The association of health and income in the elderly: experience from a southern state of Brazil

• Published in: PloS one Vol. 8; no. 9; p. e73930
• Main Authors: Fillenbaum, Gerda G, Blay, Sergio L, Pieper, Carl F, King, Katherine E, Andreoli, Sergio B, Gastal, Fábio L
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 13.09.2013; Public Library of Science (PLoS)
• Subjects: Activities of daily living; Age; Aged; Aging; Analysis; Brazil - epidemiology; Cardiovascular Diseases - economics; Cardiovascular Diseases - epidemiology; Comorbidity; Demographics; Demography; Depression (Mood disorder); Depression - economics; Depression - epidemiology; Developed countries; Diabetes; Diabetes mellitus; Disorders; Economies of scale; Education; Educational Status; Family Characteristics; Female; Gastrointestinal diseases; Geriatrics; Health; Health Status; High income; Households; Humans; Income; Income - statistics & numerical data; Kidney Diseases - economics; Kidney Diseases - epidemiology; Kidneys; Low income groups; Lung Diseases - economics; Lung Diseases - epidemiology; Male; Mental depression; Mental Disorders - economics; Mental Disorders - epidemiology; Middle Aged; Mortality; Musculoskeletal Diseases - economics; Musculoskeletal Diseases - epidemiology; Nonlinear systems; Older people; Personal income; Social Class; Socioeconomic factors; Studies; Systematic review; Brazil; North Carolina; Rio Grande do Sul Brazil; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0073930

In high income, developed countries, health status tends to improve as income increases, but primarily through the 50(th)-66(th) percentile of income. It is unclear whether the same limitation holds in middle income countries, and for both general assessments of health and specific conditions. Data were obtained from Brazil, a middle income country. In-person interviews with a representative sample of community residents age ≥ 60 (N=6963), in the southern state of Rio Grande do Sul, obtained information on demographic characteristics including household income and number of persons supported, general health status (self-rated health, functional status), depression, and seven physician-diagnosed, self-reported health conditions. Analyses used household income (adjusted for number supported and economies of scale) together with higher order income terms, and controlled for demographics and comorbidities, to ascertain nonlinearity between income and general and specific health measures. In fully controlled analyses income was associated with general measures of health (linearly with self-rated health, nonlinearly with functional status). For specific health measures there was a consistent linear association with depression, pulmonary disorders, renal disorders, and sensory impairment. For musculoskeletal, cardiovascular (negative association), and gastrointestinal disorders this association no longer held when comorbidities were controlled. There was no association with diabetes. Contrary to findings in high income countries, the association of household-size-adjusted income with health was generally linear, sometimes negative, and sometimes absent when comorbidities were controlled.