*This is a guest blogpost regarding our recently published study “Contribution of chronic conditions to gender disparities in disability in the older population in Brazil, 2013″. This paper is our Editors’ Choice of the issue, due to its outstanding scientific quality and public health relevance. You can download it for free here
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The global phenomenon of population ageing has also reached Brazil: a child born in Brazil today can expect to live 20 years more than one born 50 years ago. While most developed countries had more than a century to adjust to this demographic change, the Brazilian population is growing older at a faster pace than most developed nations. The main reason for the rapid increase in longevity in Brazil is the fast decline in infant mortality (135 to 20/1000 births from 1950 to 2010) and the drastic reduction in fertility rates from 6.2 (1950) to 1.8 (2010), which is below the world average of 2.5 in 2010.
However, longer life span does not necessarily imply good health. Chronic conditions are more common in older populations, yet most conditions can be prevented, effectively managed, or delayed. In our study, back pain was the most frequent condition in the older Brazilian population, affecting 1 in every 4 men and almost one third of the women. Diabetes was also common: 1 out of 5 older individuals reported diabetes.
It is expected that those who survive to old age will experience considerable difficulties in functioning. This is mainly due to the increase in chronic conditions in older individuals. According to our study, one in every 3 individuals aged 60 years or older reported some limitation in functioning. In other words, many older individuals in Brazil have at least some difficulty in doing basic daily tasks (such as getting dressed or getting out of bed) or tasks related to independent living skills (such as going to the doctor and using transportation).
The ageing of populations is often followed by the burden of chronic conditions, and consequently, the increase in disability. Given the growing burden of chronic conditions and disability, quantifying how much each condition contributes to disability is crucial to better understand the disability burden and to reduce disability in older populations. In our study, stroke and mental disorders were identified as the most disabling conditions. This means that disability was very frequent in individuals with these conditions.
Gender disparities were observed in the contribution of chronic conditions to disability: while stroke, back pain, and arthritis were the main contributors to the disability burden among men, diabetes, heart diseases, and arthritis contributed most in women. These top 3 conditions accounted for almost one third of the disability in men and one fifth in women.
Although living longer reflects improvements in health and living conditions and thus, is a desirable trend worldwide, it demands a comprehensive public health response. Disability does not have to predominate as people age. To ensure healthy ageing of the Brazilian population, the gender inequalities in the contribution of chronic conditions to the disability burden should be considered in the definition of public health policies to reduce disability in the older population in Brazil.