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

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

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Revista Brasileira de Epidemiologia

Português Español

Brazil

Português Español

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

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

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO:

Objetivo:

Descrever as características socioeconômicas, comportamentais, clínicas e aquelas relacionadas à saúde de idosos brasileiros com Doença de Alzheimer (DA).

Métodos:

Foram analisados dados de linha de base do Estudo Longitudinal da Saúde dos Idosos Brasileiros (ELSI-Brasil). Essa pesquisa nacional entrevistou 9.412 adultos com pelo menos 50 anos. O diagnóstico de DA e as variáveis de exposição (sociodemográficas, clínicas, comportamentais e aquelas relacionadas à saúde) foram avaliados por meio de entrevista face a face baseada em questionário. As análises multivariadas foram ajustadas por possíveis fatores de confusão, e os valores foram relatados na razão de prevalência (RP) e intervalo de confiança de 95% (IC95%).

Resultados:

Participantes com DA apresentam diferenças demográficas significativas em comparação com idosos sem DA, como aposentadoria e baixa escolaridade. Os respondentes relataram mais consultas médicas, quedas, e maior frequência e duração de hospitalizações quando comparado a participantes sem DA. Essas características podem estar relacionadas à pior saúde física e mental observada nessa população. Dois em cada três idosos com DA no Brasil relataram que se sentiam deprimidos ou tristes na maior parte do tempo. As análises ajustadas revelaram que os pacientes com DA tinham maior probabilidade de serem diagnosticados com diabetes [PR = 1,83 (IC95% 1,08 – 3,12)], depressão [PR = 3,07% (IC95% 1,63 – 5,79)], doença de Parkinson [PR = 17,63 (IC95% 6,99 – 44,51)], e acidente vascular cerebral [PR = 3,55 (IC95% 1,90 – 6,67)] em comparação com adultos mais velhos sem diagnóstico de DA.

Conclusão:

Idosos com DA no Brasil relataram problemas de saúde física e mental em comparação com a população idosa sem DA.

Palavras-chave:
Doença de Alzheimer; Idoso; Estudos de coortes; Brasil

		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