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. 2020 Mar 9;10(1):4375.
doi: 10.1038/s41598-020-61127-7.

Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts

Marciane Kessler  1   2 , Elaine Thumé  3 , Shaun Scholes  4 , Michael Marmot  4 , Luiz Augusto Facchini  3   5 , Bruno Pereira Nunes  3 , Karla Pereira Machado  3 , Mariangela Uhlmann Soares  3 , Cesar de Oliveira  4
Affiliations

Modifiable risk factors for 9-year mortality in older English and Brazilian adults: The ELSA and SIGa-Bagé ageing cohorts

Marciane Kessler et al. Sci Rep. .

Abstract

To quantify and compare 9-year all-cause mortality risk attributable to modifiable risk factors among older English and Brazilian adults. We used data for participants aged 60 years and older from the English Longitudinal Study of Ageing (ELSA) and the Bagé Cohort Study of Ageing (SIGa-Bagé). The five modifiable risk factors assessed at baseline were smoking, hypertension, diabetes, obesity and physical inactivity. Deaths were identified through linkage to mortality registers. For each risk factor, estimated all-cause mortality hazard ratios (HR) and population attributable fractions (PAF) were adjusted by age, sex, all other risk factors and socioeconomic position (wealth) using Cox proportional hazards modelling. We also quantified the risk factor adjusted wealth gradients in mortality, by age and sex. Among the participants, 659 (ELSA) and 638 (SIGa-Bagé) died during the 9-year follow-up. Mortality rates were higher in SIGa-Bagé. HRs and PAFs showed more similarities than differences, with physical inactivity (PAF 16.5% ELSA; 16.7% SIGa-Bagé) and current smoking (PAF 4.9% for both cohorts) having the strongest association. A clear graded relationship existed between the number of risk factors and subsequent mortality. Wealth gradients in mortality were apparent in both cohorts after full adjustment, especially among men aged 60-74 in ELSA. A different pattern was found among older women, especially in SIGa-Bagé. These findings call attention for the challenge to health systems to prevent and modify the major risk factors related to non-communicable diseases, especially physical inactivity and smoking. Furthermore, wealth inequalities in mortality persist among older adults.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Nine-year sex-adjusted survival probability among participants in the English (ELSA) and Brazilian (Bagé) ageing cohorts by age group.
Figure 2
Figure 2
PAFs for all-cause mortality among participants in the English (ELSA) and Brazilian (Bagé) ageing cohorts.
Figure 3
Figure 3
Social gradient in all-cause mortality after adjustment for risk factors by age and sex. ELSA.
Figure 4
Figure 4
Social gradient in all-cause mortality after adjustment for risk factors by age and sex. SIGa-Bagé.
See this image and copyright information in PMC

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