title: Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke.
abstract: BACKGROUND
  The combined effect of diabetes and stroke on disability and mortality remains largely unexplored in Brazil and Latin America. Previous studies have been based primarily on data from developed countries. This study addresses the empirical gap by evaluating the combined impact of diabetes and stroke on disability and mortality in Brazil.
  
  
  METHODS
  The sample was drawn from two waves of the Survey on Health and Well-being of the Elderly, which followed 2,143 older adults in São Paulo, Brazil, from 2000 to 2006. Disability was assessed via measures of activities of daily living (ADL) limitations, severe ADL limitations, and receiving assistance to perform these activities. Logistic and multinomial regression models controlling for sociodemographic and health conditions were used to address the influence of diabetes and stroke on disability and mortality.
  
  
  RESULTS
  By itself, the presence of diabetes did not increase the risk of disability or the need for assistance; however, diabetes was related to increased risks when assessed in combination with stroke. After controlling for demographic, social and health conditions, individuals who had experienced stroke but not diabetes were 3.4 times more likely to have ADL limitations than those with neither condition (95% CI 2.26-5.04). This elevated risk more than doubled for those suffering from a combination of diabetes and stroke (OR 7.34, 95% CI 3.73-14.46). Similar effects from the combination of diabetes and stroke were observed for severe ADL limitations (OR 19.75, 95% CI 9.81- 39.76) and receiving ADL assistance (OR 16.57, 95% CI 8.39-32.73). Over time, older adults who had experienced a stroke were at higher risk of remaining disabled (RRR 4.28, 95% CI 1.53,11.95) and of mortality (RRR 3.42, 95% CI 1.65,7.09). However, risks were even higher for those who had experienced both diabetes and stroke. Diabetes was associated with higher mortality.
  
  
  CONCLUSIONS
  Findings indicate that a combined history of stroke and diabetes has a great impact on disability prevalence and mortality among older adults in São Paulo, Brazil.
authors.affiliation: Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA. fandrade@illinois.edu
authors.forename: Flávia Cristina Drumond
authors.initials: FC
authors.lastname: Andrade
authors.forename: Pilar Egüez
authors.initials: PE
authors.lastname: Guevara
authors.forename: Maria Lúcia
authors.initials: ML
authors.lastname: Lebrão
authors.forename: Yeda Aparecida de Oliveira
authors.initials: YA
authors.lastname: Duarte
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001938:Brazil / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000401:mortality*