Socioeconomic inequalities in active life expectancy and disability related to obesity among older people

Background: The rapid increase in life expectancy in Chile, with obesity as the main nutritional problem in all age groups, makes it necessary to ask whether the years gained are healthy Aim: To study the trajectories of disability associated with obesity in Chilean elderly groups from different socio-economic and demographic backgrounds. Material and Methods: Longitudinal study of 3 cohorts of older adults from Santiago: the SABE cohort including 1235 people born before 1940; the Alexandros cohort including 950 people born between 1940 and 1948 from Primary Health Care centers and the ISAPRES cohort of 266 people from private health insurance registries (ISAPRES) born before 1947. An interview yielded socio demographic data and history of diseases. Anthropometric measurements and hand dynamometry were performed. Cognitive status was assessed by the mini mental state examination, depressive symptoms through the geriatric depression socore-5 and functional limitations through self-reporting of basic (ADL), instrumental (IADL) and advanced daily living (AADL) activities. Results: We report here baseline results from ISAPRES and SABE cohorts. Important social and gender differentials were observed. After adjustment by age and gender, a significant lower frequency of limitations in ADL (odds ratio (OR) = 0.17; 95% confidence intervals (CI): 0.079-0.343), IADL (OR = 0.27; 95%Cl: 0.159-0.452), and AADL (OR = 0.42; 95%CI: 0.298-0.599) persisted in the ISA PRE cohort, compared to the SABE cohort. Obesity was associated with functional limitations only in AADL (OR = 1.65; 95%Cl: 1.18-2.31) and hand dynamometry was associated with lower functional limitation in ADL, IADL and AADL. Conclusions: This study demonstrates profound socio-economic and gender inequalities in older people, thus showing that the years of healthy life gained are not the same for the whole society (Rev Med Chile 2011; 139: 1276-1285).