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Summary
This study, published in Revista de Saúde Summary
This study, published in Revista de Saúde Pública (2013), investigates whether the elimination of certain chronic diseases can lead to a compression of morbidity among elderly individuals in São Paulo, Brazil. It uses population-based data from the 2000 SABE (Health, Wellbeing and Ageing) study and official mortality records to evaluate changes in disability-free life expectancy (DFLE) resulting from the hypothetical removal of specific chronic conditions.
Background and Objectives
Chronic non-communicable diseases (NCDs) such as cardiovascular diseases, diabetes, and chronic pulmonary conditions account for approximately 50% of diseases in developing countries and are major contributors to morbidity and mortality.
In Brazil, these diseases represent the main health burden and priority for healthcare systems.
The compression of morbidity theory posits that delaying the onset of debilitating diseases compresses the period of morbidity into a shorter segment at the end of life, thus increasing healthy life expectancy.
Other theories include:
Expansion of morbidity: Mortality declines due to reduced lethality but incidence remains or increases, leading to longer periods of morbidity.
Dynamic equilibrium: Both mortality and morbidity decline, keeping years lived with severe disability relatively constant.
The study aims to analyze whether eliminating certain chronic diseases would compress morbidity among elderly individuals, improving overall health expectancy.
Methodology
Design: Analytical, population-based, cross-sectional study.
Population: 2,143 elderly individuals (aged 60+) from São Paulo, Brazil, sampled probabilistically in 2000 as part of the SABE study.
Data collection:
Structured questionnaire covering sociodemographics, health status, functional capacity, and chronic diseases.
Self-reported presence of 9 chronic diseases based on ICD-10: systemic arterial hypertension, diabetes mellitus, heart disease, lung disease, cancer, joint disease, cerebrovascular disease, falls in previous year, and nervous/psychiatric problems.
Functional disability defined by difficulties in activities of daily living (dressing, eating, bathing, toileting, ambulation, fecal and urinary incontinence).
Statistical analysis:
Sullivan’s method used to compute life expectancy (LE) and disability-free life expectancy (DFLE).
Cause-deleted life tables estimated probabilities of death with elimination of specific diseases.
Multiple logistic regression (controlling for age) assessed disability prevalence changes with disease elimination.
Assumption: independence between causes of death and disability.
Sampling weights and corrections for design effects were applied to represent the São Paulo elderly population.
Key Findings
Sample Characteristics
Females represented 58.6% of the sample.
Higher proportion of women aged 75+ (24.2%) than men (19.2%).
Women more frequently widowed or single; men had higher employment rates.
Women more likely to live alone.
Smart Summary
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