Life course, gender and ethnic inequalities in functional disability in a Brazilian urban elderly population.
OBJECTIVE
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 comorbidity). 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.
Guerra
Ricardo O
RO
Department of Physical Therapy, Federal University of Rio Grande do Norte, Natal, Brazil. roguerra@ufrnet.br
Alvarado
Beatriz Eugenia
BE
Zunzunegui
Maria Victoria
MV
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D003071:Cognition; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009790:Occupations; D012727:Sex Characteristics; D012959:Socioeconomic Factors; D014505:Urban Population