Ethnic differences in disability-free life expectancy and disabled life expectancy in older adults in Chile.
Chile
Disability-free life expectancy
Ethnicity
Older adults
Journal
BMC geriatrics
ISSN: 1471-2318
Titre abrégé: BMC Geriatr
Pays: England
ID NLM: 100968548
Informations de publication
Date de publication:
31 Jan 2024
31 Jan 2024
Historique:
received:
03
10
2023
accepted:
19
01
2024
medline:
1
2
2024
pubmed:
1
2
2024
entrez:
31
1
2024
Statut:
epublish
Résumé
Although about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown. To estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile. Disability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan's method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile. Non-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively). This is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.
Sections du résumé
BACKGROUND
BACKGROUND
Although about 10% of the Latin American population is indigenous, ethnic differences in disability-free life expectancy (DFLE) and life expectancy with disability (DLE) are unknown.
OBJECTIVE
OBJECTIVE
To estimate disability-free life expectancy and disabled life expectancy among Mapuche (the largest indigenous group) and non-indigenous older adults aged 60 years or more in Chile.
METHOD
METHODS
Disability was measured following a methodology that combines limitations of daily living, cognitive impairment and dependence previously validated in Chile. Finally, the DFLE was estimated using Sullivan's method combining life tables by ethnicity and disability proportions from the EDES survey designed for the study of ethnic differentials in health and longevity in Chile.
RESULTS
RESULTS
Non-Indigenous people have a higher total and Disability-free life expectancy compared to Mapuche people at all ages. While at age 60 a Mapuche expects to live 18.9 years, of which 9.4 are disability-free, a non-Indigenous expects to live 26.4 years, of which 14 are disability-free. In addition, although the length of life with disability increases with age for both populations, Mapuche who survive to age 80 or 90 expect to live 84% and 91% of their remaining life with disability, higher proportions compared to non-indigenous people (62.9% and 75%, respectively).
CONCLUSIONS
CONCLUSIONS
This is the first study addressing inequities in DFLE between the Mapuche and non-Indigenous population, reflected in lower total life expectancy, lower DFLE and higher DLE in Mapuche compared to the non-Indigenous population. Our results underscore the need for increased capacity to monitor mortality risks among older people, considering ethnic differences.
Identifiants
pubmed: 38297194
doi: 10.1186/s12877-024-04728-5
pii: 10.1186/s12877-024-04728-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
116Subventions
Organisme : Agencia Nacional de Investigación y Desarrollo
ID : PAI77190035
Informations de copyright
© 2024. The Author(s).
Références
Comisión Económica para América. Latina y El Caribe (Cepal). CEPALSTAT. 2023 2023.
De Maio FG. Understanding chronic non-communicable diseases in Latin America: towards an equity-based research agenda. Global Health. 2011;7. https://doi.org/10.1186/1744-8603-7-36 .
Kassebaum NJ, Arora M, Barber RM, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990–2015: a systematic analysis for the global burden of Disease Study 2015. The Lancet. 2016;388. https://doi.org/10.1016/S0140-6736(16)31460-X .
Saito Y, Robine JM, Crimmins EM. The methods and materials of health expectancy. Stat J IAOS. 2014;30. https://doi.org/10.3233/SJI-140840 .
Van De Water HPA, Perenboom RJM, Boshuizen HC. Policy relevance of the health expectancy indicator; an inventory in European Union countries. Health Policy (New York). 1996;36. https://doi.org/10.1016/0168-8510(95)00803-9 .
Crimmins EM, Zhang Y, Saito Y. Trends over 4 decades in disability-free life expectancy in the United States. Am J Public Health. 2016;106. https://doi.org/10.2105/AJPH.2016.303120 .
Freedman VA, Wolf DA, Spillman BC. Disability-free life expectancy over 30 years: a growing female disadvantage in the US population. Am J Public Health. 2016;106. https://doi.org/10.2105/AJPH.2016.303089 .
Crimmins EM, Cambois E. Social Inequalities in Health Expectancy. In: Robine J-M, Jagger C, Mathers CD, et al. editors. Determining Health expectancies. John Wiley & Sons, Ltd; 2002. pp. 111–25.
Acosta LD, Monteverde LM, Bramajo ON. Trayectorias de salud en la Argentina: ¿compresión o expansión de la morbilidad? Revista Latinoamericana de Población 2022;16, https://doi.org/10.31406/relap2022.v16.e202205 .
Belon AP, Lima MG, Barros MBA. Gender differences in healthy life expectancy among Brazilian elderly. Health Qual Life Outcomes. 2014;12. https://doi.org/10.1186/1477-7525-12-88 .
Camargos MCS, Gonzaga MR. Live longer and better? Estimates of healthy life expectancy in the Brazilian population. Cad Saude Publica. 2015;31. https://doi.org/10.1590/0102-311X00128914 .
Guedes GR, Castro M, Camargos S, et al. Educational and sex differences in the functional disability life expectancy for the elderly: Brazil, 1998 and 2003. Caderno De Saúde Coletiva. 2011;19:187–96.
Campolina AG, Adami F, Santos JLF, et al. The health transition and changes in healthy life expectancy in the elderly population: possible impacts of chronic disease prevention. Cad Saude Publica. 2013;29. https://doi.org/10.1590/s0102-311x2013000600018 .
Romero DE, Leite I da, Szwarcwald C. CL. Healthy life expectancy in Brazil: applying the Sullivan method. Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 2005;21 Suppl, https://doi.org/10.1590/s0102-311x2005000700002 .
Szwarcwald CL, da Silva de Almeida W, de Souza Júnior PRB, et al. Socio-spatial inequalities in healthy life expectancy in the elderly, Brazil, 2013 and 2019. Cad Saude Publica. 2022;38. https://doi.org/10.1590/0102-311X00124421 .
Moreno X, Lera L, Moreno F, et al. Socioeconomic inequalities in life expectancy and disability-free life expectancy among Chilean older adults: evidence from a longitudinal study. BMC Geriatr. 2021;21. https://doi.org/10.1186/s12877-021-02126-9 .
Moreno X, Lera L, Albala C. Disability-free life expectancy and life expectancy in good self-rated health in Chile: gender differences and compression of morbidity between 2009 and 2016. PLoS ONE. 2020;15:1–12.
doi: 10.1371/journal.pone.0232445
Moreno X, Lera L, Márquez C, et al. Forecasting healthy life expectancy among Chilean Community-Dwelling older adults with and without Sarcopenia. Front Med (Lausanne). 2022;9. https://doi.org/10.3389/fmed.2022.841810 .
Moreno X, Albala C, Lera L, et al. Gender, nutritional status and disability-free life expectancy among older people in Santiago, Chile. PLoS ONE. 2018;13. https://doi.org/10.1371/journal.pone.0194074 .
Sandoval M. Diferencial educacional en la expectativa de vida saludable de los adultos mayores en Chile, 2013. Anais Do XX Encontro Nacional de Estudos Populacionais. 2016, 1–20.
Osuna MM, Farina M, Ailshire J. Gender differences in Disability Life Expectancy among older adults in Colombia Age 60 and older. Innov Aging. 2020;4. https://doi.org/10.1093/geroni/igaa057.1636 .
García MA, Saenz JL, Downer B, et al. Rural and Urban Differences in Cognitive Healthy Life Expectancies among older adults in Mexico. Understanding the Context of Cognitive Aging; 2021.
Rodríguez-Abrego G, Ramírez-Sánchez T, de Torres-Cosme J. JL. Esperanza De vida saludable en adultos mayores con seguridad social. Rev Med Inst Mex Seguro Soc 2014;52.
Andrade F. Estimating diabetes and diabetes-free life expectancy in Mexico and seven major cities in Latin America and the Caribbean. Revista Panam De Salud Publica/Pan Am J Public Health. 2009;26. https://doi.org/10.1590/S1020-49892009000700002 .
Beltrán-Sánchez H, Andrade FCD. Educational and sex differentials in life expectancies and disability-free life expectancies in São Paulo, Brazil, and Urban areas in Mexico. J Aging Health. 2013;25. https://doi.org/10.1177/0898264313491425 .
Brenes Camacho G, Agudelo Botero M, Redondo N, et al. La medición de la esperanza de vida libre de limitaciones cognitivas y la esperanza de vida con limitaciones cognitivas en América Latina. Notas Poblacion. 2019;45. https://doi.org/10.18356/352e86da-es .
Rose AMC, Hennis AJ, Hambleton IR. Sex and the city: differences in disease- and disability-free life years, and active community participation of elderly men and women in 7 cities in Latin America and the Caribbean. BMC Public Health. 2008;8. https://doi.org/10.1186/1471-2458-8-127 .
Rueda-Salazar S, Spijker J, Devolder D, et al. The contribution of social participation to differences in life expectancy and healthy years among the older population: a comparison between Chile, Costa Rica and Spain. PLoS ONE. 2021;16. https://doi.org/10.1371/journal.pone.0248179 .
Prina AM, Wu YT, Kralj C, et al. Dependence- and disability-free life expectancy across eight low- and Middle-Income countries: a 10/66 study. J Aging Health. 2020;32:401–9.
doi: 10.1177/0898264319825767
pubmed: 30698491
Payne CF. Aging in the Americas: disability-free life expectancy among adults aged 65 and older in the United States, Costa Rica, Mexico, and Puerto Rico. J Gerontol B Psychol Sci Soc Sci. 2018;73:337–48.
pubmed: 26347520
Sandoval MH, Alvear Portaccio M, Albala C. Life expectancy by ethnic origin in Chile. Front Public Health 11:1147542.
Chackiel J, Ortega A. Tablas de Mortalidad Femenina de Guatemala, Honduras y Nicaragua. Santiago, 1977.
Comisión Económica para América. Latina y el Caribe (CEPAL) NU. Mortalidad infantil y en la niñez de pueblos indígenas y afrodescendientes de América Latina: inequidades estructurales, patrones diversos y evidencia de derechos no cumplidos. Colección Documentos de proyectos 2010:1–45.
Robles A. Mortalidad adulta entre poblaciones indígenas y no indígenas de Guatemala Y Bolivia. Notas Poblacion. 1996;64:1–30.
Sandoval MH, Alvear Portaccio ME. Death certificate: the urgent consideration of ethnic and racial origin in Chile. Lancet Reg Health - Americas. 2022;16. https://doi.org/10.1016/j.lana.2022.100402 .
Sandoval MH, Turra CM. El Gradiente educativo en la mortalidad adulta en Chile. Revista Latinoam De Población. 2015;9:1–29.
doi: 10.31406/relap2015.v9.i2.n17.5
Sandoval MH, Turra CM, Luz L. The importance of Education for Middle- and old-age mortality in Chile: estimates from Panel Data Linked to Death records. J Aging Health. 2022;34:71–7.
doi: 10.1177/08982643211027404
pubmed: 34139877
Anderson I, Robson B, Connolly M, et al. Indigenous and tribal peoples’ health (the Lancet-Lowitja Institute Global Collaboration): a population study. Lancet. 2016;388:131–57.
doi: 10.1016/S0140-6736(16)00345-7
pubmed: 27108232
MINSAL M de S. Perfil Epidemiológico Básico de La Población Mapuche Residente En El Área de Cobertura Del Servicio de Salud Araucanía Norte. Santiago, 2011.
Ministerio de Salud (MINSAL). Perfil Epidemiológico Básico de La Población Mapuche Residente En El Área de Cobertura Del Servicio de Salud Araucanía Norte. Santiago, 2011.
Oyarce AM, Romeggi MI, Vidal A. Como Viven Los Mapuches. Análisis Del Censo de Población de Chile de 1982. Santiago, 1989.
Instituto Nacional de Estadísticas (INE). Censo de Población y Vivienda. 2017.
Aravena Reyes A. In: Aravena A, editor. Mapuches En Santiago. Memorias De Inmigrantes Y Residentes. Relatos Para Una Antropología Implicada Sobre Indígenas Urbanos. 1 ed. Concepción: Ediciones Escaparate; 2008.
Alvarado Lincopi C. Silencios coloniales, silencios micropolíticos. Memorias De violencias y dignidades mapuche en Santiago De Chile. Aletheia. 2016;6:1–17.
Aravena A. La Identidad mapuche - warriache: Procesos Migratorios contemporáneos e identidad mapuche urbana. Tomo I Actas Del 4o Congreso Chileno De Antropología. Santiago de Chile: Colegio de Antropólogos de Chile A. G; 2001. pp. 285–97.
Nahuelpan Moreno H. Formación colonial del estado y desposesión en Ngulumapu. In: Nahuelpan Moreno H, Huinca Piutrin H, Mariman Quemado P, et al. editors. Ta Iñ Fijke Xipa Rakizuameluwün. Historia, Colonialismo Y Resistencia Desde El País Mapuche. 1st ed. Temuco: Ediciones Comunidad de Historia Mapuche; 2012. pp. 119–52.
Antileo Baeza E. Migración Mapuche Y continuidad colonial. In: Nahuelpan Moreno H, Huinca Piutrin H, Mariman Quemado P, et al. editors. Ta Iñ Fijke Xipa Rakizuameluwün. Historia, Colonialismo Y Resistencia Desde El País Mapuche. 1st ed. Temuco: Ediciones Comunidad de Historia Mapuche; 2012. pp. 187–209.
CEPAL (Comisión. Económica para América Latina Y El Caribe). La Ineficiencia De La Desigualdad. Santiago de Chile; 2018.
CEPAL (Comisión Económica para América Latina y el Caribe). Los Pueblos Indígenas En América Latina. Avances En El Último Decenio Y Retos Pendientes Para La Garantía De Sus Derechos. Santiago de Chile; 2014.
Gaudin Y, Pareyón R. Brechas Estructurales En América Latina Y El Caribe. Una Perspectiva Conceptual-Metodológica.; 2020.
Brass W. Evaluation of Birth and Death Registration Using Age Distribution and Child Survivorship Data., 1979.
Fuentes-García A, Sánchez H, Lera L, et al. Desigualdades socioeconómicas en El proceso de discapacidad en una cohorte de adultos mayores de Santiago de Chile. Gac Sanit. 2013;27. https://doi.org/10.1016/j.gaceta.2012.11.005 .
Quiroga P, Albala BC, Klaasen G. Validation of a screening test for age associated cognitive impairment, in Chile. Rev Méd Chile 2004:467–78.
Sullivan DF. A single index of mortality and morbidity. HSMHA Health Rep. 1971;86. https://doi.org/10.2307/4594169 .
Jagger C, Oyen H, Van, Robine J-M. Health Expectancy calculation by the Sullivan Method: a practical guide. Newcastle University Isntitute of Ageing; 2014.
Chang MH, Molla MT, Truman BI, et al. Differences in healthy life expectancy for the US population by sex, race/ethnicity and geographic region: 2008. J Public Health (United Kingdom). 2015;37. https://doi.org/10.1093/pubmed/fdu059 .
Solé-Auró A, Beltrán-Sánchez H, Crimmins EM. Are differences in disability-free life expectancy by gender, race, and Education Widening at older ages? Popul Res Policy Rev. 2015;34. https://doi.org/10.1007/s11113-014-9337-6 .
Hayward MD, Heron M. Racial inequality in active life among adult americans. Demography. 1999;36. https://doi.org/10.2307/2648135 .
Dwyer-Lindgren L, Kendrick P, Kelly YO, et al. Life expectancy by county, race, and ethnicity in the USA, 2000–19: a systematic analysis of health disparities. The Lancet. 2022;400. https://doi.org/10.1016/S0140-6736(22)00876-5 .
Gracey M, King M. Indigenous health part 1: determinants and disease patterns. The Lancet. 2009;374. https://doi.org/10.1016/S0140-6736(09)60914-4 .
Montenegro RA, Stephens C. Indigenous health in Latin America and the Caribbean. Lancet. 2006;367. https://doi.org/10.1016/S0140-6736(06)68808-9 .
Hill K, Barker B, Vos T. Excess indigenous mortality: are indigenous australians more severely disadvantaged than other indigenous populations? Int J Epidemiol. 2007;36. https://doi.org/10.1093/ije/dym011 .
Phillips B, Daniels J, Woodward A, et al. Mortality trends in Australian Aboriginal peoples and New Zealand Maori. Popul Health Metr. 2017;15. https://doi.org/10.1186/s12963-017-0140-6 .
Australian Bureau of Statiscs (ABS). Calculating experimental life tables for use in population estimates and projections of Aboriginal and Torres Strait Islander Australians, 1991 to 2001. Demography Working Paper 2004.
Chackiel J. Métodos De estimación De La Fecundidad Y La mortalidad a partir de censos, una aplicación a pueblos indígenas de Panamá. Notas Poblacion. 2005;79:171–210.
Chiavegatto Filho ADP, Beltrań-Sánchez H, Kawachi I. Racial disparities in life expectancy in Brazil: challenges from a multiracial society. Am J Public Health. 2014;104. https://doi.org/10.2105/AJPH.2013.301565 .
Urrego R. Transición demográfica racial de los pueblos indígenas en Colombia: análisis de la influencia de la reetnización, de la dinámica demográfica y de la captaciòn en los censos de 1993 y 2005. 2019.
OECD, Economic Outlook. Volume 2023 Issue 1. 2023, https://doi.org/10.1787/16097408 .
Phelan JC, Link BG, Tehranifar P. Social conditions as Fundamental causes of Health inequalities: theory, evidence, and Policy implications. J Health Soc Behav. 2010;51:28–40.
doi: 10.1177/0022146510383498
Crimmins EM, Saito Y. Trends in healthy life expectancy in the United States, 1970–1990: gender, racial, and educational differences. Soc Sci Med. 2001;52. https://doi.org/10.1016/S0277-9536(00)00273-2 .
Pedrero M-M. Hacia Una Recuperación Económica Transformadora de América Latina-Abya Yala: Desafíos Para Garantizar Los Derechos Colectivos de Los Pueblos Indígenas. Santiago, 2023.
Amigo H, Bustos P. Salud y nutrición del niño indígena chileno (Mapuche). Cad Saude Publica. 2019;35. https://doi.org/10.1590/0102-311x00073918 .
Carrasco PE, Pérez BF, Angel BB, et al. Prevalencia De Diabetes tipo 2 y obesidad en Dos Poblaciones aborígenes De Chile en ambiente urbano. Rev Med Chil. 2004;132. https://doi.org/10.4067/s0034-98872004001000005 .
Gallardo-Peralta LP, Sánchez-Moreno E, De Roda ABL, et al. Ethnicity, social support, and depression among elderly Chilean people. J Psychol. 2015;149. https://doi.org/10.1080/00223980.2014.946462 .
Fuentes P, Albala C. An update on aging and dementia in Chile. Dement Neuropsychol. 2014;8:317–22.
doi: 10.1590/S1980-57642014DN84000003
pubmed: 29213920
pmcid: 5619178
Ministerio de Salud (MINSAL). Estrategia Nacional de Salud Para Los Objetivos Sanitarios al 2030 2022. Santiago, 2022.