The association of health and income in the elderly: experience from a southern state of Brazil.

OBJECTIVES: In high income, developed countries, health status tends to improve as income increases, but primarily through the 50(th)-66(th) percentile of income. It is unclear whether the same limitation holds in middle income countries, and for both general assessments of health and specific conditions. METHODS: Data were obtained from Brazil, a middle income country. In-person interviews with a representative sample of community residents age ≥ 60 (N=6963), in the southern state of Rio Grande do Sul, obtained information on demographic characteristics including household income and number of persons supported, general health status (self-rated health, functional status), depression, and seven physician-diagnosed, self-reported health conditions. Analyses used household income (adjusted for number supported and economies of scale) together with higher order income terms, and controlled for demographics and comorbidities, to ascertain nonlinearity between income and general and specific health measures. RESULTS: In fully controlled analyses income was associated with general measures of health (linearly with self-rated health, nonlinearly with functional status). For specific health measures there was a consistent linear association with depression, pulmonary disorders, renal disorders, and sensory impairment. For musculoskeletal, cardiovascular (negative association), and gastrointestinal disorders this association no longer held when comorbidities were controlled. There was no association with diabetes. CONCLUSION: Contrary to findings in high income countries, the association of household-size-adjusted income with health was generally linear, sometimes negative, and sometimes absent when comorbidities were controlled.

Prevalence and concomitants of arthritis in the elderly in Rio Grande do Sul, Brazil.

OBJECTIVES: Information on the prevalence and concomitants of arthritis in developing countries is sparse. It is unclear whether they are comparable to findings in developed countries. To ascertain the prevalence, demographic characteristics, and health-related concomitants of arthritis in older persons in the southern state of Rio Grande do Sul, Brazil, a middle income country. METHODS: The state of Rio Grande do Sul, Brazil, was subdivided into nine regions. Stratified random sampling was used to identify 880 community residents age ≥60 years in each region. One region with suspect data was excluded. Of 7040 community residents contacted in eight regions, 6963 participated (1.1% refusal rate). In 1995, trained, monitored interviewers, using structured questionnaires, conducted in-home interviews gathering information on demographic characteristics (age, sex, race/ethnicity, education, income, living arrangements, employment status), health behaviors (physical activity, tobacco use, social activity), functional limitations, depression, and 15 self-reported health conditions, including arthritis. Data were analyzed using descriptive statistics and logistic regression. RESULTS: Arthritis, reported by 43% of the sample, was more prevalent in women, among the less educated, those with lower income, and higher age. Severity, but not prevalence, differed by race/ethnicity. Controlled analyses indicated significant association with female gender, lower education, and less social activity. Arthritis was associated with reduced odds of stroke, but increased odds of hypertension, varicosities, bronchitis, renal problems, headache, gastrointestinal disorders, and depression. Arthritis was not significantly associated with age or functional limitations, and associations did not differ by gender. CONCLUSIONS: The prevalence, demographic and health characteristics associated with self-reported arthritis in this southern state in Brazil are similar to findings elsewhere in Brazil, and in developed countries.

Prevalence and correlates of functional status in an older community--representative sample in Brazil.

OBJECTIVE: Information on dependency level of elderly in rapidly aging developing countries is limited, but this is needed to ascertain the extent of need for help with activities of daily living (ADLs). METHOD: In-person information was obtained in 1995 from a statewide survey of representative community residents >/=60 years of age in the state of Rio Grande do Sul, Brazil (N = 7,040), on demographic characteristics, health conditions, social ties, health behaviors, and ADL performance. RESULTS: Nearly 40% needed help with one or more ADLs. In controlled analyses, need for help approximately doubled with each succeeding decade. Increased education and income and regular physical activity reduced risk. Selected health conditions (stroke, depression, poor self-rated health) were consistently associated with need for help. DISCUSSION: A large proportion of noninstitutionalized elderly have ADL problems. In addition to health care, interventions promoting equity of access to education and economic opportunity could reduce ADL dependency in coming generations.

Predicting the revolving door phenomenon among patients with schizophrenic, affective disorders and non-organic psychoses

Objetivo: Identificar as variáveis preditoras do fenômeno de reinternaçöes (recidividade) em hospital psiquiátrico no momento da segunda internaçäo. Métodos: A amostra consistiu em 3.093 pacientes com diagnóstico de esquizofrenia, transtorno afetivo e psicose näo orgânica acompanhados durante um período de, no mínimo, 5 anos e, no máximo, 24 anos. Foram considerados pacientes recidivistas os que tiveram 4 ou mais internaçöes no período do estudo. Foi utilizado o modelo de regressäo logística para análise do impacto das varáveis sexo, idade, estado civil, cidade de residência, diagnóstico, tempo de permanência na primeira internaçäo, tempo entre a primeira e a segunda internaçäo, segundo o padräo de re-hospitalizaçäo. Resultados: As variáveis com maior poder de prediçäo foram tempo entre a primeira e a segunda internaçäo, tempo de permanência na primeira internaçäo e diagnóstico de esquizofrenia. Conclusöes: Os resultados säo importantes para o planejamento de saúde pública, com o intuito de promover melhores cuidados a um grupo de pacientes pequeno, mas com um alto impacto na utilizaçäo do serviço