Trajectories of Health from the Mexican Health and Aging Study (MHAS/ENASEM)

Rebeca Wong, PhD Sealy Center on Aging WHO/PAHO Collaborating Center on Aging University of Texas Medical Branch rewong@utmb.edu

National Academy of Medicine, Mexico City, May 28-29, 2015

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MHAS/ENASEM: Prospective Longitudinal Study of Aging in Mexico

MHAS Timeline 2001-2015

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2001 2012 2003 2015

Sample: Born in 1951 or earlier Add sample: Born 1952-1962: n=5,896

15,186 Individuals

546 Deceased

2,742 Deceased (Accumulated=3,288)

Wave 1 Wave 2 Wave 3 Wave 4

1.00 0.99 0.99 0.98 0.98 0.97 0.96 0.96 0.95 0.94 0.94

0.93 0.88

0.84 0.79

0.73 0.68

0.62 0.57

0.52 0.48 0.48

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1

1 2 3 4 5 6 7 8 9 10 11

Prop

ortio

n Su

rviv

ing

Survival Time (Years)

Without disease Only infectiousOnly chronic Both types of diseases

Survival Analysis for Infectious and Chronic Conditions, 2001-2012

Source: González-González, C., A. Palloni, and R. Wong (2015). Mortality and its association with chronic and infectious diseases in Mexico: a panel data analysis of older adults. Salud Pública de México, 57.

Risk of dying is 3 times higher for those with both chronic and infectious diseases at baseline compared to those with only chronic diseases

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Hazard Ratios for Mortality as a Function of BMI, 2001-2012

Source: Kumar, A. et al. (2015). The Effect of Obesity on Incidence of Disability and Mortality in Mexicans Aged 50 Years and Older . Salud Pública de México, 57.

0.8

1

1.2

1.4

1.6

1.8

2

2.2

1516171819202122232425262728293031323334353637383940

Haz

ard

Rat

io fo

r Mor

talit

y

BMI at Baseline

Lowest hazard ratio of dying occurs at BMI = 25.4 compared to higher or lower levels of BMI

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Hazard Ratios for ADL Disability as a Function of BMI, 2001-2012

Source: Kumar, A. et al. (2015). The Effect of Obesity on Incidence of Disability and Mortality in Mexicans Aged 50 Years and Older . Salud Pública de México, 57.

0.8

1

1.2

1.4

1.6

1.8

2

2.2

2.4

1516171819202122232425262728293031323334353637383940

Haz

ard

Rat

io fo

r Dis

abili

ty

BMI at Baseline

Lowest hazard ratio of having an ADL limitation occurs at BMI = 26 compared to higher or lower levels of BMI

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Risk of 11-year Disability Onset by Education, Men age 50-59

Source: Sáenz, J.L. and R. Wong. Educational Gradients and Pathways of Disability Onset among Older Mexicans. Under review, Research on Aging.

*

* *

*

0.50

1.00

1.50

2.00

2.50

3.00

3.50

0 Years 1-5 Years 6 Years 7+ (Ref)

Odd

s R

atio

s

Years of Education

Raw Combined

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Risk of ADL disability onset over 11 years is 3 times higher for those with no-education compared to those with 7+ years education

Trajectories of Number of ADL Limitations by Age and Years of Education

Source: Díaz-Venegas, C. and R. Wong. Trajectories of Limitations in Activities of Daily Living among Older Adults in Mexico. Under review in Disability & Health. 8

Among Mexican population 65+ in 2012: (National Health Survey, ENSANUT) Prevalence of self-reported diabetes was 41%

Overweight and obesity: Overweight 40.2% Obese 30% Abdominal obesity 82.4%

Importance of Diabetes and Obesity

Probability of Incidence of Diabetes by Body Weight, 2012

Source: Palloni, A., H. Beltrán-Sánchez, B. Novak, G. Pinto, and R. Wong (2015). Adult Obesity, Disease and Longevity in Mexico. Salud Pública de México, 57.

Risk of new diabetes is 2.6 and 1.8 times higher for obese and overweight people relative to those with normal weight in 2001

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Pro

babi

lity

(%)

6.3 6.0 7.2 7.0

11.0 10.7

12.5 12.1

15.4 15.0

17.4 17.0

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

50 years 80 years 50 years 80 years

Men Women

Normal Overweight Obese

Projected Prevalence of Diabetes 2012 to 2050 Population aged 50 and older, FEM-Mexico

0.42

0.19

0.32

0.00

0.05

0.10

0.15

0.20

0.25

0.30

0.35

0.40

0.45

Scenario 1, No reduction in diabetes incidenceScenario 2, 25% reduction in diabetes incidence

Source: González-González, C., R. Wong, B. Tysinger, & D. Goldman. Work in-progress. 11

Projected Population Ages 50+ with Diabetes, years 2012 to 2050, FEM-Mexico

21.6

4.0

17.1

0

5

10

15

20

25M

illio

ns

Scenario 1, No reduction in diabetes incidenceScenario 2, 25% reduction in diabetes incidence

Difference: 4.6 millions

Source: González-González, C., R. Wong, B. Tysinger, & D. Goldman. Work in-progress. 12

Conclusion MHAS/ENASEM has analytical power

for studies of health transitions Policy makers can use knowledge of

health and mortality transitions to project the future needs of older adults

Clearly, availability of longitudinal, national data is driving the generation of this line of research

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University of Texas Medical Branch INEGI, México University of Wisconsin Instituto Nacional de Geriatría, México Instituto Nacional de Salud Pública, México

MHAS Collaborators

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MHAS financed partly by grant NIA/NIH R01 AG018016