Income inequality and functional capacity of the elderly in a city in Southeastern Brazil

Veloso, Marylane Viana; Sousa, Neuciani Ferreira da Silva; Medina, Lhais de Paula Barbosa; Barros, Marilisa Berti de Azevedo

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Revista Brasileira de Epidemiologia

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ORIGINAL ARTICLE • Rev. bras. epidemiol. 23 • 2020 • https://doi.org/10.1590/1980-549720200093 copy

Income inequality and functional capacity of the elderly in a city in Southeastern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

Estimate the magnitude of the income inequality in the prevalence of functional dependency for basic and instrumental activities of daily life (BADLs, IADLs) and the abandonment of advanced activities (AADLs).

Methods:

This was a cross-sectional, population-based study, developed using sample data of 986 elderly people from a health survey carried out in the municipality of Campinas, São Paulo, in 2014/15. The prevalence of functional dependency in BADLs and IADLs and of abandonment of the AADLs was estimated according to monthly family income per capita. A multiple regression Poisson analysis was developed to estimate the prevalence ratio (PR) adjusted by gender and age.

Results:

There was no significant association between income and functional dependency for BADLs. Of the seven IADLs analyzed, five presented a higher prevalence of dependency in the lower-income stratum, with special highlight to using the phone (PR = 3.50), controlling medication usage (PR = 2.44), and use of transportation (PR = 2.35). The abandonment of AADLs was higher among low-income elderly people in all activities analyzed, with the greatest inequalities observed in making contact by letter, phone and e-mail (PR = 3.76), using the Internet (PR = 3.34), driving vehicles (PR = 2.85) and visiting family (PR = 2.77).

Conclusions:

The broad inequality detected among income stratum regarding the functional capability for the IADLs and abandonment of the AADLs emphasize the importance of fully implementing and maintaining the policies and programs directed toward the social protection of elderly adults. The focus should be on the most socially vulnerable segments, with the aim of achieving a population that is more equal, active, independent, and involved in participatory ageing.

Keywords:
the Elderly; Health surveys; Health status disparities; Activities of daily living

Variables	%	Family income per capita*			p-value
Variables	%	> 2 n = 332	1 to 2 n = 366	< 1 n = 280	p-value
Sex
Male	42.3	43.4	45.0	37.3	0.0785
Female	57.7	56.6	55.0	62.7	0.0785
Age group (years)
60-69	56.8	63.7	54.2	51.3	0.0621
70-79	27.8	21.7	30.9	31.7
80 e +	15.4	14.6	14.9	17.0
Schooling (years)
9 +	26.3	49.2	15.7	10.2	< 0.0001
4 to 8	41.7	39.5	46.2	38.8
0 to 3	32.0	11.3	38.1	51.0
Race/color
White	71.2	80.0	68.9	62.8	0.0016
Non-white	28.8	20.0	31.1	37.2	0.0016
No. of household appliances
1 to 10	52.5	23.9	69.3	67.6	< 0.0001
11 and +	47.5	76.1	30.7	32.4	< 0.0001
Has access to computer	44.7	61.5	31.5	40.0	< 0.0001
Does paid work	22.1	24.9	20.8	20.2	0.4124
Has a private health plan	46.9	75.7	36.5	23.0	< 0.0001
No. of diseases
None	12.1	11.9	13.3	10.7	0.7202
1 to 2	33.9	35.8	33.7	31.5
3 and more	54.0	52.3	53.0	57.8
Self-rated health: fair/poor/very poor	34.2	26.4	34.8	43.8	0.0008
Dependence for at least 1 BADL	8.4	5.9	9.0	10.8	0.0894
Dependence for at least 1 IADL	42.9	34.7	44.8	51.6	0.0067
Abandonment for at least 1 AADL	58.7	52.1	57.2	69.3	0.0009

Activities	Family income per capita*			RP * (95%CI)**
Activities	> 2 (1)	1 a 2 (2)	< 1 (3)	(2/1)	(3/1)
Basic activities
Bathing	5.1	6.5	8.3	1.16 (0.66 - 2.06)	1.38 (0.73 - 2.58)
Getting dressed	4.8	8.1	6.9	1.49 (0.79 - 2.80)	1.20 (0.64 - 2.22)
Using the bathroom	3.0	4.0	4.8	1.20 (0.55 - 2.64)	1.35 (0.66 - 2.79)
Lying down and getting up	3.5	4.4	5.9	1.18 (0.53 - 2.64)	1.44 (0.61 - 3.37)
Feeding oneself	2.5	3.5	4.7	1.33 (0.57 - 3.09)	1.68 (0.63 - 4.46)
Dependency for 1 or more	5.9	9.0	10.8	1.38 (0.80 - 2.38)	1.57 (0.91 - 2.70)
Instrumental activities
Using the phone	4.7	10.3	18.4	2.13 (1.21 - 3.75)	3.50 (1.80 - 6.81)
Using transportation	9.7	20.7	26.5	1.98 (1.21 - 3.22)	2.35 (1.50 - 3.67)
Going shopping	20.0	26.0	36.6	1.22 (0.88 - 1.70)	1.59 (1.21 - 2.07)
Preparing meals	6.1	7.0	10.2	1.04 (0.61 - 1.76)	1.41 (0.87 - 2.29)
Doing household chores	23.5	26.4	24.3	1.08 (0.80 - 1.48)	0.90 (0.68 - 1.20)
Taking medications	6.6	11.7	18.2	1.64 (1.01 - 2.66)	2.40 (1.39-4.15)
Taking care of finances	18.2	25.9	31.5	1.37 (1.05 - 1.79)	1.56 (1.15 - 2.10)
Dependency for 1 or more	34.7	44.8	51.6	1.25 (0.96 - 1.62)	1.34 (1.11 - 1.63)

Variables	Family income per capita*			PR* (95%CI)**
Variables	> 2 (1)	1 a 2 (2)	< 1 (3)	(2/1)	(3/1)
Volunteering	33.4	44.1	48.6	1.29 (0.93 - 1.78)	1.47 (1.04 - 2.07)
Contacting people by letter, email or phone	4.0	9.7	16.4	2.29 (1.13 - 4.60)	3.76 (1.78 - 7.92)
Visiting family or friends	4.4	9.7	12.7	2.13 (0.95 - 4.78)	2.77 (1.24 - 6.17)
Participating in social activities	32.9	40.7	54.9	1.21 (0.93 - 1.59)	1.63 (1.20 - 2.23)
Using the internet	8.3	9.7	28.5	1.16 (0.36 - 3.68)	3.34 (1.43 - 7.79)
Traveling	21.0	26.5	38.0	1.21 (0.89 - 1.63)	1.67 (1.22 - 2.29)
Driving vehicles	19.7	35.1	57.9	1.82 (1.26 - 2.63)	2.85 (1.92 - 4.25)
Stopped doing 1 or more	52.1	57.2	69.3	1.07 (0.95 - 1.21)	1.28 (1.11 - 1.49)

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E-mail: revbrepi@usp.br

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[1] Corresponding author: Marylane Viana Veloso. Rua Luiz Pires de Lima, 3.770, CEP: 64047-020, São João, Teresina (PI), Brazil. E-mail: marylanevviana@gmail.com