Disability Transitions and Health Expectancies among Adults 45 Years and Older in Malawi: A Cohort-Based Model
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{"title"=>"Disability Transitions and Health Expectancies among Adults 45 Years and Older in Malawi: A Cohort-Based Model", "type"=>"journal", "authors"=>[{"first_name"=>"Collin F.", "last_name"=>"Payne", "scopus_author_id"=>"36189959700"}, {"first_name"=>"James", "last_name"=>"Mkandawire", "scopus_author_id"=>"26655920300"}, {"first_name"=>"Hans Peter", "last_name"=>"Kohler", "scopus_author_id"=>"7402757445"}], "year"=>2013, "source"=>"PLoS Medicine", "identifiers"=>{"sgr"=>"84878280620", "pmid"=>"23667343", "isbn"=>"1549-1277", "scopus"=>"2-s2.0-84878280620", "issn"=>"15491277", "pui"=>"369013956", "doi"=>"10.1371/journal.pmed.1001435"}, "id"=>"e0938b74-6161-353f-9a1e-38e19cda8a56", "abstract"=>"BACKGROUND: Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA); by 2060, persons aged 45 y and older are projected to be 25% of SSA's population, up from 10% in 2010. Aging in SSA is associated with unique challenges because of poverty and inadequate social supports. However, despite its importance for understanding the consequences of population aging, the evidence about the prevalence of disabilities and functional limitations due to poor physical health among older adults in SSA continues to be very limited.\\n\\nMETHODS AND FINDINGS: Participants came from 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Health, a study of the rural population in Malawi. We investigate how poor physical health results in functional limitations that limit the day-to-day activities of individuals in domains relevant to this subsistence-agriculture context. These disabilities were parameterized based on questions from the SF-12 questionnaire about limitations in daily living activities. We estimated age-specific patterns of functional limitations and the transitions over time between different disability states using a discrete-time hazard model. The estimated transition rates were then used to calculate the first (to our knowledge) microdata-based health expectancies calculated for SSA. The risks of experiencing functional limitations due to poor physical health are high in this population, and the onset of disabilities happens early in life. Our analyses show that 45-y-old women can expect to spend 58% (95% CI, 55%-64%) of their remaining 28 y of life (95% CI, 25.7-33.5) with functional limitations; 45-y-old men can expect to live 41% (95% CI, 35%-46%) of their remaining 25.4 y (95% CI, 23.3-28.8) with such limitations. Disabilities related to functional limitations are shown to have a substantial negative effect on individuals' labor activities, and are negatively related to subjective well-being.\\n\\nCONCLUSIONS: Individuals in this population experience a lengthy struggle with disabling conditions in adulthood, with high probabilities of remitting and relapsing between states of functional limitation. Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in SSA inadequately target the physical health of mature and older adults.", "link"=>"http://www.mendeley.com/research/disability-transitions-health-expectancies-among-adults-45-years-older-malawi-cohortbased-model", "reader_count"=>58, "reader_count_by_academic_status"=>{"Unspecified"=>4, "Professor > Associate Professor"=>3, "Librarian"=>3, "Researcher"=>13, "Student > Doctoral Student"=>3, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>2, "Student > Master"=>11, "Other"=>1, "Student > Bachelor"=>4, "Lecturer"=>2, "Professor"=>3}, "reader_count_by_user_role"=>{"Unspecified"=>4, "Professor > Associate Professor"=>3, "Librarian"=>3, "Researcher"=>13, "Student > Doctoral Student"=>3, "Student > Ph. D. Student"=>9, "Student > Postgraduate"=>2, "Student > Master"=>11, "Other"=>1, "Student > Bachelor"=>4, "Lecturer"=>2, "Professor"=>3}, "reader_count_by_subject_area"=>{"Unspecified"=>5, "Agricultural and Biological Sciences"=>5, "Business, Management and Accounting"=>1, "Computer Science"=>2, "Economics, Econometrics and Finance"=>1, "Engineering"=>1, "Environmental Science"=>1, "Nursing and Health Professions"=>3, "Mathematics"=>1, "Medicine and Dentistry"=>20, "Sports and Recreations"=>1, "Psychology"=>6, "Social Sciences"=>10, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>20}, "Social Sciences"=>{"Social Sciences"=>10}, "Sports and Recreations"=>{"Sports and Recreations"=>1}, "Psychology"=>{"Psychology"=>6}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>5}, "Environmental Science"=>{"Environmental Science"=>1}, "Engineering"=>{"Engineering"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Computer Science"=>{"Computer Science"=>2}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}}, "reader_count_by_country"=>{"Canada"=>2, "Netherlands"=>1, "United States"=>1, "Kenya"=>1, "Switzerland"=>2}, "group_count"=>6}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1054777"], "description"=>"<p>(A) The projected population growth by age group in SSA, 2010–2060 (2010 = 100). (B) The share of the total SSA population by age group. (C) Person-years lived (PYL) by age group. Source: authors' calculations based on United Nations population projections <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001435#pmed.1001435-United1\" target=\"_blank\">[5]</a>.</p>", "links"=>[], "tags"=>["epidemiology", "geriatrics", "Global health", "Public health", "Economics", "Sociology", "ssa", "person-years", "lived"], "article_id"=>698712, "categories"=>["Medicine", "Sociology"], "users"=>["Collin F. Payne", "James Mkandawire", "Hans-Peter Kohler"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001435.g001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Population_growth_by_age_group_in_SSA_2010_8211_2060_share_of_total_population_by_age_groups_and_person_years_lived_by_age_group_/698712", "title"=>"Population growth by age group in SSA 2010–2060, share of total population by age groups, and person-years lived by age group.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-05-07 02:25:12"}
  • {"files"=>["https://ndownloader.figshare.com/files/1054778"], "description"=>"<p>MLSFH sample flow 2006–2010.</p>", "links"=>[], "tags"=>["epidemiology", "geriatrics", "Global health", "Public health", "Economics", "Sociology"], "article_id"=>698713, "categories"=>["Medicine", "Sociology"], "users"=>["Collin F. Payne", "James Mkandawire", "Hans-Peter Kohler"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001435.g002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_MLSFH_sample_flow_2006_8211_2010_/698713", "title"=>"MLSFH sample flow 2006–2010.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-05-07 02:25:13"}
  • {"files"=>["https://ndownloader.figshare.com/files/1054779"], "description"=>"<p>(A) The annual probability of transitioning from healthy to moderately limited (mod. limited) and severely limited (sev. limited). (B) The annual probability of transitioning from moderately limited to healthy and severely limited. (C) The annual probability of transitioning from severely limited to healthy and moderately limited. (D) Annual probability of mortality for healthy, moderately limited and severely limited individuals.</p>", "links"=>[], "tags"=>["epidemiology", "geriatrics", "Global health", "Public health", "Economics", "Sociology"], "article_id"=>698714, "categories"=>["Medicine", "Sociology"], "users"=>["Collin F. Payne", "James Mkandawire", "Hans-Peter Kohler"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001435.g003"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Estimated_annual_transition_probabilities_/698714", "title"=>"Estimated annual transition probabilities.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-05-07 02:25:14"}
  • {"files"=>["https://ndownloader.figshare.com/files/1054780"], "description"=>"<p>This figure shows a comparison between the number of years an average individual will spend in healthy, moderately limited (mod. limited), and severely limited (sev. limited) life at age 45, 55, 65, and 75 y. Markers represent the overall distribution of life-years spent in each state, not the ordering of these life-years; individuals in our analysis can recover and relapse between disability states, so not all years of limitation are spent at the end of life.</p>", "links"=>[], "tags"=>["epidemiology", "geriatrics", "Global health", "Public health", "Economics", "Sociology", "years", "moderately"], "article_id"=>698715, "categories"=>["Medicine", "Sociology"], "users"=>["Collin F. Payne", "James Mkandawire", "Hans-Peter Kohler"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001435.g004"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Average_number_of_years_of_active_moderately_limited_and_severely_limited_life_expectancy_and_total_life_expectancy_/698715", "title"=>"Average number of years of active, moderately limited, and severely limited life expectancy, and total life expectancy.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-05-07 02:25:15"}
  • {"files"=>["https://ndownloader.figshare.com/files/1054781"], "description"=>"<p>This figure shows the proportion of remaining life an average individual will spend in healthy, moderately limited (mod. limited), and severely limited (sev. limited) life at age 45, 55, 65, and 75 y, for women (A) and men (B). The height and area of each bar is proportional to the overall remaining LE of the synthetic cohorts with initial ages of 45, 55, 65 and 75 y, and the differently shaded areas represent the distribution of the remaining LE across the three disability states: healthy, moderately limited, and severely limited. The bars do not necessarily reflect the ordering of these life-years by disability states, as individuals in our analysis can recover and relapse between disability states, so not all years of limitation are spent at the end of life.</p>", "links"=>[], "tags"=>["epidemiology", "geriatrics", "Global health", "Public health", "Economics", "Sociology", "expectancy", "moderately"], "article_id"=>698716, "categories"=>["Medicine", "Sociology"], "users"=>["Collin F. Payne", "James Mkandawire", "Hans-Peter Kohler"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001435.g005"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Distribution_of_remaining_life_expectancy_by_disability_state_healthy_moderately_limited_and_severely_limited_/698716", "title"=>"Distribution of remaining life expectancy by disability state: healthy, moderately limited, and severely limited.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2013-05-07 02:25:16"}
  • {"files"=>["https://ndownloader.figshare.com/files/1054783"], "description"=>"<p>Disability classification is based on MLSFH questions (1) “Do you have any health problems that limit you in carrying out moderate activities?” and (2) “Do you have any health problems that limit you in carrying out strenuous activities?”, with each question providing a list of moderate/strenuous activities and response categories being “not limited,” “limited a little,” and “limited a lot.” Individuals who indicated that they had no limitations in either set of activities were classified as healthy, those who responded “somewhat limited” on either question were classified as moderately disabled, and individuals who responded “limited a lot” on either question were classified as severely disabled. “Dead” refers to mortality between survey waves among respondents who were interviewed in the MLSFH 2006 and/or 2008. “Pain interfering with work” is based on the question “During the past 4 wk, how much did pain interfere with your normal work (including both work outside the home and housework)?” Individuals responding “moderately,” “quite a bit,” or “extremely” were classified as being limited by pain. Individuals responding “somewhat unsatisfied” or “very unsatisfied” to the question “How satisfied are you with your life, all things considered?” were classified as having low life satisfaction. Three severely limited individuals aged 45–64 y and four severely limited individuals aged 65+ y had missing values on working for income, pain interfering with work, and life satisfaction, and were removed from the denominator for percentage calculations.</p>", "links"=>[], "tags"=>["epidemiology", "geriatrics", "Global health", "Public health", "Economics", "Sociology", "interfering", "subjective", "mature", "adults"], "article_id"=>698718, "categories"=>["Medicine", "Sociology"], "users"=>["Collin F. Payne", "James Mkandawire", "Hans-Peter Kohler"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001435.t001"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Self_reported_disability_percentage_working_for_income_in_the_past_2_weeks_pain_interfering_with_work_and_subjective_well_being_for_mature_adults_aged_45_y_in_the_MLSFH_/698718", "title"=>"Self-reported disability, percentage working for income in the past 2 weeks, pain interfering with work, and subjective well-being for mature adults (aged 45+ y) in the MLSFH.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-05-07 02:25:18"}
  • {"files"=>["https://ndownloader.figshare.com/files/1054784"], "description"=>"<p>Estimates were obtained from synthetic cohorts of 100,000 45-, 55-, 65-, and 75-y-olds created via microsimulation, based on observed transition rates from 2006–2010 MLSFH data.</p><p>mod. limited, moderately limited; sev. limited, severely limited.</p>", "links"=>[], "tags"=>["epidemiology", "geriatrics", "Global health", "Public health", "Economics", "Sociology", "expectancy", "ages"], "article_id"=>698719, "categories"=>["Medicine", "Sociology"], "users"=>["Collin F. Payne", "James Mkandawire", "Hans-Peter Kohler"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001435.t002"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Microsimulation_estimated_average_remaining_life_expectancy_at_ages_45_8211_75_y_by_sex_/698719", "title"=>"Microsimulation-estimated average remaining life expectancy at ages 45–75 y, by sex.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2013-05-07 02:25:19"}
  • {"files"=>["https://ndownloader.figshare.com/files/1054785", "https://ndownloader.figshare.com/files/1054786", "https://ndownloader.figshare.com/files/1054788", "https://ndownloader.figshare.com/files/1054789", "https://ndownloader.figshare.com/files/1054790", "https://ndownloader.figshare.com/files/1054794", "https://ndownloader.figshare.com/files/1054796", "https://ndownloader.figshare.com/files/1054797", "https://ndownloader.figshare.com/files/1054798", "https://ndownloader.figshare.com/files/1054800", "https://ndownloader.figshare.com/files/1054807", "https://ndownloader.figshare.com/files/1054808", "https://ndownloader.figshare.com/files/1054812", "https://ndownloader.figshare.com/files/1054813", "https://ndownloader.figshare.com/files/1054815"], "description"=>"<div><p>Background</p><p>Falling fertility and increasing life expectancy contribute to a growing elderly population in sub-Saharan Africa (SSA); by 2060, persons aged 45 y and older are projected to be 25% of SSA's population, up from 10% in 2010. Aging in SSA is associated with unique challenges because of poverty and inadequate social supports. However, despite its importance for understanding the consequences of population aging, the evidence about the prevalence of disabilities and functional limitations due to poor physical health among older adults in SSA continues to be very limited.</p><p>Methods and Findings</p><p>Participants came from 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Health, a study of the rural population in Malawi. We investigate how poor physical health results in functional limitations that limit the day-to-day activities of individuals in domains relevant to this subsistence-agriculture context. These disabilities were parameterized based on questions from the SF-12 questionnaire about limitations in daily living activities. We estimated age-specific patterns of functional limitations and the transitions over time between different disability states using a discrete-time hazard model. The estimated transition rates were then used to calculate the first (to our knowledge) microdata-based health expectancies calculated for SSA. The risks of experiencing functional limitations due to poor physical health are high in this population, and the onset of disabilities happens early in life. Our analyses show that 45-y-old women can expect to spend 58% (95% CI, 55%–64%) of their remaining 28 y of life (95% CI, 25.7–33.5) with functional limitations; 45-y-old men can expect to live 41% (95% CI, 35%–46%) of their remaining 25.4 y (95% CI, 23.3–28.8) with such limitations. Disabilities related to functional limitations are shown to have a substantial negative effect on individuals' labor activities, and are negatively related to subjective well-being.</p><p>Conclusions</p><p>Individuals in this population experience a lengthy struggle with disabling conditions in adulthood, with high probabilities of remitting and relapsing between states of functional limitation. Given the strong association of disabilities with work efforts and subjective well-being, this research suggests that current national health policies and international donor-funded health programs in SSA inadequately target the physical health of mature and older adults.</p><p><i>Please see later in the article for the Editors' Summary</i></p></div>", "links"=>[], "tags"=>["epidemiology", "geriatrics", "Global health", "Public health", "Economics", "Sociology", "transitions", "expectancies", "adults", "45", "years", "older", "cohort-based"], "article_id"=>698720, "categories"=>["Medicine", "Sociology"], "users"=>["Collin F. Payne", "James Mkandawire", "Hans-Peter Kohler"], "doi"=>["https://dx.doi.org/10.1371/journal.pmed.1001435.s001", "https://dx.doi.org/10.1371/journal.pmed.1001435.s002", "https://dx.doi.org/10.1371/journal.pmed.1001435.s003", "https://dx.doi.org/10.1371/journal.pmed.1001435.s004", "https://dx.doi.org/10.1371/journal.pmed.1001435.s005", "https://dx.doi.org/10.1371/journal.pmed.1001435.s006", "https://dx.doi.org/10.1371/journal.pmed.1001435.s007", "https://dx.doi.org/10.1371/journal.pmed.1001435.s008", "https://dx.doi.org/10.1371/journal.pmed.1001435.s009", "https://dx.doi.org/10.1371/journal.pmed.1001435.s010", "https://dx.doi.org/10.1371/journal.pmed.1001435.s011", "https://dx.doi.org/10.1371/journal.pmed.1001435.s012", "https://dx.doi.org/10.1371/journal.pmed.1001435.s013", "https://dx.doi.org/10.1371/journal.pmed.1001435.s014", "https://dx.doi.org/10.1371/journal.pmed.1001435.s015"], "stats"=>{"downloads"=>0, "page_views"=>0, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Disability_Transitions_and_Health_Expectancies_among_Adults_45_Years_and_Older_in_Malawi_A_Cohort_Based_Model_/698720", "title"=>"Disability Transitions and Health Expectancies among Adults 45 Years and Older in Malawi: A Cohort-Based Model", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2013-05-07 02:25:20"}

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Relative Metric

{"start_date"=>"2013-01-01T00:00:00Z", "end_date"=>"2013-12-31T00:00:00Z", "subject_areas"=>[{"subject_area"=>"/Biology and life sciences", "average_usage"=>[269, 466, 588, 697, 800, 896, 988, 1076, 1165, 1254, 1340, 1417]}, {"subject_area"=>"/People and places", "average_usage"=>[270, 456, 573, 676, 773, 867, 955, 1037, 1120, 1205, 1286, 1363, 1436]}, {"subject_area"=>"/People and places/Population groupings", "average_usage"=>[265, 456, 578, 682, 782, 881, 965, 1053, 1133, 1223, 1310, 1391, 1457]}, {"subject_area"=>"/Social sciences", "average_usage"=>[289, 475, 593, 703, 805, 902, 990, 1078, 1158, 1250, 1336, 1417, 1482]}]}
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