Palloni, Alberto, Beth J. Soldo, Rebeca Wong, and Mary McEniry
Working paper no. 2003-03
Context: We know precious little about adult health in developing countries in general and Latin America in particular. We know even less about the health conditions of elderly individuals. Since Mexico and many other countries in Latin America and the Caribbean region are and will continue to experience a very rapid process of aging, it is important to generate pertinent information and analyze it promptly to identify key features that could be used to formulate and design health policies. This is particularly useful in Mexico, and other countries of the region, which have embarked in sweeping reforms of the health sector.
Objective: We aim to investigate the health profile of elderly Mexicans aged 50 and over. We are guided by two overarching concerns. First, does the health profile of elderly Mexicans reveal any special features, distinct from what one would expect from extant research on elderly individuals? Second, is there any evidence of relations between current health status and conditions to which these individuals were subject early during their childhood?
Design, setting and population: MHAS (Mexican Health and Aging Study) is a two-wave panel of a nationally representative sample of the non-institutionalized elderly Mexican population (50 and over) and their surviving spouses. The sample included approximately 9,806 target individuals and 5,424 spouses. The rate of response for targets was 89.2% and for spouses 97.2%. The interviews for the first panel on which we focus in this paper took place during 2001 and lasted about 1.5 hours. They included modules on demographic characteristics, physical and mental health, limited marital and migration history, early childhood characteristics, family and kin, intergenerational transfers and pension, income and assets. Limited anthropometry (height, weight, knee height, waist and hip circumference) and mobility (one leg stand) was obtained for 20% of the sample.
Main outcome measures: The main outcome measures obtained by MHAS were self-reported health, functional limitations (Activities of Daily Living [ADLs] and Instrumental Activities of Daily Living [IADLs]), anthropometric measures (height, weight, knee height, waist and hip circumference) as well as self-reported chronic conditions.
Results: (a) Age patterns by self-reported health behave as expected: the proportion reporting in bad health increases by age, and females are more likely than males to report themselves in bad health; (b) Similarly, the proportion reporting at least one ADL or at least one IADL increases sharply with age, and females are more likely than males to report at least one ADL (or IADL); (c) Of all the chronic conditions examined the most salient is self-reported diabetes. Even though we know that self-reports result in underestimates of diabetes prevalence, the observed prevalence is very high for both males and females but more so for females. The same patterns are observed for obesity; (d) Comparisons with the Health and Retirement Study (HRS) in the U.S. reveal that elderly in Mexico are particularly disadvantaged in terms of self reported health and IADL but not with regard to ADL. However, the most salient contrast is, once again, the one that emerges with diabetes and obesity: MHAS individuals display a higher propensity of being diabetic and obese; (e) Relations between diabetes and obesity, on the one hand, and early conditions reflected in anthropometry and retrospective reports, on the other, are not very strong but the evidence from the data is indicative of potentially important connections.
Conclusions: Preliminary findings from MHAS reveal a mixed picture. On the one hand we find that self reports of health status, ADL and IADL are in line with expectations and deviate only weakly, for example, from patterns among U.S. elderly. On the other hand we find high prevalence of diabetes and obesity, higher than among elderly in HRS, but only partial support to establish a connection between these conditions and early childhood characteristics.