Risk factors in an ageing population: Evidence from SAGE Ruy López Ridaura, Rosalba Rojas: National Institute of Public Health, Mexico Center of Research in Population Health. Nirmala Naidoo: Department of Health Statistics and Informatics, WHO 1
Rationale Modern risks (associated with chronic disease and accidents) with high impact on mortality and burden of disease even in low income countries specially in ageing population. Over time, major risks to health shift from traditional risks (associated with poverty) to modern risks (e.g. overweight and obesity). Modern and traditional risks may have different time trajectories in different populations (countries) depending on the context. As proximal cause, modifiable risk factor as target of public policy. The roots of risks factors as complex chain of determinants that varies across population and age categories. 2
Item from STEPS 3
SAGE: Risk Factors Methods National representative samples of 6 participating countries: China, India, Russian Federation, South Africa, Ghana and Mexico. Over sample of 50+ Population A selected set of risk factors indicators Individual Questionnaire: Physical activity (GPAQ), Tobacco, Alcohol and Fruit andf Vegetables. Physical examination: Anthropometry (BMI and WC) and Blood pressure. Proportion of the population classified as high risk Time trends: SAGE(2009-2010) - WHS(2002-2003) 4
Daily tobacco use (Smoke and smokeless) 70 60 18-49 50-59 60-69 70-79 80+ 50 40 30 20 10 0 Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Prevalence of current daily tobacco use: SAGE (2009-2010) 5
Heavy alcohol consumption (More 5 ( ) 4 ( ) drinks in at least 2 days per week) 25 18-49 50-59 60-69 70+ 20 15 10 5 0 Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Prevalence of heavy alcohol drinkers: SAGE (2009-2010) 6
Obesity (BMI 30 Kg/m2) 60,0 18-49 50-59 60-69 70-79 80+ 50,0 40,0 30,0 20,0 10,0 0,0 Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Prevalence obesity (measured) : SAGE (2009-2010) 7
Abdominal Obesity (WC: 85cm for women and 95cm for men) 100,0 90,0 80,0 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 18-49 50-59 60-69 70-79 80+ Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Prevalence abdominal obesity: SAGE (2009-2010) 8
Underweight (BMI 18.5 Kg/m2) 60,0 18-49 50-59 60-69 70-79 80+ 50,0 40,0 30,0 20,0 10,0 0,0 Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Prevalence undernutrition (measured) : SAGE (2009-2010) 9
High blood pressure (SBP 130 or DBP 85 among undiagnosed hypertension) Undiagnosed hypertension 90,0 46,8 42,7 24,4 20,4 35,2 34,1 65,1 67,6 48,4 18-49 50-59 60-69 70-79 80+ 51,8 47,7 42,0 80,0 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Prevalence of Prehypertension among undiagnosed hypertensive: SAGE (2009-2010) 10
Insufficient Fruit & Veg Consumption ( 5 portion per day) F/V 100,0 90,0 80,0 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 0,39 0,47 0,47 0,49 0,81 0,93 0,90 0,88 1,11 1,13 2,20 2,20 18-49 50-59 60-69 70-79 80+ Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Prevalence of Insufficient fruit and vegetables consumption: SAGE (2009-2010) 11
Insufficient physical activity ( 600 METs/ week or 5 days Moderate PA / week) 90,0 80,0 70,0 60,0 50,0 40,0 30,0 20,0 10,0 0,0 18-49 50-59 60-69 70-79 80+ Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Prevalence of Insufficient physical actvity: SAGE (2009-2010) 12
Time Trends: SAGE (2009) - WHS (2003) 13
Daily Tobacco use trends: SAGE (2009) - WHS (2003) 20,0 15,0 10,0 5,0 0,0-5,0-10,0-15,0-20,0-25,0 18-49 50-59 60-69 70-79 80+ Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Difference in prevalence of current daily tobacco use: SAGE (2009-2010) WHS (2003) 14
Heavy alcohol time trends: SAGE (2009) - WHS (2003) 10 18-49 50-59 60-69 70+ 5 0-5 -10-15 Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Difference in prevalence of heavy alcohol drinkers: SAGE (2009-2010) - WHS (2003) 15
Obesity time trends SAGE (2009) - WHS (2003) 25,0 20,0 18-49 50-59 60-69 70-79 80+ 15,0 10,0 5,0 0,0-5,0-10,0-15,0 Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Difference in prevalence obesity SAGE (measured) (2009-2010) - WHS (self report) (2003) 16
Underweight Time Trends SAGE (2009) - WHS (2003) 25,0 20,0 15,0 10,0 5,0 0,0-5,0-10,0-15,0-20,0 18-49 50-59 60-69 70-79 80+ Male Female Male Female Male Female Male Female Male Female Male Female China India Russian Federation South Africa Ghana Mexico Difference in prevalence undernutrition: SAGE (measured) (2009-2010) - WHS (self report) (2003) 17
Urban-Rural (Mexico) 18
Daily tobacco use SAGE México 30 25 20 15,9 16,1 Urban Rural % 15 12,0 10 7,5 11,3 8,0 12,7 5 0 5,1 5,2 2,8 18 a 49 50 a 59 60 a 69 70 a 79 80 y mas 19
BMI-SAGE-México. Rural Urban Porciento 90 80 70 60 50 40 30 20 10 0 Underweight 18-49 Overweight 50-59 60-69 Obesity 70-79 80+ Porciento 90 80 70 60 50 40 30 20 10 0 18-49 Underweight 50-59 Overweight 60-69 Obesity 70-79 80+ 20
Physical activity-sage-méxico. Urban Rural 100 100 80 80 Porciento 60 40 Porciento 60 40 20 20 0 18-49 Insufficient 50-59 Moderate 60-69 High 70-79 80+ 0 18-49 50-59 60-69 Insufficient Moderate High 70-79 80+ 21
Conclusions Wide variation across country, gender and age categories. Countries in different stages of "risk transition" Old people behaves accordingly to the country estimates. High proportion of old people in the high risk categories for some risk factors: HBP and insufficient fruit and vegetables in all countries Tobacco y alcohol in some countries Obesity and underweight in different countries. The health impact of these risks in the older population still unclear, at least for some of them. Differences across population might be explained by context differences, which can be explored with SAGE data 22
Next steps Preliminary results, need to be confirmed after including sampling weights and standardized rates to compare across countries. Evaluate variables explaining variation across populations. Expand our evaluation: "Traditional" risk factors. Biomarker to come (HbA1c, CRP, and others) As a panel study, SAGE will allow us to evaluate the impact of this risk factors in mortality, disease incidence and wellbeing specifically during the ageing process. 23
Acknowledgments SAGE initiative coordination at WHO headquarters Somnath Chatterji, Paul Kowal and Nirmala Naidoo. Colleagues from other SAGE participating countries. Colleagues in Mexico from INSP Juan Pablo Gutierrez, Martin Romero, Aurora Franco and field work team Rosalba Rojas, Laura Mendoza, Erika Mayorga and Martha Cruz SAGE participants. 24