Background
Methods
Participants and procedures
Measures
Statistical analyses
Results
Variable | Cuba | Dominican Republic | Puerto Rico | Peru urban | Peru Rural | Venezuela | Mexico urban | Mexico rural | China urban | China rural | India urban | India rural | Nigeria |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Response rate (%) | 94 | 95 | 93 | 80 | 88 | 80 | 84 | 86 | 74 | 96 | 72 | 98 | 98 |
Achieved sample (n) | 2944 | 2011 | 2008 | 1381 | 552 | 1965 | 1003 | 1000 | 1160 | 1002 | 1005 | 999 | 914 |
Age in years (MV*) | 7 | 0 | 0 | 1 | 0 | 4 | 1 | 0 | 0 | 0 | 4 | 0 | 0 |
Mean (SD) | 75.1 (7.0) | 75.3 (7.5) | 76.3 (7.4) | 75.0 (7.4) | 74.2 (7.3) | 72.3 (6.9) | 74.5 (6.6) | 74.1 (6.7) | 73.9 (6.2) | 72.4 (6.0) | 71.3 (6.1) | 72.6 (5.8) | 72.7 (7.6) |
Gender (MV) | 0 | 2 | 6 | 0 | 0 | 33 | 0 | 0 | 0 | 0 | 15 | 0 | 0 |
Female (%) | 1913 (65.0%) | 1325 (65.9%) | 1347 (67.3%) | 888 (64.3%) | 295 (53.4%) | 1226 (63.5%) | 666 (66.4%) | 602 (60.2%) | 661 (57.0%) | 556 (55.5%) | 571 (57.7%) | 545 (54.6%) | 539 (59.0%) |
Education (MV) | 8 | 19 | 9 | 8 | 8 | 40 | 2 | 0 | 0 | 0 | 2 | 0 | 6 |
Did not complete primary education (%) | 730 (24.9%) | 1414 (71.0%) | 461 (23.1%) | 127 (9.3%) | 225 (41.3%) | 601 (31.2%) | 581 (58.1%) | 837 (83.7%) | 385 (33.2%) | 693 (69.2%) | 662 (66.0%) | 855 (85.6%) | 678 (74.2%) |
Marital status (MV) | 8 | 15 | 6 | 10 | 1 | 45 | 0 | 1 | 0 | 0 | 3 | 0 | 67 |
Currently married (%) | 1271 (43.3%) | 586 (29.4%) | 967 (48.3%) | 784 (57.2%) | 308 (55.9%) | 921 (48.0%) | 470 (46.9%) | 538 (53.9%) | 829 (71.5%) | 585 (58.4%) | 523 (52.2%) | 481 (48.1%) | 581 (68.6%) |
Coresidence (MV) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Living with children (%) | 1422 (48.3%) | 963 (47.9%) | 611 (30.4%) | 890 (64.4%) | 326 (59.1%) | 1578 (80.3%) | 565 (56.3%) | 523 (52.3%) | 446 (38.4%) | 679 (67.8%) | 719 (71.5%) | 625 (62.6%) | ‡ |
Number of assets (MV) | 8 | 5 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 4 | 0 | |
Median (interquartile range) | 6 (5-6) | 5 (4-6) | 7 (6-7) | 6 (6-6) | 5 (4-6) | 6 (6-7) | 6 (6-7) | 4 (3-6) | 5 (5-6) | 6 (5-7) | 4 (3-5) | 3 (2-4) | ‡ |
Pension coverage (MV) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Disclosed government and/or occupational pension (%) | 2417 (82.1%) | 611 (30.4%) | 1051 (52.3%) | 908 (65.7%) | 357 (64.7%) | 1147 (58.4%) | 729 (72.7%) | 254 (25.4%) | 1050 (90.5%) | 38 (3.8%) | 117 (11.6%) | 346 (34.6%) | 9 (1.0%) |
Health Insurance coverage (MV) | 4 | 6 | 8 | 1 | 62 | 0 | 0 | 1 | 0 | 5 | 0 | 79 | |
Possess health insurance (%) | n/a | 430 (21.4%) | 1909 (95.4%) | 1111 (80.5%) | 399 (72.3%) | 862 (43.9%) | 546 (54.4%) | 280 (28.0%) | 14 (1.2%) | 769 (76.8%) | 13 (1.3%) | 0 (0.0%) | 1 (0.1%) |
Dementia (MV) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
10/66 or DSM-IV criteria (%) | 323 (11.0%) | 242 (12.0%) | 233 (11.6%) | 130 (9.4%) | 36 (6.5%) | 145 (7.4%) | 93 (9.3%) | 87 (8.7%) | 84 (7.2%) | 56 (5.6%) | 75 (7.5%) | 108 (10.8%) | 87 § (9.5%) |
Depression (MV) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Any ICD-10 depressive episode (%) | 144 (4.9%) | 278 (13.8%) | 47 (2.3%) | 87 (6.3%) | 16 (2.9%) | 107 (5.5%) | 47 (4.7%) | 45 (4.5%) | 3 (0.3%) | 7 (0.7%) | 39 (3.9%) | 126 (12.6%) | 5 (0.5%) |
Physical impairments (MV) | 6 | 2 | 6 | 1 | 1 | 33 | 0 | 0 | 0 | 0 | 1 | 0 | 21 |
Three or more (%) | 292 (9.9%) | 465 (23.1%) | 429 (21.4%) | 224 (16.2%) | 40 (7.3%) | 489 (24.9%) | 158 (15.8%) | 185 (18.5%) | 208 (17.9%) | 39 (3.9%) | 41 (4.1%) | 168 (16.8%) | 10 (1.1%) |
Mobility restriction (MV) | 8 | 2 | 7 | 6 | 1 | 67 | 3 | 0 | 4 | 2 | 2 | 0 | 67 |
Severe difficulty or cannot walk one km (%) | 546 (18.6%) | 439 (21.9%) | 603 (30.1%) | 143 (10.4%) | 30 (5.4%) | 204 (10.7%) | 126 (12.6%) | 146 (14.6%) | 119 (10.3%) | 51 (5.1%) | 84 (8.4%) | 225 (22.5%) | 64 (7.6%) |
Participants' characteristics
Healthcare service utilization
Community Healthcare Services | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Centres | n | Gov't Primary Care | Hospital outpatient | Private Doctor | Other Services | Traditional Healer | Any Community Medical Service* | Hospital Admission | Dentist | |
Crude prevalence
|
Standardised
†
prevalence (95% CI)
| |||||||||
Cuba MV† = 6 | 2944 | 1012 (34.4%) | 659 (22.4%) | 4 (0.1%) | 189 (6.4%) | 13 (0.4%) | 1465 (49.9%) | 50.4% (48.7-52.2%) | 62 (2.1%) | 181 (6.2%) |
Dominican Republic MV = 2 | 2011 | 222 (11.0%) | 453 (22.5%) | 409 (20.4%) | 35 (1.7%) | 5 (0.3%) | 960 (47.8%) | 45.0% (42.7-47.2%) | 61 (3.0%) | 87 (4.3%) |
Puerto Rico MV = 6 | 2008 | 198 (9.9%) | 20 (1.0%) | 1461 (72.8%) | 8 (0.4%) | 0 (0.0%) | 1639 (81.9%) | 79.8% (78.0-81.6%) | 107 (5.3%) | 320 (16.0%) |
Peru urban MV = 1 | 1381 | 155 (11.2%) | 451 (32.7%) | 147 (10.7%) | 39 (2.8%) | 5 (0.4%) | 670 (48.6%) | 48.1% (45.6-50.6%) | 31 (2.2%) | 90 (6.5%) |
Peru rural MV = 1 | 552 | 66 (12.0%) | 90 (16.3%) | 13 (2.4%) | 5 (0.9%) | 5 (0.9%) | 155 (28.1%) | 29.3% (25.7-32.9%) | 3 (0.5%) | 12 (2.2%) |
Venezuela MV = 33 | 1965 | 443 (22.9%) | 450 (23.3%) | 574 (29.7%) | 147 (7.6%) | 14 (0.7%) | 1211 (62.7%) | 60.3% (58.1-62.5%) | 77 (4.0%) | 156 (8.1%) |
Mexico urban MV = 0 | 1003 | 362 (36.1%) | 259 (25.8%) | 197 (19.6%) | 60 (6.0%) | 17 (1.7%) | 721 (71.9%) | 70.2% (67.5-72.9%) | 22 (2.2%) | 118 (11.8%) |
Mexico rural MV = 0 | 1000 | 410 (41.0%) | 111 (11.1%) | 186 (18.6%) | 45 (4.5%) | 33 (3.3%) | 646 (64.6%) | 63.3% (60.4-66.2%) | 16 (1.6%) | 36 (3.6%) |
China urban MV = 0 | 1160 | 242 (20.9%) | 271 (23.4%) | 1 (0.1%) | 2 (0.2%) | 3 (0.3%) | 448 (38.6%) | 32.4% (29.9-34.8%) | 28 (2.4%) | 13 (1.1%) |
China rural MV = 0 | 1002 | 38 (3.8%) | 22 (2.2%) | 3 (0.3%) | 1 (0.1%) | 0 (0.0%) | 61 (6.1%) | 8.7% (6.3-11.1%) | 5 (0.5%) | 0 (0.0%) |
India urban MV = 1 | 1005 | 42 (4.2%) | 124 (12.3%) | 417 (41.5%) | 8 (0.8%) | 3 (0.3%) | 566 (56.4%) | 61.5% (58.7-64.3%) | 10 (1.0%) | 3 (0.3%) |
India rural MV = 0 | 999 | 185 (18.5%) | 307 (30.7%) | 473 (47.3%) | 185 (18.5%) | 82 (8.2%) | 677 (67.8%) | 61.1% (57.5-64.7%) | 17 (1.7%) | 86 (8.6%) |
Nigeria MV = 20 | 914 | 25 (2.7%) | 108 (12.1%) | 75 (8.4%) | 41 (4.6%) | 83 (9.3%) | 272 (30.4%) | 42.5% (37.9-47.2%) | 40 (4.5%) | 6 (0.7%) |
Sites | Government Primary Care | Hospital outpatient | Private Doctor | Weighted proportion of consultations requiring out of pocket payments |
---|---|---|---|---|
Cuba | 6/1012 (0.6%) | 8/659 (1.3%) | n/a | 0.8% |
Dominican Republic | 61/222 (27.5%) | 185/453 (40.8%) | 303/409 (74.1%) | 50.6% |
Puerto Rico | 13/198 (6.6%) | 0/20 (0.0%) | 150/1461 (10.3%) | 9.7% |
Peru urban | 45/155 (29.0%) | 44/450 (9.8%) | 100/147 (68.0%) | 26.5% |
Peru rural | 44/66 (66.7%) | 15/90 (16.7%) | 10/13 (76.9%) | 40.8% |
Venezuela | 25/443 (5.6%) | 13/450 (2.9%) | 389/574 (67.8%) | 29.1% |
Mexico urban | 57/362 (15.7%) | 53/259 (20.5%) | 177/197 (89.8%) | 35.1% |
Mexico rural | 123/410 (30.0%) | 23/111 (20.7%) | 171/186 (91.9%) | 44.8% |
China urban | 240/242 (99.2%) | 269/271 (99.3%) | 1/1 (100%) | 99.2% |
China rural | 38/38 (100%) | 22/22 (100%) | 3/3 (100%) | 100.0% |
India urban | 11/41 (26.2%) | 16/124 (12.9%) | 403/417 (96.6%) | 73.9% |
India rural | 20/185 (10.8%) | 84/307 (27.4%) | 457/473 (96.6%) | 58.1% |
Nigeria | 11/25 (44.0%) | 72/108 (66.6%) | 41/75 (54.7%) | 59.6% |
Correlates of use of community healthcare services
Model 1 * | Model 2† | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Site | Age (per 5 year band) | Male Gender | Education (per level) | Currently Married | Living with children | Assets | Health insurance | ICD-10 Depression | Dementia | Physical impairment | Mobility restriction |
Cuba
| 0.97 (0.94-1.01) | 0.93 (0.86-1.01) | 1.06 (1.02-1.10) | 1.09 (1.00-1.18) | 1.05 (0.98-1.13) | 0.91 (0.84-0.98) | Not applicable | 1.11 (0.96-1.28) | 0.87 (0.76-0.98) | 1.23 (1.16-1.30) | 0.83 (0.74-0.92) |
Dominican
Republic
| 1.00 (0.96-1.04) | 0.96 (0.87-1.07) | 1.03 (0.98-1.08) | 1.00 (0.90-1.12) | 0.98 (0.89-1.07) | 1.11 (1.01-1.22) | 1.19 (1.07-1.32) | 1.03 (0.91-1.17) | 0.97 (0.83-1.12) | 1.32 (1.23-1.41) | 0.94 (0.84-1.05) |
Puerto Rico
| 0.99 (0.97-1.01) | 0.95 (0.91-1.00) | 0.99 (0.98-1.01) | 1.01 (0.96-1.06) | 1.00 (0.95-1.04) | 1.09 (1.03-1.15) | 1.42 (1.19-1.71) | 1.11 (1.04-1.18) | 0.95 (0.89-1.02) | 1.10 (1.07-1.14) | 1.04 (0.99-1.09) |
Peru urban
| 0.97 (0.92-1.02) | 1.00 (0.89-1.11) | 1.05 (0.99-1.12) | 0.95 (0.85-1.07) | 0.94 (0.84-1.05) | 1.28 (1.14-1.44) | 1.69 (1.39-2.05) | 1.26 (1.07-1.48) | 0.89 (0.72-1.09) | 1.38 (1.07-1.48) | 1.21 (1.03-1.41) |
Peru rural
| 1.03 (0.91-1.16) | 0.93 (0.70-1.22) | 0.98 (0.85-1.13) | 1.07 (0.80-1.43) | 1.33 (0.99-1.80) | 1.04 (0.78-1.38) | 1.20 (0.87-1.65) | 1.64 (1.09-2.47) | 1.12 (0.72-1.75) | 1.53 (1.25-1.87) | 1.38 (0.97-1.96) |
Venezuela
| 1.02 (0.99-1.06) | 0.88 (0.81-0.96) | 1.00 (0.96-1.04) | 0.99 (0.91-1.07) | 0.96 (0.89-1.04) | 1.06 (0.98-1.14) | 1.11 (1.04-1.19) | 1.14 (1.03-1.27) | 0.86 (0.73-1.00) | 1.19 (1.14-1.25) | 0.98 (0.89-1.09) |
Mexico urban
| 1.04 (1.00-1.08) | 0.89 (0.82-0.98) | 1.02 (0.99-1.06) | 1.06 (0.97-1.15) | 1.03 (0.95-1.11) | 0.95 (0.87-1.03) | 1.19 (1.10-1.29) | 1.03 (0.89-1.20) | 0.92 (0.80-1.06) | 1.12 (1.06-1.17) | 1.10 (0.89-1.13) |
Mexico rural
| 0.97 (0.93-1.02) | 0.87 (0.79-0.96) | 1.02 (0.96-1.08) | 0.96 (0.87-1.05) | 1.03 (0.94-1.13) | 1.02 (0.92-1.12) | 1.22 (1.12-1.34) | 1.01 (0.82-1.25) | 0.93 (0.78-1.12) | 1.07 (1.01-1.14) | 1.01 (0.89-1.09) |
China urban
| 0.98 (0.91-1.05) | 0.93 (0.80-1.08) | 1.04 (0.98-1.10) | 0.98 (0.84-1.16) | 1.08 (0.94-1.24) | 1.34 (1.16-1.55) | 2.02 (1.36-3.00) | 0.70 (0.16-3.00) | 0.93 (0.72-1.20) | 1.88 (1.70-2.08) | 0.90 (0.72-1.14) |
China rural
| 0.79 (0.60-1.03) | 1.03 (0.62-1.73) | 0.86 (0.64-1.16) | 1.00 (0.60-1.65) | 1.22 (0.66-2.25) | 0.57 (0.32-1.03) | 1.63 (0.84-3.16) | Too few exposed | 1.62 (0.72-3.68) | 3.02 (2.19-4.17) | 2.44 (1.08-5.46) |
India urban
| 1.00 (0.95-1.05) | 0.86 (0.76-0.96) | 1.02 (0.98-1.07) | 1.46 (1.29-1.67) | 1.14 (1.00-1.30) | 1.44 (1.28-1.62) | 1.02 (0.70-1.50) | 1.20 (0.97-1.49) | 0.93 (0.74-1.16) | 1.51 (1.39-1.63) | 1.15 (1.02-1.29) |
India rural
| 0.95 (0.90-0.99) | 1.04 (0.92-1.17) | 1.03 (0.97-1.09) | 1.00 (0.89-1.12) | 0.97 (0.89-1.07) | 0.93 (0.84-1.02) | Too few exposed | 1.57 (1.47-1.67) | 0.93 (0.82-1.07) | 1.19 (1.13-1.26) | 0.95 (0.85-1.07) |
Nigeria
| 0.99 (0.91-1.08) | 1.04 (0.84-1.29) | 1.14 (1.06-1.24) | 0.89 (0.72-1.11) | Not assessed | Not assessed | Too few exposed | 2.32 (1.56-3.34) | 1.16 (0.88-1.53) | 2.00 (1.70-2.36) | 0.94 (0.66-1.33) |
Meta-analytical pooled effect
| 0.99 (0.98-1.00) | 0.93 (0.91-0.96) | 1.03 † (1.01-1.05) | 1.03 † (0.98-1.09) | 1.01 (0.99-1.04) | 1.08 † (1.00-1.17) | 1.27 † (1.16-1.38) | 1.21† (1.07-1.38) | 0.93 (0.90-0.97) | 1.37 † (1.26-1.49) | 1.02 † (0.96-1.09) |
Cochrane Q [df] (p value) | 18.1 [12] (0.11) | 13.4 [12] (0.34) | 27.9 [12] (0.006) | 38.5 [12] (< 0.001) | 13.9 [11] (0.24) | 81.4 [11] (< 0.001) | 28.8 [9] (0.001) | 100.0 [11] (< 0.001) | 7.8 [12] (0.80) | 244.0 [12] (< 0.001) | 38.3 [12] (< 0.001) |
I
2
Higgins, % (95% CI) | 45 (0 - 73) | 11 (0-51) | 0 (0-60) | 72 (49-85) | 26 (0-64) | 88 (80-92) | 60 (23-80) | 88 (0-93) | 0 (0-60) | 94 (91-96) | 73 (51-85) |