Predictors of pain in general ageing populations: results from a multi-country analysis based on ATHLOS harmonized database.

BACKGROUND: Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents. METHODS: We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors. RESULTS: A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80). CONCLUSIONS: Our results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese.

Inflammation and central adiposity as mediators of depression and uncontrolled diabetes in the study on global AGEing and adult health (SAGE).

OBJECTIVES: Diabetes and depression are commonly present in the same individuals, suggesting the possibility of underlying shared physiological processes. Inflammation, as assessed with the biomarker C-reactive protein (CRP), has not consistently explained the observed relationship between diabetes and depression, although both are associated with inflammation and share proposed inflammatory mechanisms. Central adiposity has also been associated with both conditions, potentially by causing increased inflammation. This study uses the World Health Organization's Study on global AGEing and adult health (SAGE) Mexico Wave 1 biomarker data (n = 1831) to evaluate if inflammation and central adiposity mediate the relationship between depression and diabetes. METHODS: Depression was estimated using a behavior-based diagnostic algorithm, inflammation using venous dried blood spot (DBS) CRP, central adiposity using waist-to-height ratio (WHtR), and uncontrolled diabetes using venous DBS-glycated hemoglobin (HbA1c). RESULTS: The association between depression and uncontrolled diabetes was partially mediated by CRP before but not after WHtR was considered. When WHtR was added to the model, it partially mediated the relationship between diabetes and depression while fully mediating the relationship between depression and CRP. CONCLUSIONS: These findings suggest that central adiposity may be a more significant mediator between diabetes and depression than inflammation and account for the relationship between these disorders and inflammation. Depression may cause an increase in central adiposity, which then may lead to diabetes, but the increase in known systemic inflammatory pathways caused by central adiposity may not be the key pathological mechanism.

Social determinants of health and frailty are associated with all-cause mortality in older adults.

OBJECTIVE: To examine the longitudinal association between the social determinants of health (SDH) and frailty status with all-cause mortality in older Mexican adults. MATERIALS AND METHODS: Longitudinal study with a sample of adults aged 60 and over of Study on Global AGEing and Adult Health (SAGE) in Mexico. A Cox proportional hazard model was used to estimate the SDH and frailty-related hazard ratios (HR) for mortality over the study period. RESULTS: Overall mortality rate was 16.9%. Higher education, having a higher frequency of inter-personal contacts (HR=0.96; p<0.01) reduced the risk of dying, after adjusting for potential confounders. While, not counting on someone to trust (HR= 1.59; p<0.03) and having a sense a lack of control over important decisions in life increased the mortality risk. CONCLUSIONS: Given that frailty and the SDH affect health using independent pathways, public health systems in Mexico could benefit from increasing the capacity of identifying frail and isolated older adults and providing a risk-stratified health care accordingly.

OBJETIVO: Examinar la asociación longitudinal entre los determinantes sociales en salud (DSS) y la fragilidad con la mortalidad por todas las causas en adultos mayores mexicanos. MATERIAL Y MÉTODOS: Estudio longitudinal con una muestra de adultos mayores de 60 años o más del estudio Envejecimiento Global y Salud de los Adultos (SAGE, por sus siglas en inglés) en México. Se utilizó el modelo riesgos proporcionales de Cox para estimar la asociación entre DSS y la fragilidad en la mortalidad. RESULTADOS: La tasa de mortalidad general fue 16.9%. Tener mayor educación y una mayor frecuencia de contactos interpersonales (HR= 0.96, p<0.01) reducen el riesgo de morir, después de ajustar por covariables. Mientras tanto, no contar con alguien en quien confiar (HR= 1.59; p<0.03) y tener una sensación de falta de control sobre las decisiones importantes en la vida aumentan el riesgo de mortalidad. CONCLUSIONES: Dado que la fragilidad y los DSS inciden sobre la salud usando vías independientes, el sistema de salud de México se beneficiaría al incrementar su capacidad para detectar a los adultos mayores frágiles y con aislamiento social, para proveer cuidados a la salud.

Social determinants of health and frailty are associated with all-cause mortality in older adults / Los determinantes de la salud y la fragilidad están asociados con la mortalidad por todas las causas en adultos mayores

Abstract: Objective: To examine the longitudinal association between the social determinants of health (SDH) and frailty status with all-cause mortality in older Mexican adults. Materials and methods: Longitudinal study with a sample of adults aged 60 and over of Study on Global AGEing and Adult Health (SAGE) in Mexico. A Cox proportional hazard model was used to estimate the SDH and frailty-related hazard ratios (HR) for mortality over the study period. Results: Overall mortality rate was 16.9%. Higher education, having a higher frequency of inter-personal contacts (HR=0.96;p<0.01) reduced the risk of dying, after adjusting for potential confounders. While, not counting on someone to trust (HR= 1.59;p<0.03) and having a sense a lack of control over important decisions in life increased the mortality risk. Conclusions: Given that frailty and the SDH affect health using independent pathways, public health systems in Mexico could benefit from increasing the capacity of identifying frail and isolated older adults and providing a risk-stratified health care accordingly.

Resumen: Objetivo: Examinar la asociación longitudinal entre los determinantes sociales en salud (DSS) y la fragilidad con la mortalidad por todas las causas en adultos mayores mexicanos. Material y métodos: Estudio longitudinal con una muestra de adultos mayores de 60 años o más del estudio Envejecimiento Global y Salud de los Adultos (SAGE, por sus siglas en inglés) en México. Se utilizó el modelo riesgos proporcionales de Cox para estimar la asociación entre DSS y la fragilidad en la mortalidad. Resultados: La tasa de mortalidad general fue 16.9%. Tener mayor educación y una mayor frecuencia de contactos interpersonales (HR= 0.96,p<0.01) reducen el riesgo de morir, después de ajustar por covariables. Mientras tanto, no contar con alguien en quien confiar (HR= 1.59;p<0.03) y tener una sensación de falta de control sobre las decisiones importantes en la vida aumentan el riesgo de mortalidad. Conclusiones: Dado que la fragilidad y los DSS inciden sobre la salud usando vías independientes, el sistema de salud de México se beneficiaría al incrementar su capacidad para detectar a los adultos mayores frágiles y con aislamiento social, para proveer cuidados a la salud.

Longitudinal associations of multimorbidity, disability and out-of-pocket health expenditures in households with older adults in Mexico: The study on global AGEing and adult health (SAGE).

BACKGROUND: Empirical evidence suggests that multimorbidity and disability are each significantly associated with out-of-pocket (OOP) health expenditures; however few efforts have been made to explore their joint association with OOP health expenditures. OBJECTIVES: To estimate the association of multimorbidity and disability with OOP health expenditures in households with older adults in Mexico, as well as the potential interaction effects of multimorbidity and disability on OOP health expenditures. METHODS: Longitudinal study based on data collected as part of the Study on global AGEing and adult health Wave 1 (2009) and Wave 2 (2014), a nationally representative study in Mexico with a sample of older adults aged 50 and older. The dependent variable was OOP health expenditures, and main exposure variables were multimorbidity and disability. Two-Part regression models were used to analyze the relation between multimorbidity, disability and OOP health expenditures. RESULTS: Multimorbidity was associated with the probability of incurring OOP health expenditures (OR = 1.28, CI95% 1.11-1.48), and also the tertiles of disability (2nd tertile: OR = 1.45, CI95% 1.23-1.70; 3rd tertile: OR = 2.19, CI95% 1.81-2.66). The presence of multimorbidity was associated with an increase of 13% in average OOP health costs (ß = 0.13, CI95% 0.01-0.25), and 16% for the 3rd tertile of disability (ß = 0.16, CI95% 0.01-0.31). We did not find significant interaction effects of multimorbidity and disability. CONCLUSIONS: Multimorbidity and disability appear to be important determinants of OOP health expenditures. The economic implications for the households and the health system should be highlighted, particularly in low- and middle-income countries because of the rapid growth of their aging populations.

Concordance between the diagnostic guidelines for alcohol and cannabis use disorders in the draft ICD-11 and other classification systems: analysis of data from the WHO's World Mental Health Surveys.

BACKGROUND AND AIMS: The World Health Organization's (WHO's) proposed International Classification of Diseases, 11th edition (ICD-11) includes several major revisions to substance use disorder (SUD) diagnoses. It is essential to ensure the consistency of within-subject diagnostic findings throughout countries, languages and cultures. To date, agreement analyses between different SUD diagnostic systems have largely been based in high-income countries and clinical samples rather than general population samples. We aimed to evaluate the prevalence of, and concordance between diagnoses using the ICD-11, The WHO's ICD 10th edition (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions (DSM-IV, DSM-5); the prevalence of disaggregated ICD-10 and ICD-11 symptoms; and variation in clinical features across diagnostic groups. DESIGN: Cross-sectional household surveys. SETTING: Representative surveys of the general population in 10 countries (Argentina, Australia, Brazil, Colombia, Iraq, Northern Ireland, Poland, Portugal, Romania and Spain) of the World Mental Health Survey Initiative. PARTICIPANTS: Questions about SUDs were asked of 12 182 regular alcohol users and 1788 cannabis users. MEASUREMENTS: Each survey used the World Mental Health Survey Initiative version of the WHO Composite International Diagnostic Interview version 3.0 (WMH-CIDI). FINDINGS: Among regular alcohol users, prevalence (95% confidence interval) of life-time ICD-11 alcohol harmful use and dependence were 21.6% (20.5-22.6%) and 7.0% (6.4-7.7%), respectively. Among cannabis users, 9.3% (7.4-11.1%) met criteria for ICD-11 harmful use and 3.2% (2.3-4.0%) for dependence. For both substances, all comparisons of ICD-11 with ICD-10 and DSM-IV showed excellent concordance (all κ ≥ 0.9). Concordance between ICD-11 and DSM-5 ranged from good (for SUD and comparisons of dependence and severe SUD) to poor (for comparisons of harmful use and mild SUD). Very low endorsement rates were observed for new ICD-11 feature for harmful use ('harm to others'). Minimal variation in clinical features was observed across diagnostic systems. CONCLUSIONS: The World Health Organization's proposed International Classification of Diseases, 11th edition (ICD-11) classifications for substance use disorder diagnoses are highly consistent with the ICD 10th edition and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). Concordance between ICD-11 and the DSM 5th edition (DSM-5) varies, due largely to low levels of agreement for the ICD harmful use and DSM-5 mild use disorder. Diagnostic validity of self-reported 'harm to others' is questionable.

Disability, quality of life and all-cause mortality in older Mexican adults: association with multimorbidity and frailty.

BACKGROUND: Multimorbidity and frailty are relevant conditions among older adult population. There is growing evidence about their association with poor health outcomes like disability, worst quality of life, and death. Nonetheless, the independent associations of both conditions have been studied, and few evidence exists about an interaction between them. Our aims were to assess the association of frailty and multimorbidity with the disability, quality of life and all-cause mortality as well as to analyze a potential interaction between these conditions. METHODS: Analytical samples included 1410 respondents for disability and quality of life, and 1792 for mortality. We performed a longitudinal analysis with older Mexican adults aged 50, using data collected from the WHO's Study on global AGEing and Adult Health Waves 1 and 2. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), and quality of life using the WHOQOL (WHO Quality of Life) instrument. All-cause mortality was determined by reviewing death certificates. Associations of frailty and multimorbidity with disability, quality of life and mortality were estimated using linear regression and Cox proportional hazards models. RESULTS: Multimorbidity assessed through three patterns (cardiopulmonary, vascular-metabolic, and mental-musculoskeletal) was associated with the three outcomes in this study. Cardiopulmonary and mental-musculoskeletal patterns increased the WHODAS mean score (ß = 5.05; p < 0.01 and ß = 5.10; p < 0.01, respectively) and decreased WHOQOL score (ß = - 1.81; p < 0.01 and ß = - 2.99; p < 0.01, respectively). Vascular-metabolic was associated with mortality (HR = 1.47; p = 0.04), disability (ß = 3.27; p < 0.01) and quality of life (ß = - 1.30; p = 0.02). Frailty was associated with mortality (pre-frail: HR = 1.48; p = 0.02 and frail: HR = 1.68; p = 0.03), disability (pre-frail: ß = 5.02; p < 0.01; frail: ß = 13.29; p < 0.01) and quality of life (pre-frail: ß = - 2.23; p < 0.01; frail: ß = - 4.38; p < 0.01). Interaction terms of frailty and multimorbidity were not statistically significant. CONCLUSIONS: Multimorbidity and frailty are important predictors of poor health outcomes. These results highlight the importance of carrying out health promotion and prevention actions as well as specific interventions aimed at older adults who suffer from multimorbidity and frailty, in such a way that deleterious effects on health can be avoided.

What makes the difference in people's lives when they have a mental disorder?

OBJECTIVES: The objective of this study was to identify which environmental factors are the most responsible for the disability experienced by persons with mental disorders and whether they differ (1) from those in cardiovascular diseases, chronic respiratory conditions, diabetes, and cancer, and (2) depending on the capacity level-a proxy for the impact of health conditions on the health state of individuals. METHODS: Nationally representative data from 12,265 adults in Chile collected in 2015 with the WHO Model Disability Survey was analyzed. RESULTS: The availability of personal assistance, frequency of receiving personal assistance, and assistive devices for mobility were the most important environmental factors across mental and other non-communicable diseases. Perception of discrimination and use of health services were also prominent factors. There was a huge overlap between the factors found relevant for mental and other non-communicable diseases, but a substantial variability depending on the intensity of difficulties in capacity. CONCLUSIONS: This study challenges the appropriateness of disease-specific approaches and suggests that considering intrinsic capacity levels is more informative than focusing on diagnosis alone when comparing needs and barriers that affect the performance in daily life of specific groups of individuals.

Exposure to air pollution and tobacco smoking and their combined effects on depression in six low- and middle-income countries.

BackgroundLittle is known about the joint mental health effects of air pollution and tobacco smoking in low- and middle-income countries.AimsTo investigate the effects of exposure to ambient fine particulate matter pollution (PM2.5) and smoking and their combined (interactive) effects on depression.MethodMultilevel logistic regression analysis of baseline data of a prospective cohort study (n = 41 785). The 3-year average concentrations of PM2.5 were estimated using US National Aeronautics and Space Administration satellite data, and depression was diagnosed using a standardised questionnaire. Three-level logistic regression models were applied to examine the associations with depression.ResultsThe odds ratio (OR) for depression was 1.09 (95% C11.01-1.17) per 10 µg/m3 increase in ambient PM2.5, and the association remained after adjusting for potential confounding factors (adjusted OR = 1.10, 95% CI 1.02-1.19). Tobacco smoking (smoking status, frequency, duration and amount) was also significantly associated with depression. There appeared to be a synergistic interaction between ambient PM2.5 and smoking on depression in the additive model, but the interaction was not statistically significant in the multiplicative model.ConclusionsOur study suggests that exposure to ambient PM2.5 may increase the risk of depression, and smoking may enhance this effect.

The role of unhealthy lifestyles in the incidence and persistence of depression: a longitudinal general population study in four emerging countries.

BACKGROUND: Unhealthy lifestyles and depression are highly interrelated: depression might elicit and exacerbate unhealthy lifestyles and people with unhealthy lifestyles are more likely to become depressed over time. However, few longitudinal evidence of these relationships has been collected in emerging countries. The present study aims i) to analyse whether people with unhealthy lifestyles are more likely to develop depression, and ii) to examine whether depressed people with unhealthy lifestyles are more likely to remain depressed. A total of 7908 participants from Ghana, India, Mexico and Russia were firstly evaluated in the World Health Organization's Study on Global AGEing and Adult Health (SAGE) Wave 0 (2002-2004) and re-evaluated in 2007-2010 (Wave 1). Data on tobacco use, alcohol drinking and physical activity, were collected. Logistic regressions models were employed to assess whether baseline unhealthy lifestyles were related to depression in Wave 1, among people without 12-month depression in Wave 0 and any previous lifetime diagnosis of depression, and to 12-month depression at both study waves (persistent depression). RESULTS: Baseline daily and non-daily smoking was associated with depression in Wave 1. Low physical activity and heavy alcohol drinking were associated with persistent depression. CONCLUSIONS: Unhealthy lifestyles and depression are also positively related in emerging countries. Smoking on a daily and non-daily basis was longitudinally related to depression. Depressed people with low physical activity and with heavy drinking patterns were more likely to become depressed over time. Several interpretations of these results are given. Further studies should check whether a reduction of these unhealthy lifestyles leads to lower depression rates and/or to a better clinical prognosis of depressed people.

Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-incomecountries: results from the WHO Study on global AGEing and adult health (SAGE).

BACKGROUND: In 2010 falls were responsible for approximately 80 % of disability stemming from unintentional injuries excluding traffic accidents in adults 50 years and over. Falls are becoming a major public health problem in low- and middle-income countries (LMICs) where populations are ageing rapidly. METHODS: Nationally representative standardized data collected from adults aged 50 years and over participating in the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, the Russian Federation and South Africa are analysed. The aims are to identify the prevalence of, and risk factors for, past-year fall-related injury and to assess associations between fall-related injury and disability. Regression methods are used to identify risk factors and association between fall-related injury and disability. Disability was measured using the WHO Disability Assessment Schedule Version 2.0 (WHODAS 2.0). RESULTS: The prevalence of past-year fall-related injuries ranged from 6.6 % in India to 1.0 % in South Africa and was 4.0 % across the pooled countries. The proportion of all past-year injuries that were fall-related ranged from 73.3 % in the Russian Federation to 44.4 % in Ghana. Across the six countries this was 65.7 %. In the multivariable logistic regression, the odds of past-year fall-related injury were significantly higher for: women (OR: 1.27; 95 % CI: 0.99,1.62); respondents who lived in rural areas (OR: 1.36; 95 % CI: 1.06,1.75); those with depression (OR: 1.43; 95 % CI: 1.01,2.02); respondents who reported severe or extreme problems sleeping (OR: 1.54; 95 % CI: 1.15,2.08); and those who reported two or more (compared with no) chronic conditions (OR: 2.15; 95 % CI: 1.45,3.19). Poor cognition was also a significant risk factor for fall-related injury. The association between fall-related injury and the WHODAS measure of disability was highly significant (P<0.0001) with some attenuation after adjusting for confounders. Reporting two or more chronic conditions (compared with none) was significantly associated with disability (P<0.0001). CONCLUSIONS: The findings provide a platform for improving understanding of risk factors for falls in older adults in this group of LMICs. Clinicians and public health professionals in these countries must be made aware of the extent of this problem and the need to implement policies to reduce the risk of falls in older adults.

Common risk factors for chronic non-communicable diseases among older adults in China, Ghana, Mexico, India, Russia and South Africa: the study on global AGEing and adult health (SAGE) wave 1.

BACKGROUND: Behavioral risk factors such as tobacco use, unhealthy diet, insufficient physical activity and the harmful use of alcohol are known and modifiable contributors to a number of NCDs and health mediators. The purpose of this paper is to describe the distribution of main risk factors for NCDs by socioeconomic status (SES) among adults aged 50 years and older within a country and compare these risk factors across six lower- and upper-middle income countries. METHODS: The study population in this paper draw from SAGE Wave 1 and consisted of adults aged 50-plus from China (N=13,157), Ghana (N=4,305), India (N=6,560), Mexico (N=2,318), the Russian Federation (N=3,938) and South Africa (N=3,836). Seven main common risk factors for NCDs were identified: daily tobacco use, frequent heavy drinking, low level physical activity, insufficient vegetable and fruit intake, high risk waist-hip ratio, obesity and hypertension. Multiple risk factors were also calculated by summing all these risk factors. RESULTS: The prevalence of daily tobacco use ranged from 7.7% (Ghana) to 46.9% (India), frequent heavy drinker was the highest in China (6.3%) and lowest in India (0.2%), and the highest prevalence of low physical activity was in South Africa (59.7%). The highest prevalence of respondents with high waist-to-hip ratio risk was 84.5% in Mexico, and the prevalence of self-reported hypertension ranging from 33% (India) to 78% (South Africa). Obesity was more common in South Africa, the Russia Federation and Mexico (45.2%, 36% and 28.6%, respectively) compared with China, India and Ghana (15.3%, 9.7% and 6.4%, respectively). China, Ghana and India had a higher prevalence of respondents with multiple risk factors than Mexico, the Russia Federation and South Africa. The occurrence of three and four risk factors was more prevalent in Mexico, the Russia Federation and South Africa. CONCLUSION: There were substantial variations across countries and settings, even between upper-middle income countries and lower-middle income countries. The baseline information on the magnitude of the problem of risk factors provided by this study can help countries and health policymakers to set up interventions addressing the global non-communicable disease epidemic.

Determinants of the components of arterial pressure among older adults--the role of anthropometric and clinical factors: a multi-continent study.

OBJECTIVE: The aim of this study was to evaluate the factors associated with different components of arterial blood pressure in nine nationally-representative samples of people aged ≥50 years. METHODS: Data were available for 53,289 people aged ≥18 years who participated in the SAGE (WHO Study on global AGEing and adult health) study conducted in China, Ghana, India, Mexico, Russia, and South Africa, and the COURAGE (Collaborative Research on Ageing in Europe) study conducted in Finland, Poland, and Spain, between 2007 and 2012. Standard procedures were used to obtain diastolic and systolic blood pressure (DBP, SBP) measurements to identify hypertensive participants, and to determine mean arterial blood pressure (MAP) and pulse pressure (PP). RESULTS: The analytical sample consisted of 42,116 people aged 50 years or older. South Africa had the highest prevalence of hypertension (78.3%), and the highest measurements of MAP ± SD (113.6 ± 36.4 mmHg), SBP ± SD (146.4 ± 49.5 mmHg), and DBP ± SD (97.2 ± 33.9 mmHg). In the adjusted models, dose-dependent positive associations between Body Mass Index (BMI) and MAP or PP were observed in most countries (p < 0.05). Diabetes was positively associated with PP in most countries but the association between diabetes and MAP was less consistent. Stroke was associated with both higher MAP and PP in China, Ghana, and South Africa (p < 0.05). CONCLUSIONS: Obesity and diabetes remain important modifiable risk factors for arterial peripheral resistance and stiffness as reflected by MAP and PP respectively. Controlling arterial pressure abnormalities after stroke events may be important for secondary prevention, particularly in developing countries.

Chronic conditions and sleep problems among adults aged 50 years or over in nine countries: a multi-country study.

BACKGROUND: Data on the association between chronic conditions or the number of chronic conditions and sleep problems in low- or middle-income countries is scarce, and global comparisons of these associations with high-income countries have not been conducted. METHODS: Data on 42116 individuals 50 years and older from nationally-representative samples of the Collaborative Research on Ageing in Europe (Finland, Poland, Spain) and the World Health Organization's Study on Global Ageing and Adult Health (China, Ghana, India, Mexico, Russia, South Africa) conducted between 2011-2012 and 2007-2010 respectively were analyzed. RESULTS: The association between nine chronic conditions (angina, arthritis, asthma, chronic lung disease, depression, diabetes, hypertension, obesity, and stroke) and self-reported severe/extreme sleep problems in the past 30 days was estimated by logistic regression with multiple variables. The age-adjusted prevalence of sleep problems ranged from 2.8% (China) to 17.0% (Poland). After adjustment for confounders, angina (OR 1.75-2.78), arthritis (OR 1.39-2.46), and depression (OR 1.75-5.12) were significantly associated with sleep problems in the majority or all of the countries. Sleep problems were also significantly associated with: asthma in Finland, Spain, and India; chronic lung disease in Poland, Spain, Ghana, and South Africa; diabetes in India; and stroke in China, Ghana, and India. A linear dose-dependent relationship between the number of chronic conditions and sleep problems was observed in all countries. Compared to no chronic conditions, the OR (95%CI) for 1,2,3, and ≥ 4 chronic conditions was 1.41 (1.09-1.82), 2.55 (1.99-3.27), 3.22 (2.52-4.11), and 7.62 (5.88-9.87) respectively in the overall sample. CONCLUSIONS: Identifying co-existing sleep problems among patients with chronic conditions and treating them simultaneously may lead to better treatment outcome. Clinicians should be aware of the high risk for sleep problems among patients with multimorbidity. Future studies are needed to elucidate the best treatment options for comorbid sleep problems especially in developing country settings.

Prevalence of loss of all teeth (edentulism) and associated factors in older adults in China, Ghana, India, Mexico, Russia and South Africa.

Little information exists about the loss of all one's teeth (edentulism) among older adults in low- and middle-income countries. This study examines the prevalence of edentulism and associated factors among older adults in a cross-sectional study across six such countries. Data from the World Health Organization (WHO's) Study on global AGEing and adult health (SAGE) Wave 1 was used for this study with adults aged 50-plus from China (N = 13,367), Ghana (N = 4724), India (N = 7150), Mexico (N = 2315), Russian Federation (N = 3938) and South Africa (N = 3840). Multivariate regression was used to assess predictors of edentulism. The overall prevalence of edentulism was 11.7% in the six countries, with India, Mexico, and Russia has higher prevalence rates (16.3%-21.7%) than China, Ghana, and South Africa (3.0%-9.0%). In multivariate logistic analysis sociodemographic factors (older age, lower education), chronic conditions (arthritis, asthma), health risk behaviour (former daily tobacco use, inadequate fruits and vegetable consumption) and other health related variables (functional disability and low social cohesion) were associated with edentulism. The national estimates and identified factors associated with edentulism among older adults across the six countries helps to identify areas for further exploration and targets for intervention.

Universal health coverage in emerging economies: findings on health care utilization by older adults in China, Ghana, India, Mexico, the Russian Federation, and South Africa.

BACKGROUND AND OBJECTIVE: The achievement of universal health coverage (UHC) in emerging economies is a high priority within the global community. This timely study uses standardized national population data collected from adults aged 50 and older in China, Ghana, India, Mexico, the Russian Federation, and South Africa. The objective is to describe health care utilization and measure association between inpatient and outpatient service use and patient characteristics in these six low- and middle-income countries. DESIGN: Secondary analysis of data from the World Health Organization's Study on global AGEing and adult health Wave 1 was undertaken. Country samples are compared by socio-demographic characteristics, type of health care, and reasons for use. Logistic regressions describe association between socio-demographic and health factors and inpatient and outpatient service use. RESULTS: In the pooled multi-country sample of over 26,000 adults aged 50-plus, who reported getting health care the last time it was needed, almost 80% of men and women received inpatient or outpatient care, or both. Roughly 30% of men and women in the Russian Federation used inpatient services in the previous 3 years and 90% of men and women in India used outpatient services in the past year. In China, public hospitals were the most frequently used service type for 52% of men and 51% of women. Multivariable regression showed that, compared with men, women were less likely to use inpatient services and more likely to use outpatient services. Respondents with two or more chronic conditions were almost three times as likely to use inpatient services and twice as likely to use outpatient services compared with respondents with no reported chronic conditions. CONCLUSIONS: This study provides a basis for further investigation of country-specific responses to UHC.

Sleep duration, sleep quality, and obesity risk among older adults from six middle-income countries: findings from the study on global AGEing and adult health (SAGE).

OBJECTIVES: Changes in sleep patterns often occur in older adults. Previous studies have documented associations between sleep duration, sleep quality, and obesity risk in older individuals, yet few studies have examined these trends in lower-income countries. The present cross-sectional study uses nationally representative datasets from six countries to examine these relationships. METHODS: Two hypotheses related to obesity risk and sleep patterns were tested using data from the first wave of the World Health Organization's Study on global AGEing and adult health (SAGE). This longitudinal study draws on samples of older adults (>50 years old) in six middle-income countries (China, Ghana, India, Mexico, Russian Federation, and South Africa). Self-report data were used to measure sleep duration, sleep quality, lifestyle and sociodemographic information, while anthropometric measurements were collected to assess body mass index (BMI) and waist circumference (WC). Multiple linear regressions were used to examine the relationship between sleep patterns and obesity risk while controlling for lifestyle factors. RESULTS: Shorter sleep durations in both men and women were significantly associated with higher BMI and WC measures (P < 0.05). Low sleep quality did not significantly contribute to increased obesity risk. Surprisingly, high sleep quality was significantly associated with increased male BMI and WC in China and India (P < 0.01). CONCLUSIONS: This study documented an association between short sleep duration and increased obesity risk, which is important given the global increase of obesity-related diseases.

Multi-country evaluation of affective experience: validation of an abbreviated version of the day reconstruction method in seven countries.

BACKGROUND: The Day Reconstruction Method (DRM) was developed to assess affective states as measures of experienced well-being. The present study aimed to validate an abbreviated version of the DRM in a representative sample of the population in seven countries (China, Ghana, India, Mexico, Russia, South Africa, and Spain), and to examine whether there are country differences in affect and in the relationships among the activities based on the similarity of the affect associated with each of them. METHODS: Interviews were conducted with 47,222 non-institutionalized adults from seven countries, using an abbreviated version of the DRM. A cluster analysis was carried out to classify activities on the basis of the similarity of the associated affect. In each country, the factorial structure of the affect adjectives was tested through Confirmatory Factor Analysis. Internal consistency and construct validity were also assessed. Moreover, the differences in affect across countries and the diurnal cycles of affect were evaluated. RESULTS: The DRM showed adequate psychometric properties regarding reliability and construct validity in all countries. Respondents from Ghana and South Africa reported more positive net affect whereas Indian respondents reported less positive net affect. Most of the countries showed a similar diurnal variation of affect, which tended to improve throughout the day. CONCLUSIONS: The results show that this abbreviated version of the DRM is a useful tool for multi-country evaluation of experienced well-being.

The continuum of psychotic symptoms in the general population: a cross-national study.

OBJECTIVE: To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status. METHOD: The sample was composed of 256,445 subjects (55.9% women), from nationally representative samples of 52 countries worldwide participating in the World Health Organization's World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains. RESULTS: Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55). CONCLUSIONS: The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.