risk factors in an ageing population: evidence from sage · risk factors in an ageing population:...

Study on global AGEing and adult health (SAGE) | 02 - 04 June 20101 |

Risk factors in an ageing population:Evidence from SAGE

Risk factors in an ageing population:Evidence from SAGE

Ruy López Ridaura, Rosalba Rojas: National Institute of Public Health, MexicoCenter of Research in Population Health.

Nirmala Naidoo: Department of Health Statistics and Informatics, WHO


RationaleRationale

� 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.


Item from STEPSItem from STEPS


SAGE: Risk Factors MethodsSAGE: 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)


Daily tobacco use(Smoke and smokeless)

Daily tobacco use(Smoke and smokeless)

0

10

20

30

40

50

60

70

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)

18-49 50-59 60-69 70-79 80+


Heavy alcohol consumption(More 5 (♂) 4 (♀) drinks in at least 2 days per week)

Heavy alcohol consumption(More 5 (♂) 4 (♀) drinks in at least 2 days per week)

0

5

10

15

20

25



Prevalence of heavy alcohol drinkers: SAGE (2009-2010)

18-49 50-59 60-69 70+


Obesity(BMI ≥ 30 Kg/m2)

Obesity(BMI ≥ 30 Kg/m2)

0,0

10,0

20,0

30,0

40,0

50,0

60,0



Prevalence obesity (measured) : SAGE (2009-2010)

18-49 50-59 60-69 70-79 80+


Abdominal Obesity(WC: ≥85cm for women and ≥95cm for men)

Abdominal Obesity(WC: ≥85cm for women and ≥95cm for men)

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

100,0


China India Russian

Federation

South Africa Ghana Mexico

Prevalence abdominal obesity: SAGE (2009-2010)

18-49 50-59 60-69 70-79 80+


Underweight (BMI ≤ 18.5 Kg/m2)

Underweight (BMI ≤ 18.5 Kg/m2)

0,0

10,0

20,0

30,0

40,0

50,0

60,0



Prevalence undernutrition (measured) : SAGE (2009-2010)

18-49 50-59 60-69 70-79 80+


High blood pressure(SBP ≥130 or DBP ≥85 among undiagnosed hypertension)

High blood pressure(SBP ≥130 or DBP ≥85 among undiagnosed hypertension)

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0


China India Russian

Federation

South Africa Ghana Mexico

Prevalence of Prehypertension among undiagnosed hypertensive: SAGE (2009-2010)

18-49 50-59 60-69 70-79 80+

42,047,751,848,467,665,134,135,220,424,442,746,8

Undiagnosed hypertension


Insufficient Fruit & Veg Consumption(≤ 5 portion per day)

Insufficient Fruit & Veg Consumption(≤ 5 portion per day)

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

100,0



Prevalence of Insufficient fruit and vegetables consumption: SAGE (2009-2010)

18-49 50-59 60-69 70-79 80+

2,202,201,131,110,880,900,930,810,490,470,470,39F/V


Insufficient physical activity(≤ 600 METs/ week or ≤ 5 days Moderate PA / week)

Insufficient physical activity(≤ 600 METs/ week or ≤ 5 days Moderate PA / week)

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0



Prevalence of Insufficient physical actvity: SAGE (2009-2010)

18-49 50-59 60-69 70-79 80+


Time Trends: SAGE (2009) - WHS (2003)


Daily Tobacco use trends:SAGE (2009) - WHS (2003)

Daily Tobacco use 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



Difference in prevalence of current daily tobacco use: SAGE (2009-2010) WHS (2003)

18-49 50-59 60-69 70-79 80+


Heavy alcohol time trends:SAGE (2009) - WHS (2003)

Heavy alcohol time trends:SAGE (2009) - WHS (2003)

-15

-10

-5

0

5

10



Difference in prevalence of heavy alcohol drinkers: SAGE (2009-2010) - WHS (2003)

18-49 50-59 60-69 70+


Obesity time trendsSAGE (2009) - WHS (2003)

Obesity time trendsSAGE (2009) - WHS (2003)

-15,0

-10,0

-5,0

0,0

5,0

10,0

15,0

20,0

25,0



Difference in prevalence obesity SAGE (measured) (2009-2010) - WHS (self report) (2003)

18-49 50-59 60-69 70-79 80+


Underweight Time TrendsSAGE (2009) - WHS (2003)

Underweight Time TrendsSAGE (2009) - WHS (2003)

-20,0

-15,0

-10,0

-5,0

0,0

5,0

10,0

15,0

20,0

25,0



Difference in prevalence undernutrition: SAGE (measured) (2009-2010) - WHS (self report) (2003)

18-49 50-59 60-69 70-79 80+


Urban-Rural (Mexico)


Daily tobacco use– SAGE MéxicoDaily tobacco use– SAGE México

7,5

15,9 16,1

12,0

8,0

5,1

2,8

11,3

5,2

12,7

0

5

10

15

20

25

30

18 a 49 50 a 59 60 a 69 70 a 79 80 y mas

%

Urban

Rural


..

Rural Urban

0

10

20

30

40

50

60

70

80

90

Po

rcie

nto

18-49 50-59 60-69 70-79 80+Underweight Overweight Obesity

0

10

20

30

40

50

60

70

80

90

Po

rcie

nto

18-49 50-59 60-69 70-79 80+Underweight Overweight Obesity

BMI-SAGE-MéxicoBMI-SAGE-México


..

Urban Rural

0

20

40

60

80

100

Po

rcie

nto

18-49 50-59 60-69 70-79 80+Insufficient Moderate High

Physical activity-SAGE-MéxicoPhysical activity-SAGE-México

0

20

40

60

80

100

Po

rcie

nto

18-49 50-59 60-69 70-79 80+Insufficient Moderate High


ConclusionsConclusions

� 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


Next stepsNext 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.


AcknowledgmentsAcknowledgments

� 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.

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