and

Wisconsin (P30 HD05876) and to the Center for Demography of Health and Aging, University of Wisconsin (P30 AG17266). 2 Context. We know precious little about adult health in developing countries in general and Latin America in particular. We know even less about the health conditions of elderly individuals. Since Mexico and many other countries in Latin America and the Caribbean region are and will continue to experience a very rapid process of aging, it is important to generate pertinent information and analyze it promptly to identify key features that could be used to formulate and design health policies. This is particularly useful in Mexico, and other countries of the region, which have embarked in sweeping reforms of the health sector. Objective. We aim to investigate the health profile of elderly Mexicans aged 50 and over. We are guided by two overarching concerns. First, does the health profile of elderly Mexicans reveal any special features, distinct from what one would expect from extant research on elderly individuals? Second, is there any evidence of relation

The Elderly in Latin America and the Caribbean

Texto dispoñible en galego, español e inglésEste artigo céntrase nos perfís de saúde da poboacion máis madura e defende a hipótese de que o estado de saúde dos máis vellos viuse afectado significativamente pola evolución da mortalidade nos países da rexión. Utilizamos o SABE (Survey on Health and Well-Being of Elders) sobre unha mostra representativa do tipo cross-section de 10.000 persoas de 60 anos e máis, mediante enquisas realizadas a domicilio en sete grandes cidades de América Latina e do Caribe. Analizamos os seguintes indicadores de saúde: o estado de saúde subxectivo (baseándonos na declaración dos enquisados), as limitacións funcionais, as actividades cotiás (Activities of Daily Living -ADL-) e as actividades instrumentais cotiás (Instrumental Activities of Daily Living -IADL-), a obesidade (relación entre o peso en quilogramos e o cadrado da altura en centímetros) e as condicións crónicas segundo a declaración dos enquisados (incluíndose a diabetes). Analizamos as pautas de saúde e as condicións crónicas e de enfermidade confesadas polo entrevistado; tamén examinamos a relación entre as condicións da infancia e a saúde no adulto. En particular, pretendemos demostrar que as condicións de saúde da infancia teñen relación coa saúde na etapa adulta. Con todo, as relacións non son fortes e a evidencia é bastante feble aínda no mellor dos casosEste artículo se centra en los perfiles de salud de la poblacion más madura y defiende la hipótesis de que el estado de salud de los más viejos se ha visto afectado significativamente por la evolución de la mortalidad en los países de la región. Utilizamos el SABE (Survey on Health and Well-Being of Elders) sobre una muestra representativa del tipo cross-section de 10.000 personas de 60 años y más, mediante encuestas realizadas a domicilio en siete grandes ciudades de América Latina y del Caribe. Analizamos los siguientes indicadores de salud: el estado de salud subjetivo (basándonos en la declaración de los encuestados), las limitaciones funcionales, las actividades cotidianas (Activities of Daily Living -ADL-) y las actividades instrumentales cotidianas (Instrumental Activities of Daily Living -IADL-), la obesidad (relación entre el peso en kilogramos y el cuadrado de la altura en centímetros) y las condiciones crónicas según la declaración de los encuestados (incluyéndose la diabetes). Analizamos las pautas de salud y las condiciones crónicas y de enfermedad confesadas por el entrevistado; también examinamos la relación entre las condiciones de la infancia y la salud en el adulto. En particular, pretendemos demostrar que las condiciones de salud de la infancia tienen relación con la salud en la etapa adulta. Sin embargo, las relaciones no son fuertes y la evidencia es bastante débil aún en el mejor de los casosThis paper focuses on elderly health profiles and examines the conjecture that elderly health status has been significantly impacted by the evolution of mortality in countries of the region. We use SABE (Survey on Health and Well-Being of Elders), a cross-sectional representative sample of over 10,000 elderly aged 60 and above in private homes fielded in seven major cities in Latin America and the Caribbean. We examine the following health outcomes: self-reported health, functional limitations-Activities of Daily Living (ADL’s) and Instrumental Activities of Daily Living (IADL’s), obesity (ratio of weight in kilograms to the square of height in centimeters), and self reported chronic conditions (including diabetes). We examine patterns of self-reported health, self-reported chronic conditions, and disability. We also examine relations between early childhood conditions and adult health. In particular, we attempt to illustrate the idea that early childhood conditions and adult health are related. However, the relations are not strong and the evidence for it is weak at bestS

Displacement due to armed conflict and violence in childhood and adulthood and its effects on older adult health. The case of the middleincome country of Colombia

Q11-13Large population displacement in developing economies due to internal armed conflict and violence is of international concern. There has been relatively little research on the long-term consequences of displacement on older adult health among populations characterized by rapid demographic, epidemiological, and nutritional transitions during the 20th century. We examine displacement in the middle-income country of Colombia, which experienced these rapid transitions and a large population displacement over the last 50-60 years due to internal armed conflict and violence. Using a nationally representative survey of adults 60 years and older, SABE-Colombia (2014-2015, n = 23,694), we estimate the degree to which displacement relative to those never displaced is associated with older adult health (self-reported health, major illness/stress, at least one chronic condition, heart disease), controlling for age, gender, SES (socioeconomic status), residence, early life conditions (infectious diseases, poor nutrition, health, SES, family violence), and adult behavior (smoking, exercise, nutrition). We found (1) strong associations between poor early life conditions and older adult health with little attenuation of effects after controlling for displacement, adult SES, and lifestyle; (2) strong associations between displacement and self-reported health; along with poor early life conditions, displacement increases the chances of poor health at older ages; (3) significant positive interaction effects between childhood infections and displacement during young adulthood for older adult stress/major illness, suggesting the importance of the timing of displacement; (4) significant interaction effects between childhood infections and being displaced during childhood, indicating lower levels of older adult stress/major illness and suggesting the possibility of resilience due to childhood adversity. We conclude that displacement compounds the effects of poor early life conditions and that timing of displacement can matter. The results raise the possibility of similar patterns in the health of aging populations in lowincome countries that also experience displacement and rapid demographic and epidemiological transitions

Patterns of SES Health Disparities Among Older Adults in Three Upper Middle- and Two High-Income Countries

Artículo original23-37Objectives To examine the socioeconomic status (SES) health gradient for obesity, diabetes, and hypertension within a diverse group of health outcomes and behaviors among older adults (60+) in upper middle-income countries benchmarked with high-income countries. Method We used data from three upper middle-income settings (Colombia-SABE-Bogotá, Mexico-SAGE, and South Africa-SAGE) and two high-income countries (England-ELSA and US-HRS) to estimate logistic regression models using age, gender, and education to predict health and health behaviors. Results The sharpest gradients appear in middle-income settings but follow expected patterns found in high-income countries for poor self-reported health, functionality, cognitive impairment, and depression. However, weaker gradients appear for obesity, hypertension, diabetes, and other chronic conditions in Colombia and Mexico and the gradient reverses in South Africa. Strong disparities exist in risky health behaviors and in early nutritional status in the middle-income settings. Discussion Rapid demographic and nutritional transitions, urbanization, poor early life conditions, social mobility, negative health behavior, and unique country circumstances provide a useful framework for understanding the SES health gradient in middle-income settings. In contrast with high-income countries, the increasing prevalence of obesity, an important risk factor for chronic conditions and other aspects of health, may ultimately change the SES gradient for diseases in the future

In utero exposures, season of birth and population studies of older adults: Author's reply

Early life conditions Season of birth Infant mortality Aging In utero conditions Heart disease Diabetes Puerto Rico

Impacts of the 1918 flu on survivors’ nutritional status: A double quasi-natural experiment

Three files needed to reproduce our work (data, code, results) are in https://gitlab.com/csic-echo/1918-flu-puerto-rico.Robust empirical evidence supports the idea that embryonic and, more generally, intrauterine disruptions induced by the 1918-flu pandemic had long-term consequences on adult health status and other conditions. In this paper we assess the 1918-flu long-term effects not just of in utero exposure but also during infancy and early childhood. A unique set of events that took place in Puerto Rico during 1918–1919 generated conditions of a “double quasi-natural experiment”. We exploit these conditions to empirically identify effects of exposure to the 1918 flu pandemic and those of the devastation left by an earthquake-tsunami that struck the island in 1918. Because the earthquake-tsunami affected mostly the Western coast of the island whereas early (in utero and postnatal) exposure to the flu was restricted to those born in the interval 1917–1920, we use geographic variation to identify the effects of the quake and timing of birth variation to identify those of the flu. We benefit from availability of information on markers of nutritional status in a nationally representative sample of individuals aged 75 and older in 2002. We make two contributions. First, unlike most fetal origins research that singles out early nutritional status as a determinant of adult health, we hypothesize that the 1918 flu damaged the nutritional status of adult survivors who, at the time of the flu, were in utero or infants. Second, we target markers of nutritional status largely set when the adult survivors were infants and young children. Estimates of effects of the pandemic are quite large mostly among females and those who were exposed to the earthquake-tsunami. Impacts of the flu in areas less affected by the earthquake are smaller but do vary by area flu severity. These findings constitute empirical evidence supporting the conjecture that effects of the 1918 flu and/or the earthquake are associated not just with disruption experienced during the fetal period but also postnatally.This work was supported by the National Institute on Aging (https://www.nia.nih.gov/), National Institute of Child Health and Development (https://www.nichd.nih.gov), Fogarty International Center Global Research Training in Population and Health (https://www.fic.nih.gov) and European Research Council (https://erc.europa.eu/) via the following project grants R01-AG016209 (AP), R03-AG015673(AP), R01-AG018016(AP), R37-AG025216 (AP), RO1-AG056608 (AP;HBS), RO1-AG052030(AP;HBS); D43-TW001586(AP), R24-HD047873(AP), P30-AG-017266(AP), R24 HD041022(UCLA:HBS); European Union Horizon 2020 Research and Innovation Programme, Project No 788582(AP).Peer reviewe