Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes and stroke

Pilar Guevara, University of Illinois at Urbana-Champaign
Flavia Andrade, University of Illinois at Urbana-Champaign
Maria Lebrao, Universidade de São Paulo
Yeda Duarte, Universidade de São Paulo

The combined effect of diabetes and stroke on disability and mortality remains largely unexplored in Brazil and Latin America. This study addresses this gap and analyses the impact of diabetes and stroke, in combination, on disability and mortality in Brazil. The sample was drawn from two waves of the Survey on Health and Well-being of the Elderly, which followed 2,143 older adults in São Paulo, Brazil from 2000 to 2006. Disability was assessed via measures of activities of daily living (ADL) limitations, severe ADL limitations, and receiving assistance to perform these activities. Logistic and multinomial regression models controlling for sociodemographic and health conditions were used to address the influence of diabetes and stroke on disability and mortality. By itself, the presence of diabetes did not increase the risk of disability or the need for assistance, however, diabetes was related to increased risks when assessed in combination with stroke. After controlling for demographic, social and health conditions, individuals who had experienced stroke but not diabetes were 3.4 times more likely to have ADL limitations than those with neither condition. This elevated risk more than doubled for those suffering from a combination of diabetes and stroke (OR 7.34, 95% CI 3.73-14.46). Similar effects were observed for severe ADL limitations and receiving ADL assistance. Over time, older adults who had experienced a stroke were at higher risk of developing ADL limitations, of remaining disabled and of mortality. However, risks were even higher for those who had experienced both diabetes and stroke. A combined history of stroke and diabetes represents a major burden on the quality of life among older adults in São Paulo. Results highlight the need for specialized health programs to assist a growing population of diabetic patients recovering from a stroke. Implications related to policy programs in Brazil are discussed.