Who are the people with Alzheimer's disease in Brazil? Findings from the Brazilian Longitudinal Study of Aging

Feter, Natan; Leite, Jayne Santos; Caputo, Eduardo Lucia; Cardoso, Rodrigo Kohn; Rombaldi, Airton José

doi:10.1590/1980-549720210018

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Revista Brasileira de Epidemiologia

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Original Article • Rev. bras. Epidemiol. 24 • 2021 • https://doi.org/10.1590/1980-549720210018 copy

Who are the people with Alzheimer's disease in Brazil? Findings from the Brazilian Longitudinal Study of Aging

Quem são as pessoas com Doença de Alzheimer no Brasil? Resultados do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil)

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Objective:

To describe the socioeconomic, behavioral, clinical, and health-related characteristics of Brazilian older adults with Alzheimer's disease (AD).

Methods:

Baseline data from the Brazilian Longitudinal Study of Aging were analyzed. This nationwide survey interviewed 9,412 adults aged at least 50 years. Self-reported medical diagnosis of AD and exposure variables (sociodemographic, clinical, behavioral, and health-related) were assessed by face-to-face questionnaire-based interview. Multivariate analyses accounted for possible confounding factors, and values were reported in prevalence ratio (PR) and 95% confidence interval (95%CI).

Results:

Participants with AD have important demographic differences compared with older non-AD participants such as low education level and retirement. Clinically, these patients reported more medical appointments, falls, and higher frequency and duration of hospitalizations compared with non-AD participants. These characteristics may be related to worse physical and mental health observed in this population. Indeed, two out of five older adults with AD in Brazil reported always feeling lonely, while two out of three said they felt depressed or sad much of the time. Adjusted analyses showed that patients with AD were 95% (95%CI 1.08 – 3.50) more likely to be hospitalized in a year compared with non-AD older adults. People with AD in Brazil were more likely to be diagnosed with diabetes (PR = 1.83 [95%CI 1.08 – 3.12]), depression (PR = 3.07% [95%CI 1.63 – 5.79]), Parkinson's disease (PR = 17.63 [95%CI 6.99 – 44.51]), and stroke (PR = 3.55 [95%CI 1.90 – 6.67]) compared with non-AD participants.

Conclusion:

Older adults with AD in Brazil reported impaired physical and mental health compared with the non-AD population.

Keywords:
Alzheimer disease; Aged; Cohort studies; Brazil

		Crude			Adjusted^* * adjusted for sex, age, ethnicity, marital status, education level, occupation, health insurance, and fall.
		PR	95%CI	p-value	PR	95%CI	p-value
Women (ref: men)		1.80	1.05 – 3.08	0.031^a a heterogeneity test;	1.02	0.54 – 1.94	0.956^a a heterogeneity test;
Age, years		1.12	1.10 – 1.14	< 0.001^b b linear trend test;	1.11	1.08 – 1.15	< 0.001^b b linear trend test;
Ethnicity (ref: white)
	Mixed-race	1.07	0.62 – 1.84	0.117^a a heterogeneity test;	1.70	0.93 – 3.02	0.007^a a heterogeneity test;
	Black	0.30	0.08 – 1.14		0.08	0.01 – 0.64
	Asian	0.21	0.03 – 1.54		0.41	0.06 – 3.56
Marital status (ref: single)
	Married	0.86	0.36 – 2.08	0.002^a a heterogeneity test;	1.00	0.32 – 3.13	0.809^a a heterogeneity test;
	Divorced/separated	0.71	0.22 – 2.26		1.52	0.49 – 4.71
	Widowed	2.88	1.25 – 6.63		1.21	0.40 – 3.64
Education level (ref: high school or higher)
	Elementary school or lower	0.72	0.38 – 1.35	< 0.001^b b linear trend test;	2.61	1.00 – 6.83	0.531^b b linear trend test;
Occupation (ref: employed)
	Unemployed	27.09	4.00 – 183.61	< 0.001^a a heterogeneity test;	16.77	1.99 – 141.51	0.016^a a heterogeneity test;
	Retired	91.81	12.89 – 654.03	< 0.001^a a heterogeneity test;	21.44	2.95 – 155.72	0.016^a a heterogeneity test;
Health insurance (ref: no)		1.50	0.90 – 1.53	0.121^a a heterogeneity test;	1.02	0.60 – 1.72	0.954^a a heterogeneity test;
≥ 10 medical visits in the last 12 months (ref: < 10 visits)		4.21	2.69 – 6.58	< 0.001^b b linear trend test;	3.19	1.76 – 5.79	< 0.001^a a heterogeneity test;
Hospitalized in the last 12 months (ref: no)		3.39	2.19 – 5.23	< 0.001^b b linear trend test;	1.95	1.08 – 3.50	0.026^b b linear trend test;
Fall in the last 12 months (ref: no)		2.16	1.28 – 3.65	0.004^b b linear trend test;	1.34	0.68 – 2.64	0.399^b b linear trend test;
Hospitalization longer than one week (ref: one week or less)		5.42	2.23 – 13.19	< 0.001^b b linear trend test;	2.27	0.87 – 5.92	0.046^b b linear trend test;
Last dentist visit (ref: <2 years ago)		1.80	1.44 – 2.26	< 0.001^a a heterogeneity test;	1.90	1.06 – 3.42	0.031^a a heterogeneity test;
Looked for any medical service in the last 2 weeks (ref: no)		4.21	2.69 – 6.58	< 0.001^b b linear trend test;	1.44	0.75 – 2.79	0.272^a a heterogeneity test;
Last mammography exam (ref: < 3 years ago)		2.68	1.49 – 4.83	0.001^a a heterogeneity test;	0.98	0.47 – 2.05	0.963^a a heterogeneity test;
Last eye exam (ref: < 2 years ago)		1.28	1.07 – 1.53	0.007^a a heterogeneity test;	1.24	1.05 – 1.46	0.012^a a heterogeneity test;

		Crude			Adjusted^* * adjusted for sex, age, ethnicity, marital status, education level, occupation, health insurance, and fall.
		PR	95%CI	p-value	PR	95%CI	p-value
Health status (ref: Very good/good)
	Fair	1.03	0.54 – 1.98	0.056^b b linear trend test;	1.20	0.55 – 2.63	0.117^b b linear trend test;
	Poor/very poor	3.00	1.52 – 5.94	0.056^b b linear trend test;	2.61	1.21 – 5.64	0.117^b b linear trend test;
Self-rated hearing (ref: excellent/good)
	Regular	1.39	0.77 – 2.54	< 0.001^b b linear trend test;	0.72	0.32 – 1.64	0.200^b b linear trend test;
	Bad – very bad	7.31	3.75 – 14.25	< 0.001^b b linear trend test;	2.45	0.95 – 6.30	0.200^b b linear trend test;
Self-rated long-distance vision (ref: excellent/good)
	Regular	1.93	1.0 – 3.76	< 0.001^b b linear trend test;	1.06	0.49 – 2.33	0.153^b b linear trend test;
	Bad – very bad	3.64	2.05 – 6.46	< 0.001^b b linear trend test;	1.87	0.87 – 4.02	0.153^b b linear trend test;
Walking test, tertile (ref: 1^st and 2^nd tertile)^d d lower score indicates high functional impairment;
	3^rd(slowest)	3.97	1.67 – 9.44	0.002^b b linear trend test;	0.86	0.28 – 2.65	0.875^b b linear trend test;
Impaired ADL (ref: less than 3)
	3 or more	23.75	13.22 – 42.67	< 0.001^b b linear trend test;	10.59	4.43 – 25.25	< 0.001^b b linear trend test;
Quality of life (ref: 1^st[lowest])
	2^nd	0.42	0.14 – 1.19	0.103^b b linear trend test;	0.50	0.14 – 1.72	0.438^b b linear trend test;
	3^rd(highest)	0.34	0.08 – 1.43	0.103^b b linear trend test;	0.60	0.15 – 2.68	0.438^b b linear trend test;
Elevated depression symptoms (ref: no)^e e score higher than 4 in the 8-item CES-D;		2.01	0.69 – 5.91	0.202^b b linear trend test;	2.61	0.88 – 7.79	0.085^a a heterogeneity test;
Happy most of the time (ref: no)		0.46	0.22 – 0.95	0.036^a a heterogeneity test;	0.41	0.15 – 1.09	0.073^a a heterogeneity test;
Sad most of the time (ref: no)		3.66	1.76 – 7.61	0.001^a a heterogeneity test;	2.75	1.13 – 6.67	0.026^a a heterogeneity test;
Feel lonely (ref: sometimes or never)
	Always	4.77	1.74 – 13.07	0.005^b b linear trend test;	2.52	0.73 – 8.67	0.158^b b linear trend test;
Central obesity^b b linear trend test; (ref: no)		1.86	1.15 – 3.00	0.012^a a heterogeneity test;	1.23	0.67 – 2.23	0.505^a a heterogeneity test;
Physical activity (ref: inactive)
	Insufficiently active	0.33	0.17 – 0.64	< 0.001^b b linear trend test;	0.41	0.14 – 1.21	0.242^b b linear trend test;
	Active	0.29	0.14 – 0.59	< 0.001^b b linear trend test;	0.59	0.23 – 1.53	0.242^b b linear trend test;
Smoking habit (ref: never)
	Former smoker	0.78	0.44 – 1.37	0.120^a a heterogeneity test;	0.75	0.38 – 1.49	0.348^a a heterogeneity test;
	Smoker	0.39	0.16 – 0.98	0.120^a a heterogeneity test;	0.81	0.27 – 2.39	0.348^a a heterogeneity test;
Sleep quality (ref: very good/good)
	Regular	1.19	0.64 – 2.18	0.363^b b linear trend test;	1.16	0.57 – 2.36	0.675^b b linear trend test;
	Bad/very bad	1.57	0.84 – 2.96	0.363^b b linear trend test;	1.17	0.47 – 2.96	0.675^b b linear trend test;
Drugs for sleep (ref: no)		3.78	2.19 – 6.55	< 0.001^a a heterogeneity test;	2.54	1.29 – 5.01	0.007^a a heterogeneity test;
Hypertension (ref: no)		1.91	1.08 – 3.38	0.026^a a heterogeneity test;	1.30	0.71 – 2.39	0.390^a a heterogeneity test;
Diabetes (ref: no)		2.41	1.38 – 4.22	0.002^a a heterogeneity test;	1.83	1.08 – 3.12	0.040^a a heterogeneity test;
Diagnosed depression (ref: no)		3.57	2.18 – 5.86	< 0.001^a a heterogeneity test;	3.07	1.63 – 5.79	0.001^a a heterogeneity test;
Parkinson's disease (ref: no)		21.41	11.20 – 40.92	< 0.001^a a heterogeneity test;	17.63	6.99 – 44.51	< 0.001^a a heterogeneity test;
Stroke (ref: no)		6.37	3.94 – 10.29	< 0.001^a a heterogeneity test;	3.55	1.90 – 6.67	< 0.001^a a heterogeneity test;

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[1] Corresponding author: Natan Feter. Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, 4072, Brisbane, Australia. E-mail: natanfeter@hotmail.com