimentos. Há diversidade alimentar e nutricional entre áreas urbano-rurais. O incentivo ao consumo de fruta/hortaliça nas áreas urbanas deve considerar a disponibilidade de fruta/hortaliça na vizinhança, enquanto nas áreas rurais deve ser em conjunto com a produção do próprio alimento. O consumo adequado de sal e a manutenção da CC nos valores ideais devem ser reforçados nas áreas urbanas.

El objetivo fue identificar diferencias alimentarias y antropométricas entre adultos mayores brasileños (≥ 50 años) que viven en áreas urbano-rurales. Se trata de un estudio transversal con datos de la segunda ola (9.949 participantes) del Estudio Longitudinal Brasileño sobre el Envejecimiento (2019-2021). Se evaluaron el consumo semanal de alimentos, como frutas/verduras, frijoles y pescado; autopercepción del consumo de sal; entorno alimentario (disponibilidad de frutas/verduras en el barrio y la producción propia de alimentos); y parámetros antropométricos objetivos (índice de masa corporal [IMC] y circunferencia de la cintura [CC]). Los análisis se ajustaron por escolaridad. Se observó un menor consumo de frutas/verduras en las zonas rurales respecto a las urbanas en ≥ 5 días/semana (74,6% vs. 86,4%), mayor consumo adecuado de sal (96,8% vs. 92,1%), y estas diferencias se observaron para hombres y mujeres. La CC elevada fue menor en las zonas rurales (61,9% vs. 68%), y fue significativa solo para los hombres. Hubo una menor disponibilidad de frutas/verduras en el barrio (41,2% vs. 88,3%) y mayor producción propia de alimentos (38,2% vs. 13,2%) en las zonas rurales. El consumo de frutas/verduras en ≥ 5 días/semana fue menor en las zonas rurales cuando hubo frutas/verduras disponibles en el barrio y ausencia de producción del propio alimento. Existe una diversidad alimentaria y nutricional entre las zonas urbanas y rurales. Fomentar el consumo de frutas/verduras en las zonas urbanas debe tener en cuenta la disponibilidad de frutas/verduras en el barrio, mientras que en las zonas rurales debe tener en cuenta también la producción del propio alimento. Se debe reforzar el consumo adecuado de sal y el mantenimiento de la CC en valores ideales en las zonas urbanas.

A decreased trajectory of loneliness among Brazilians aged 50 years and older during the COVID-19 pandemic: ELSI-Brazil.

This study aimed to estimate prevalence of loneliness among older Brazilian adults over the first seven months of the COVID-19 pandemic and to identify the predictors of loneliness trajectories. Pre-pandemic data derived from face-to-face interviews of participants of the 2019-2020 Brazilian Longitudinal Study of Aging (ELSI-Brazil), which is a nationally representative study of community-dwelling individuals aged 50 years and over. Pandemic data were based on three rounds of telephone interviews among those participants, conducted from May to October 2020. Loneliness was measured by a single-item question, considering those who had at least two repeated measures. Explanatory variables included depression, living alone, leaving home in the last week, and virtual connectedness in the last month. Mixed-effects logistic regression was used to estimate odds ratios with their 95% confidence intervals (95%CI) and to investigate loneliness trajectories and their predictors. In total, 5,108 participants were included. The overall prevalence of loneliness in the pre-pandemic period was 33.1% (95%CI: 29.4-36.8), higher than the pandemic period (round 1: 23.6%, 95%CI: 20.6-26.9; round 2: 20.5%, 95%CI: 17.8-23.5; round 3: 20.6%, 95%CI: 17.1-24.6). A significant interaction (p ≤ 0.05) was evidenced only between depression and time; participants with depression showed a greater reduction in loneliness levels. Although loneliness levels in Brazil have decreased during the pandemic, this pattern is not present for all older adults. Individuals with depression had a more significant reduction, probably due to feeling closer to their social network members during the stay-at-home recommendations.

Differences in determinants of active aging between older Brazilian and English adults: ELSI-Brazil and ELSA.

This study aimed to investigate differences in determinants of active aging between older Brazilian and English adults and to verify the association of behavioral, personal, and social determinants with physical health. This cross-sectional study was based on the ELSI-Brazil (2015-2016) and ELSA (2016-2017) cohorts. Active aging determinants included behavior (smoking, sedentary lifestyle, and poor sleep quality), personal (cognitive function and life satisfaction), and social determinants (education, loneliness, and volunteering), according to the World Health Organization. Physical health included activities limitation and multimorbidity. We estimated age- and sex-adjusted prevalence for each indicator and mean score, and used the negative binomial regression for statistical analysis. We included 16,642 participants, 9,409 from Brazil and 7,233 from England. Overall, all active aging determinants were worse in Brazil than in England, except for life satisfaction (no difference). The most remarkable difference was found for social determinants score in Brazil (mean difference of 0.18; p < 0.05), mainly due to a significantly lower education level in Brazil (70.6%; 95% confidence interval - 95%CI: 69.7-71.5) than England (37.1%; 95%CI: 35.1-39.1). All determinants (behavioral, personal, and social) were associated with health in Brazil and in England. However, the behavioral domain was stronger associated with health in England (coefficient = 2.76; 95%CI: 2.46-3.10) than in Brazil (coefficient = 1.38; 95%CI: 1.26-1.50; p < 0.001). Older English adults beneficiate more from healthier behaviors than Brazilians, which depend more on social policies.

COVID-19 vulnerability among Brazilian sexual and gender minorities: a cross-sectional study.

Minority groups are more prone to worsen their personal and social vulnerabilities during the COVID-19 pandemic. This study aimed to identify factors associated with the highest COVID-19 vulnerability in the Brazilian sexual and gender minorities. This is a cross-sectional study based on 826 respondents of the Brazilian LGBT+ Health Survey, conducted online from August to November 2020. The COVID-19 vulnerability was based on a previous vulnerability index created by an LGBT+ institution, which comprises three dimensions (income, COVID-19 exposure, and health). The outcome was the highest score quartile. Statistical analysis was based on logistic regression models. The COVID-19 vulnerability was higher in heterosexual and other scarce sexual orientations (OR = 2.34; 95%CI: 1.01-9.20, vs. homosexual), cisgender men (OR = 3.52; 95%CI: 1.35-4.44, vs. cisgender women), and those aged ≥ 50 years (OR = 3.74; 95%CI: 1.24-11.25, vs. 18-29 years old). A negative association was found with complete graduate education (OR = 0.06; 95%CI: 0.02-0.22, vs. complete high school), being white (OR = 0.44; 95%CI: 0.23-0.83), and proper facemask use (OR = 0.31; 95%CI: 0.13-0.76). Except for proper facemask use, factors associated with higher COVID-19 vulnerability are structural determinate and suggest overlapping vulnerabilities, as described by the syndemic model. It guides strategies to deal with the pandemic, which includes a joint approach to the common epidemic that affects sexual and gender minorities, broadening the intersectoral approach to decrease inequalities.

Education and income-related inequalities in multimorbidity among older Brazilian adults.

OBJECTIVES: This study aimed to evaluate the existence of socioeconomic inequalities related to the prevalence of multimorbidity in the Brazilian population aged 60 and older. METHODS: This was a cross-sectional study with data from the last Brazilian National Health Survey (PNS) collected in 2019. Multimorbidity was the dependent variable and was defined as the presence of two or more chronic diseases. All the diseases were assessed based on a self-reported previous medical diagnosis. Education and per capita family income were the measures of socioeconomic position. Socioeconomic inequalities related to multimorbidity were assessed using two complex measures of inequality; the Slope Index of Inequality (SII) and the Concentration Index (CI). RESULTS: The prevalence of multimorbidity in Brazil was 56.5% 95% CI (55.4; 57.6) and varied from 46.9% (44.3; 49.6) in the North region to 59.3% (57.0; 61.5) in the South region. In general, individuals with higher socioeconomic positions had a lower prevalence of multimorbidity. Significant absolute and relative income inequalities were observed in the South region [SII -9.0; CI -0.054], Southeast [SII -9.8; CI -0.06], and Middle-east [SII -10.4; CI -0.063]. Absolute and relative education inequalities were significant for the country and two of its regions (Southeast [SII -12.7; CI -0.079] and South [SII -19.0; CI -0.109]). CONCLUSIONS: The prevalence of multimorbidity is high in Brazil and all of its macro-regions. The significant findings concerning the inequalities suggest that the distribution of this condition is more concentrated among those with lower education and income.

Factors associated with lifestyle deterioration during the COVID-19 pandemic among Brazilian lesbians, gays, bisexuals, transsexuals, transvestites and related identities: a cross-sectional study. / Fatores associados à piora no estilo de vida durante a pandemia de COVID-19 na população brasileira de lésbicas, gays, bissexuais, transexuais, travestis e identidades relacionadas: estudo transversal.

OBJECTIVE: To verify factors associated with deteriorating lifestyle during the COVID-19 pandemic, including physical activity, cigarette and alcohol intake in lesbians, gays, bisexuals, transsexuals, transvestites and people with related identities (LGBT+). METHODS: This was a cross-sectional study with individuals aged ≥18 years. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI). RESULTS: Of the 975 participants, 48.9% (95%CI 45.7;52.1) decreased physical activity, 6.2% (95%CI 4.8;7.9) increased cigarette smoking, and 17.3% (95%CI 15.0;19.8) increased alcohol intake. Physical activity deteriorated among individuals who adhered to mask use (OR=2.26; 95%CI 1.20;4.23), cigarette smoking increased among individuals who had a chronic health condition (OR=2.39; 95%CI 1.03;5.56), and alcohol intake increased among cisgender women (OR=1.95; 95%CI 1.31;2.92) and individuals living with a partner (OR=1.89; 95%CI 1.23;2.91). CONCLUSION: Lifestyle deterioration stood out among cisgender women, individuals with a chronic health condition and those who adhered to mask use.

Association Between Physical Functioning and Time Until a New Hospitalization in Community-Dwelling Older Adults: A Prospective Cohort Study.

BACKGROUND AND PURPOSE: Physical functioning refers to the ability to independently perform activities that require physical ability, and may be an important tool for predicting a higher risk of hospitalization. The objective of this study was to verify whether aspects of physical functioning are independently associated with the risk for new hospitalization in older adults seen in primary health care. METHODS: This prospective cohort study consisted of 473 older adults 60 years and older who had not been hospitalized in the prior year. Hospitalization records were obtained with authorization from the hospital admission. Depending on physical functioning, the probability of a new hospital admission within the next 5 years was determined based on survival analysis and the Kaplan-Meier curve. Physical functioning was evaluated using 5 easy-to-administer tests: handgrip strength using a Jamar dynamometer, functional performance using the Short Physical Performance Battery, balance using the step test, mobility using the Timed Up and Go (TUG) test, and gait speed using the 4-m walk test. The association between poor physical functioning and new hospitalization was verified using a Cox regression model, adjusted for sex, age, number of comorbidities, number of medications, and BMI. Models were implemented separately for each physical functioning test. RESULTS: In the sample, 32% had been hospitalized at least once in 5 years. The Kaplan-Meier curve showed a decrease in the probability of nonhospitalization within the next 5 years. Cox regression analysis showed an association between hospitalization within the next 5 years and mobility on the TUG test of more than 12.4 seconds in the crude (hazard ratio [HR] = 1.33, 95% CI = 1.10-1.60) and adjusted models (HR = 1.26, 95% CI = 1.02-1.56), and balance using the step test of more than 7.5 seconds in the crude (HR = 1.27, 95% CI = 1.03-1.56) model. CONCLUSIONS: Physical functioning tests demonstrated that poor physical performance predicts new hospitalization, and reinforced the importance of their application in physical therapy practice in primary health care settings.

The Brazilian LGBT+ Health Survey: methodology and descriptive results.

The understanding of health care demands and possible access barriers may support policymaking and best practices targeting the lesbian, gay, bisexual, transgender, and related identities (LGBT+) population. The aims of the Brazilian LGBT+ Health Survey were to characterize the LGBT+ population during the COVID-19 pandemic and to specify the characteristics of the COVID-19 pandemic in this population. This is a cross-sectional online study, with a convenience sample of 976 individuals identified as LGBT+, aged 18 years or older from Brazil. It allows investigations of sexuality, discrimination, internal homophobia, health-related behaviors, and health care access. The study adopts a conceptual framework (i.e., validated tools and measures) common to other epidemiological studies, allowing comparisons. We describe the study methodology, some descriptive results, and health-selected indicators compared with the Brazilian National Health Survey. Most of the respondents were from Southeast Region (80.2%), mean aged 31.3 (± 11.5 years). Regarding COVID-19, 4.8% tested positive. Both weekly episodes of discrimination (36%) and depression prevalence (24.8%) were high among the LGBT+ population in Brazil, highlighting mental health and homophobia as major concerns in the LGBT+ context during the pandemic. Although a decade has passed since the institution of the Brazilian National Policy for Comprehensive LGBT Health, appropriate training of health professionals to offer adequate services is still needed. Knowledge of the specific health demands of this group might guide person-centered best practices, promote sexual minority high-acceptance settings, and contribute to higher equity during the pandemic.

Difficulty in taking medication and stroke among older adults with systemic arterial hypertension: the Fibra Study.

This article aims to investigate whether difficulty in taking medication is associated with stroke among older adults with Systemic Arterial Hypertension (SAH) and to explore their association with living arrangements. Cross-sectional study was based on 3,502 older adults with SAH from the four universities pole of Frailty in Brazilian Older People (Fibra) Study, Brazil, including 14 municipalities of the five Brazilian regions. We used the medical diagnosis of stroke and difficulty in taking medications (self-reported difficulty and financial difficulty affording prescribed medications). Multivariate analysis was performed using logistic regression. Differently from women, older men with SAH, which report difficulty in taking medication (unintentional non-adherence), have higher odds of stroke. When stratified by living arrangements, those living with a partner have even higher odds of stroke compared to those without difficulty in taking medication and living alone. None association was found for difficulty affording prescribed medication for both men and women. Unintentional difficulty in taking medication plays a role in SAH treatment among men. Primary care strategies for controlling blood pressure should not be focus only on patients but targeting spouses as well.

[Predisposition to severe forms of COVID-19 and adherence to preventive measures: the role of social support]. / Predisposição a formas graves de COVID-19 e adesão às medidas de prevenção: o papel do apoio social.

This study sought to assess the adherence to preventive measures among the elderly more prone to severe forms of COVID-19, and the association and interaction with social support. It is a cross-sectional study conducted with a sample of 3,477 participants of the telephone survey of the Brazilian Longitudinal Study of Aging (ELSI-COVID-19 initiative), who reported going out of the home in the past week. The adherence was based on the frequency of leaving the house, the need to venture outside the home, use of masks, and sanitization of hands. Statistical analysis was based on the Poisson model with robust variance. Predisposing factors for severe forms of COVID-19 included age ≥65 years, hypertension, diabetes, and obesity. Social support included living arrangements and social distancing during the pandemic. Approximately 46% of the participants showed higher adherence, which was positively associated with the number of predisposing factors for severe forms of COVID-19. Social support was not associated with adherence, nor was this association modified after adjustments. The conclusion drawn is that higher adherence is concentrated among the elderly with greater predisposition to severe forms of COVID-19, irrespective of social support, albeit preventive measures should be adopted by all.

Objetivou-se verificar a adesão às medidas de prevenção em idosos com maior predisposição a formas graves de COVID-19 e sua associação e interação com o apoio social. Trata-se de um estudo transversal realizado em amostra de 3.477 participantes do inquérito telefônico do Estudo Longitudinal da Saúde dos Idosos Brasileiros (iniciativa ELSI-COVID-19), que informaram ter saído de casa na semana anterior à realização do inquérito. A adesão foi aferida pela frequência com que saiu de casa, necessidade de sair de casa, uso de máscara e higienização das mãos. As análises basearam-se no modelo Poisson com variância robusta. Idade ≥ 65 anos, hipertensão, diabetes e obesidade foram considerados fatores predisponentes para formas graves de COVID-19. O apoio social incluiu o arranjo domiciliar e a conexão social na pandemia. Aproximadamente 46% apresentaram melhor adesão, que foi associada positivamente ao número de fatores predisponentes para formas graves. O apoio social não foi associado à adesão e não modificou essa associação, após ajustamentos. Conclui-se que a adesão às medidas de prevenção, que deveria ser estendida a todos, está concentrada nos idosos com maior predisposição a formas graves de COVID-19, independentemente do apoio social.

[Factors associated with preventive health services search among Brazilian adults: National Health Survey, 2013]. / Fatores associados à busca por serviços preventivos de saúde entre adultos brasileiros: Pesquisa Nacional de Saúde, 2013.

The objective of this article is to examine factors associated with preventive health services search among Brazilian adults. Sample included adults participants from the National Health Survey (2013), that had reported any health service search in prior 15 days, categorized into "treatment/diagnosis" or "preventive" service. Exploratory variables included sex, age, race, marital status, education, household situation, private health plan enrolment and time of FHS enrolment. Associations were verified by prevalence ratios (PR), estimated using robust Poisson regression, considering complexity of sampling parameters. Final sample included 32,377 individuals, 12,94% have searched "preventive" services. Preventive search was more often among women and less often among the older adults, those not living with partner, with less education. Having private health plan was associated with less preventive services search. FHS enrolment were not associated with preventive search. By conclusion, although some efforts and the importance of preventive actions, most of individuals search for treatment services.

O objetivo deste artigo é verificar os fatores associados à busca por serviços preventivos de saúde pela população adulta brasileira. A amostra foi composta por participantes da Pesquisa Nacional de Saúde (2013), que relataram procura por algum serviço de saúde nos últimos 15 dias, classificado em "tratamento/diagnóstico" ou "preventivo". As variáveis exploratórias incluíram sexo, faixa etária, cor de pele, estado conjugal, escolaridade, localização do domicílio, posse de plano privado de saúde e tempo de cadastro na ESF. As associações foram verificadas pelas razões de prevalência (RP), obtidas pelo modelo de Poisson, considerando a complexidade do desenho amostral. A amostra foi composta por 32.377 indivíduos que buscaram o serviço de saúde, sendo 12,94% para ações "preventivas". A procura por estes cuidados foi mais frequente entre mulheres e menos frequente entre os mais velhos, que não viviam com companheiro, com menor escolaridade. Não possuir plano privado de saúde foi associado a menor busca por prevenção. Ser adscrito à ESF não foi associada a busca por ações preventivas. Mesmo com os esforços e com o reconhecimento da importância da prevenção, a maioria dos indivíduos ainda busca os serviços de saúde para tratamento.

Relationship between work before the epidemic and having gone out to work during the epidemic among participants in the Brazilian Longitudinal Study of Aging: results of the ELSI-COVID-19 initiative. / Relação entre trabalho antes da epidemia e ter saído para trabalhar durante esse período entre participantes do Estudo Longitudinal da Saúde dos Idosos Brasileiros: resultados da iniciativa ELSI-COVID-19.

The objective of this study was to examine the prevalence of going out to work during the COVID-19 epidemic, and the factors associated with this, among adults aged 50 years and over who were in paid employment before its onset. We used data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted through face-to-face interviews between August 2019 and March 2020 (before the onset of the epidemic), in a representative national sample of adults aged 50 and over, and data obtained through telephone interviews carried out among the same participants (ELSI-COVID-19 initiative), conducted between May 26 and June 8, 2020 (during the epidemic). The analyses were based on odds ratios (OR) estimated by logistic regression. The participants' mean age was 59.9 years (SD = 6.5). The prevalence of going out to work in the previous seven days was 38.4% (95%CI: 31.3-46.1), 50.2% among men and 25.1% among women (formal work, self-employment, and informal work). The results showed that among men, the likelihood of going out to work was lower among those aged 60 to 69 years compared to those aged 50 to 59 years (OR = 0.27; 95%CI: 0.15-0.48). Among women, the likelihood was lower among those who were self-employed (OR = 0.28; 95%CI: 0.12-0.64) or in informal employment before the epidemic (OR = 0.25; 95%CI: 0.09-0.69), compared to those in formal employment. One of the hypotheses to explain this association is that women in informal employment were more likely to be dismissed, and that self-employed women have stopped working during the epidemic.

O objetivo do estudo foi examinar a prevalência e fatores associados a ter saído para trabalhar durante a epidemia da COVID-19, entre adultos com 50 anos ou mais que exerciam trabalho remunerado antes do seu início. Foram utilizados dados da segunda onda do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil), conduzida por meio de entrevista face a face, entre agosto de 2019 e março de 2020 (antes do início da epidemia), em amostra nacional representativa de adultos com 50 anos ou mais, e dados obtidos por meio de entrevistas telefônicas realizadas entre esses participantes (iniciativa ELSI-COVID-19), conduzidas entre 26 de maio e 8 de junho de 2020 (durante a epidemia). As análises foram baseadas nas odds ratios (OR) estimadas pela regressão logística. A média de idade dos participantes foi 59,9 anos (DP = 6,5). A prevalência de ter saído para trabalhar nos sete dias anteriores foi de 38,4% (IC95%: 31,3-46,1), 50,2% entre os homens e 25,1% entre as mulheres (trabalho formal, por conta própria e informal). Os resultados mostraram que, entre os homens, a chance de ter saído para trabalhar foi menor entre aqueles de 60 a 69 anos em comparação com aqueles de 50 a 59 anos (OR = 0,27; IC95%: 0,15-0,48). Entre as mulheres, a probabilidade de ter saído para trabalhar foi menor entre aquelas que trabalhavam por conta própria (OR = 0,28; IC95%: 0,12-0,64) ou tinham vínculo informal de trabalho antes da epidemia (OR = 0,25; IC95%: 0,09-0,69), em comparação àquelas com vínculo formal de trabalho. Uma das hipóteses para explicar essa associação é que as mulheres com vínculo informal tenham sido dispensadas e aquelas que trabalhavam por conta própria tenham deixado de trabalhar durante a epidemia.

El objetivo del estudio fue examinar la prevalencia y factores asociados a haber salido para trabajar durante la epidemia de la COVID-19, entre adultos con 50 años o más, que ejercían trabajo remunerado antes del inicio de la misma. Se utilizaron datos de la segunda fase del Estudio Brasileño Longitudinal del Envejecimiento (ELSI-Brasil), llevada a cabo mediante una entrevista cara a cara, entre agosto de 2019 y marzo de 2020 (antes del inicio de la epidemia), en una muestra nacional representativa de adultos con 50 años o más, y datos obtenidos por medio de entrevistas telefónicas realizadas entre estos participantes (iniciativa ELSI-COVID-19), realizadas entre el 26 de mayo y 8 de junio de 2020 (durante la epidemia). Los análisis se basaron en las odds ratios (OR) estimadas por regresión logística. La media de edad de los participantes fue 59,9 años (DP = 6,5). La prevalencia de haber salido para trabajar durante los siete días anteriores fue de un 38,4% (IC95%: 31,3-46,1), 50,2% entre hombres y un 25,1% entre las mujeres (trabajo formal, por cuenta propia e informal). Los resultados mostraron que, entre los hombres, la oportunidad de haber salido a trabajar fue menor entre aquellos con edades comprendidas entre los 60 a 69 años, en comparación con aquellos de 50 a 59 años (OR = 0,27; IC95%: 0,15-0,48). Entre las mujeres, la probabilidad de haber salido a trabajar fue menor entre aquellas que trabajaban por cuenta propia (OR = 0,28; IC95%: 0,12-0,64) o tenían un vínculo laboral informal antes de la epidemia (OR = 0,25; IC95%: 0,09-0,69), en comparación con aquellas con un vínculo laboral formal. Una de las hipótesis para explicar esta asociación es que las mujeres con un vínculo informal fueron dispensadas del servicio y aquellas que trabajaban por cuenta propia hayan dejado de trabajar durante la epidemia.