Social determinants of cardiovascular diseases, functional limitations and disability

Resumen

Background and objectives: The accelerated aging of the population and the increase in inequalities in access to health and social assistance services constitute one of the greatest challenges for public health in most countries. The burden of non-communicable diseases (NCDs) constitutes an important health problem with serious social and economic consequences. According to the World Health Organization (WHO), NCDs are the main cause of mortality in the world. Most of these deaths are premature and are concentrated in low and middle income countries, and are caused by known and preventable risk factors. Bearing in mind that studies on social inequalities in chronic health disorders of the elderly are limited, the following objectives were proposed for this doctoral thesis: • To examine the distribution of the main behavioral and biological cardiovascular risk factors (CVRF) according to socioeconomic status (NSE) among older adults in Spain. • To evaluate the cross-sectional association between housing conditions and physical function limitations in older adults in Spain. • To evaluate the prospective association between housing conditions and physical function limitations in older adults in Spain. • To assess the contribution of the main social determinants to inequalities in disability in Europe. Methods: For the first three objetives, data from the older adult components of the Nutrition and Cardiovascular Risk Study in Spain (Seniors-ENRICA) were used. Briefly, during the years 2008-2010, 3518 men and women aged 60 and over were selected by stratified random sampling of the non-institutionalized Spanish population. Participants were followed until 2015. At baseline, 2012 and 2015, reported information was collected on sociodemographic variables, health behaviors and morbidity. In addition, blood and urine samples were collected and a physical examination was performed. For the last objective, we worked with data from the 7th wave of the European Social Survey (ESS) 2014, which included a module on social inequalities in health and their determinants for several European countries. The sample included 19882 participants 30 to 79 years of age belonging to 19 countries in Europe. Results: Older adults with higher education in Spain drank alcohol more frequently, engaged in more leisure-time physical activity, and spent less time watching television. An inverse educational gradient was also observed for obesity, metabolic syndrome, diabetes and cardiovascular disease. Those who had worked or whose father had worked in a manual occupation, showed a higher prevalence of CVRF. Differences in CVRF across socioeconomic level were generally greater in women than in men. In the Seniors-ENRICA study, poor housing conditions were associated with worse score in the Short Physical Performance Battery, greater frequency of agility limitations, and greater risk of frailty. In most European countries, the prevalence of disability was higher among women and among less educated subjects. However, substantial differences were observed between countries. Factors related to working conditions among men, and health behaviors among women, contributed the most to explain inequalities in disability. Conclusions: There are important inequalities in CVRF and in physical function limitations among older adults in Spain. Inequalities in disability in European countries are mainly explained by behavioral factors and by work-related conditions. These inequalities could be reduced by preventive actions focused on lifestyles and working conditions.