Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population

• Published in: Aging clinical and experimental research 2008-02, Vol.20 (1), p.53-61
• Main Authors: Guerra, Ricardo O., Alvarado, Beatriz Eugenia, Zunzunegui, Maria Victoria
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Brazil; Cognition; Disabled Persons - statistics & numerical data; Female; Gender; Geriatric Assessment; Geriatrics/Gerontology; Health Status; Humans; Life Change Events; Logistic Models; Male; Medicine; Medicine & Public Health; Middle Aged; Occupations; Original Article; Sex Characteristics; Socioeconomic Factors; Urban Population; Well being
• ISSN: 1594-0667; 1720-8319
• DOI: 10.1007/BF03324748

Background and aims : To examine life course social, gender and ethnic inequalities in ADL disability in a Brazilian urban elderly population. Methods : We used the São Paulo-SABE study (health, well-being and aging in Latin America and the Caribbean) to assess the associations between ADL disability and gender, ethnicity and life course social conditions (childhood socio-economic and health status, education, lifetime occupation, current perception of income), controlling for current physical and mental health (cognitive impairment and co-morbidity). ADL disability was defined as the presence of one or more difficulties with six tasks: bathing, toileting, dressing, walking across the room, eating, and getting out of bed. Results : Results suggest that social inequalities during the life course (hunger and poverty in early life; illiteracy, a low skilled occupation, having been a housewife; insufficient income) tend to result in disability in later life. The prevalence of ADL disability was higher among women (22.4%) than among men (14.8%). Mestizo/Native elders reported higher prevalence of disability compared with Whites and Blacks/Mulattos. Ethnic inequalities concerning ADL disability were explained by social and health conditions, but the gender gap persisted (OR women vs men= 2.16; 95% CI 1.32–3.55). Despite their higher rate of ADL disability in old age, women appear to be more resilient than men toward poor socio-economic conditions throughout the life course. Chronic conditions were more likely to result in ADL disability among men than women (OR= 1.83; 95% CI 1.41–2.38 in women; OR= 3.42; 95% CI 2.41–4.86 in men). Conclusions : Decreasing social inequalities during childhood and adulthood will reduce socio-economic inequalities in disability in old age, especially among men.