Background
Methods
Settings and study design
Measures
Sociodemographic status
Health status
Lifestyle risk factors
Analyses
Results
Sample characteristics
Baseline sample characteristics by ascertainment of vital status at follow up | Baseline sample characteristics by gender, for those whose vital status was known. | Baseline sample characteristics by household assets, for those whose vital status was known. | |||||||
---|---|---|---|---|---|---|---|---|---|
Vital Status known (n = 748) | Vital Status not known (n = 257) | χ2, df (p-value) | Female (n = 422) | Male (n = 316) | χ2, df (p-value) | Fewest assets - 4 or fewer (n = 459) | Most assets - 5 or more (n = 289) | χ2, df (p-value) | |
Age - mean (SD) | 71.4 (6.1) | 71.3 (6.2) | 0.31, 1001 (0.78) | 71.0 (5.8) | 71.8 (6.3) | 1.91, 644 (0.05) | 70.9 (5.9) | 72.2 (6.2) | 2.91, 744 (0.004) |
Female (%) | 422 (57.2%) | 149 (59.1%) | 0.3, 1 (0.59) | - | - | - | 272 (60.0%) | 150 (52.6%) | 3.9, 1, (0.05) |
Education
| 0.0, 1 (0.98) | 71.9, 1 (< 0.001) | 101.5, 1, (< 0.001) | ||||||
None | 314 (42.1%) | 114 (44.4%) | 240 (57.0%) | 72 (22.8%) | 245 (53.5 | 69 (24.0%) | |||
Some | 178 (23.9%) | 56 (21.8%) | 78 (18.5%) | 98 (31.0%) | 111 (24.3%) | 67 (23.3%) | |||
Primary | 160 (21.4%) | 52 (20.2%) | 74 (17.6%) | 84 (26.6%) | 77 (16.8%) | 83 (28.8%) | |||
Secondary | 66 (8.8%) | 21 (8.2%) | 20 (4.8%) | 44 (13.9%) | 23 (5.0%) | 43 (14.9%) | |||
Tertiary | 28 (3.8%) | 14 (5.4%) | 9 (2.1%) | 18 (5.7%) | 2 (0.4%) | 26 (9.0%) | |||
Marital status
| 6.0, 3 (0.11) | 184.0, 3 (< 0.001) | 10.1, 3, (0.02) | ||||||
Never married | 12 (1.6%) | 9 (3.5%) | 5 (1.2%) | 6 (1.9%) | 8 (1.7%) | 4 (1.4%) | |||
Married | 382 (51.1%) | 141 (55.3%) | 125 (29.6%) | 250 (79.1%) | 215 (46.8%) | 167 (58.0%) | |||
Widowed | 330 (44.2%) | 96 (37.6%) | 275 (65.2%) | 54 (17.1%) | 218 (47.5%) | 112 (38.9%) | |||
Divorced/separated | 23 (3.1%) | 9 (3.5%) | 17 (4.0%) | 6 (1.9%) | 18 (3.9%) | 5 (1.7%) | |||
Assets
| 0.86, 1 (0.35) | 5.0, 1 (0.03) | |||||||
1st quarter | 90 (12.0%) | 42 (16.5%) | 52 (12.4%) | 37 (11.7%) | - | - | |||
2nd quarter | 368 (49.3%) | 122 (48.0%) | 219 (52.0%) | 144 (45.6%) | - | - | |||
3rd quarter | 105 (14.1%) | 25 (9.8%) | 63 (15.0%) | 42 (13.3%) | - | - | |||
4th quarter | 184 (24.6%) | 65 (25.6%) | 67 (20.7%) | 93 (29.4%) | - | - | |||
Smoking : | 0.9, 2 (0.65) | 161.5, 2 (< 0.001) | 19.2, 2, (< 0.001) | ||||||
Never smoker | 548 (73.8%) | 182 (71.7%) | 381 (90.9%) | 162 (51.3%) | 316 (69.1%) | 232 (81.1%) | |||
Ex-smoker | 65 (8.7%) | 21 (8.3%) | 0 (0.0%) | 62 (19.6%) | 39 (8.5%) | 26 (9.1%) | |||
Current smoker | 130 (17.5%) | 51 (20.1%) | 38 (9.1%) | 92 (29.1%) | 102 (22.3%) | 28 (9.8%) | |||
Alcohol use
| 0.4, 1 (0.51) | 102.1, 1 (< 0.001) | 0.6, 1, (0.43) | ||||||
Always abstinent | 559 (83.9%) | 174 (83.7%) | 364 (99.2%) | 194 (65.1%) | 338 (83.0%) | 221 (85.3%) | |||
Moderate drinker, abstinent after the age of 65 | 45 (6.8%) | 15 (7.2%) | 2 (0.5%) | 43 (14.4%) | 29 (7.1%) | 16 (6.2%) | |||
Consistent moderate drinker | 26 (3.9%) | 13 (6.3%) | 0 (0.0%) | 26 (8.7%) | 16 (3.9%) | 10 (3.9%) | |||
Heavy drinker and/or sought treatment | 36 (5.4%) | 6 (2.9%) | 1 (0.3%) | 35 (11.7%) | 24 (5.9%) | 12 (4.6%) | |||
Physically inactive | 160 (21.5%) | 58 (23.0%) | 0.3, 1 (0.61) | 101 (23.9%) | 58 (18.4%) | 3.3, 1 (0.07) | 107 (23.4%) | 53 (18.5%) | 2.5, 1, (0.11) |
Waist circumference - mean (SD) | 83.2 (11.1) | 81.5 (11.5) | 2.01, 987 (0.05) | 82.5 (10.9) | 84.0 (11.1) | 1.71, 725 (0.08) | 81.4 (10.9) | 85.8 (11.2) | 5.21, 744, (< 0.001) |
Arm circumference - mean (SD) | 23.8 (4.2) | 23.3 (3.8) | 1.61, 991 (0.11) | 23.4 (3.9) | 24.2 (3.9) | 2.81, 728 (0.006) | 22.8 (3.4) | 25.3 (4.8) | 8.41, 744, (< 0.001) |
ICD-10 Depression | 25 (3.3%) | 14 (5.4%) | 2.3, 1 (0.13) | 13 (3.1%) | 12 (3.8%) | 0.3, 1 (0.59) | 18 (3.9%) | 7 (2.4%) | 1.2, 1, (0.27) |
Dementia | 54 (7.2%) | 21 (8.2%) | 0.3, 1 (0.62) | 33 (7.8%) | 21 (6.6%) | 0.4, 1 (0.54) | 37 (8.1%) | 17 (5.9%) | 1.3, 1, (0.26) |
Hypertension | 454 (60.7%) | 144 (56.0%) | 1.7, 1 (0.19) | 261 (61.8%) | 188 (59.5%) | 0.4, 1 (0.52) | 257 (56.0%) | 197 (68.2%) | 11.0, 1, (0.001) |
Stroke | 17 (2.3%) | 3 (1.2%) | 1.2, 1 (0.27) | 6 (1.4%) | 9 (2.8%) | 1.8, 1 (0.17) | 9 (2.0%) | 8 (2.8%) | 0.5, 1, (0.47) |
Ischaemic heart disease | 38 (5.1%) | 11 (4.3%) | 0.3, 1 (0.61) | 14 (3.3%) | 24 (7.6%) | 6.8, 1 (0.009) | 19 (4.1%) | 19 (6.6%) | 2.2, 1, (0.14) |
Diabetes | 92 (12.3%) | 29 (11.3%) | 0.2, 1 (0.66) | 51 (12.1%) | 40 (12.7%) | 0.1, 1 (0.81) | 46 (10.0%) | 46 (16.0%) | 5.8, 1, (0.02) |
Three or more limiting physical impairments | 30 (4.0%) | 11 (4.3%) | 0.0, 1 (0.85) | 16 (3.8%) | 13 (4.1%) | 0.1, 1 (0.82) | 10 (2.2%) | 20 (6.9%) | 10.4, 1, (0.001) |
Self-rated health
| 2.4, 1 (0.12) | 14.3, 1 (< 0.001) | 0.0, 1, 0.95 | ||||||
Very good | 321 (43.0%) | 97 (37.9%) | 165 (39.1%) | 153 (48.4%) | 197 (42.9%) | 124 (43.1%) | |||
Good | 269 (36.0%) | 98 (38.3%) | 149 (35.3%) | 115 (36.4%) | 165 (35.9%) | 104 (36.1%) | |||
Moderate | 126 (16.9%) | 46 (18.0%) | 83 (19.7%) | 43 (13.6%) | 78 (17.0%) | 48 (16.7%) | |||
Bad or very bad | 31 (4.1%) | 15 (5.9%) | 25 (5.9%) | 5 (1.6%) | 19 (4.1%) | 12 (4.2%) | |||
Disability - mean (SD) | 10.7 (15.2) | 10.1 (16.2) | 0.51, 999 (0.61) | 12.1 (16.1) | 8.6 (13.1) | 10.9 (15.7) | 10.4 (14.3) | 0.41, 744, (0.70) |
Mortality rate
Sex (10 MV1) | Women | Men | Both sexes combined | ||||||
---|---|---|---|---|---|---|---|---|---|
Age (3 MV1) | Deaths | Person years | Mortality rate (per 1000 person years) | Deaths | Person years | Mortality rate (per 1000 person years) | Deaths | Person years | Mortality rate (per 1000 person years) |
65-69 | 19 | 561.1 | 33.9 | 21 | 388.6 | 54.0 | 42 | 960.7 | 43.7 |
70-74 | 21 | 421.5 | 49.8 | 22 | 247.5 | 88.9 | 44 | 680.1 | 64.7 |
75-79 | 11 | 148.6 | 74.0 | 19 | 163.7 | 116.1 | 30 | 312.3 | 96.1 |
80+ | 13 | 137.0 | 94.9 | 21 | 94.8 | 221.5 | 37 | 238.2 | 155.3 |
All ages combined | 65 | 1274.4 | 51.0 | 83 | 897.3 | 92.5 | 154 | 2200.2 | 70.0 |
Bivariate analysis - baseline predictors of mortality
Socio demographic characteristic | Cumulative mortality | Hazard ratio (95%CI) | Hazard ratio (95% CI) Adjusted for Age and sex | Log-rank test |
---|---|---|---|---|
Age group (MV
1
= 2)
| χ2 = 38.3, df(3), p = <0.001 | |||
65-69 | 42/268 (13.5%) | Ref | Ref | |
70-74 | 44/231 (19.0%) | 1.5 (0.9-2.2) | 1.5 (1.0-2.3) | |
75-79 | 30/112 (26.8%) | 2.3 (1.4-3.7) | 2.2(1.4-3.6) | |
80+ | 37/92 (40.2%) | 3.5 (2.2-5.5) | 3.5 (2.2-5.5) | |
Sex (MV = 10)
| χ2 = 13.9, df (1), p = 0.0002 | |||
Female | 65/422 (15.4%) | Ref | Ref | |
Male | 83/316 (26.3%) | 1.8 (1.3-2.5) | 1.8 (1.3-2.5) | |
Marital status (MV = 1)
| χ2 = 1.73, df (3),p = 0.63 | |||
Never married | 4/12(33.3%) | Ref | Ref | |
Married | 87/382 (22.7%) | 0.5 (0.2-1.6) | 0.5 (0.1-1.4) | |
Widowed | 59/330(17.8%) | 0.5 (0.2-1.5) | 0.6 (0.2-1.8) | |
Divorced/separated | 4/23(17.4%) | 0.4 (0.1-1.7) | 0.4 (0.1-1.8) | |
Living arrangements (MV = 0)
| χ2 = 0.2, df (1), p = 0.66 | |||
Alone or with spouse only | 22/117 (18.8%) | 0.9 (0.5-1.4) | 0.9 (0.5-1.4) | |
With others | 132/631 (20.9%) | Ref | Ref | |
Educational level (MV = 2)
| χ2 = 0.0, df (1),p = 0.99 | |||
None | 68/314 (21.6%) | Ref | Ref | |
Some | 33/178 (18.5%) | 0.9 (0.6-1.4) | 0.7(0.5-1.2) | |
Primary | 35/160 (21.8%) | 1.0 (0.7-1.6) | 0.8 (0.5-1.2) | |
Secondary & Higher | 17/94(18.1%) | 0.9 (0.5-1.6) | 0.6 (0.3-1.1) | |
Have friends (MV = 2)
| χ2 = 4.70, df(1), p = 0.03 | |||
Yes | 66/382 (17.2%) | Ref | Ref | |
No | 87/364 (24%) | 1.4 (1.0-1.9) | 1.3 (0.9-1.8) | |
Frequency of meeting friends (MV = 2)
| χ2 = 4.2, df(4), p = 0.3 | |||
Daily | 51/288 (17.7%) | Ref | Ref | |
2-3 times/week | 7/42 (16.6%) | 1.0 (0.4-2.3) | 1.1 (0.5-2.5) | |
At least weekly | 5/31 (16.1%) | 1.1 (0.4-2.8) | 1.3 (0.5-3.3) | |
Less often | 3/16 (18.7%) | 1.2 (0.3 -3.7) | 1.1 (0.3-3.6) | |
No friends/never see | 87/369 (23.6%) | 1.4 (1.0 -2.0) | 1.5 (1.0-2.1) | |
Socioeconomic status
| ||||
Declared Income (MV = 0)
| χ2 = 2.65, df(2), p = 0.26 | |||
< Rs.3000 | 104/446 (23.3%) | Ref | Ref | |
Rs.3000 to 6000 | 28/197 (14.2%) | 0.9 (0.6 -1.4) | 1.0 (0.6-1.5) | |
> Rs. 6000 | 22/105 (20.9%) | 1.4 (0.8 -2.2) | 1.3 (0.8-2.2) | |
Number of Assets (MV = 1)
| χ2 = 0.75, df(1), p = 0.39 | |||
1st quarter (fewest) | 16/90 (17.7%) | Ref | Ref | |
2nd quarters | 79/368 (21.4%) | 1.4 (0.8 -2.4) | 1.4 (0.8 -2.5) | |
3rd quarters | 19/105 (18.1%) | 1.4 (0.7-2.7) | 1.3 (0.6 -2.5) | |
4th quarter (highest) | 39/184 (21.2%) | 1.5 (0.8 -2.7) | 1.3 (0.7 -2.3) | |
Pension receipt (MV = 0)
| χ2 = 0.00, df(1), p = 0.96 | |||
Yes | 135/653 (20.6%) | Ref | Ref | |
No | 19/95 (20.0%) | 1.0 (0.6-1.6) | 0.9 (0.5 -1.4) | |
Food insecurity (MV = 3)
| χ2 = 0.28, df(1), p = 0.59 | |||
No | 121/598 (20.2%) | Ref | Ref | |
Yes | 33/147 (22.4%) | 1.1 (0.7 -1.6) | 1.1 (0.7 -1.6) |
Life style factors | Cumulative mortality | Hazard ratio (95%CI) | Hazard ratio (95% CI) Adjusted for Age + Gender | Log-rank test |
---|---|---|---|---|
Smoking (MV
1
= 5)
| χ2 = 7.04, df(2),p = 0.02 | |||
Never smoked | 102/548 (18.6%) | Ref | Ref | |
Smokeless tobacco | 7/36 (19.4%) | 0.9 (0.4 -2.0) | 0.7 (0.3 -1.7) | |
Smoking tobacco | 43/158 (27.1%) | 1.6 (1.1 -2.2) | 1.1 (0.7 -1.6) | |
Alcohol use (MV = 82)
| χ2 = 5.65, df(1),p = 0.02 | |||
Always abstinent | 108/559 (19.3%) | Ref | Ref | |
Moderate drinker, abstinent after the age of 65 | 8/45 (17.9%) | 0.8 (0.4-1.7) | 0.6 (0.3-1.2) | |
Consistent moderate drinker | 7/26 (26.9%) | 1.4 (0.7-3.1) | 1.0 (0.4-2.1) | |
Heavy drinker and/or sought treatment for alcohol problem | 14/36 (38.9%) | 2.1 (1.2-3.7) | 1.4 (0.8-2.6) | |
Diet and nutrition
| ||||
Fish in diet (MV = 3)
| χ2 = 0.77, df (2),p = 0.68 | |||
Never | 26/139 (18.7%) | Ref | Ref | |
Some days | 103/503 (20.4%) | 1.0 (0.7 -1.6) | 1.1 (0.7 -1.7) | |
Most of the days | 25/103 (24.2%) | 1.2 (0.7 -2.2) | 1.3 (0.7 -2.3) | |
Meat in diet (MV = 2)
| χ2 = 0.07, df(2),p = 0.96 | |||
Never | 34/180 (18.8%) | Ref | ||
Some days | 100/474 (21.1%) | 1.0 (0.7 -1.5) | 1.0 (0.7 -1.5) | |
Most of the days | 20/92 (21.7%) | 1.0(0.5 -1.7) | 1.0 (0.6 -1.8) | |
Physical activity (MV = 3)
| χ2 = 7.32, df (1),p = 0.006 | |||
Yes | 124/637 (19.4%) | Ref | Ref | |
No | 28/107 (28.0%) | 1.7 (1.1 -2.5) | 1.5 (1.0 -2.3) | |
Arm circumference (MV = 9)
| χ2 = 10.1, df(1),p = 0.001 | |||
1st quarter | 59/200 (29.5%) | Ref | Ref | |
2nd quarter | 38/185 (20.5%) | 0.6 (0.4 -1.0) | 0.6 (0.4-0.9) | |
3rd quarter | 25/156 (16.0%) | 0.5 (0.3 -0.9) | 0.5 (0.3-0.9) | |
4th quarter | 30/198 (15.1%) | 0.5 (0.3 -0.7) | 0.4 (0.3-0.7) | |
Per centimetre | - | 0.90 (0.85-0.94) | 0.89 (0.84-0.94) | |
Waist circumference (MV = 12)
| χ2 = 14.6, df(3),p = 0.002 | |||
1st quarter | 33/174 (19.0%) | (Ref) | (Ref) | |
2nd quarter | 58/189 (30.7%) | 1.8 (1.2-2.8) | 1.7 (1.1-2.7) | |
3rd quarter | 31/187 (16.6%) | 0.9 (0.5-1.5) | 0.9 (0.5-1.5) | |
4th quarter | 29/186 (15.6%) | 0.9 (0.5-1.4) | 0.9 (0.5-1.4) |
Morbidities & Life style | Cumulative mortality | Hazard ratio (95%CI) | Hazard ratio (95% CI) Adjusted for Age + Gender | Log-rank test |
---|---|---|---|---|
Survey clinical diagnosis
| ||||
Dementia (MV
1
= 0)
| χ2 = 25.0, df(1) p = < 0.001 | |||
No | 129/694 (18.6%) | Ref | Ref | |
Yes | 25/54 (46.3%) | 2.8 (1.8 -4.3) | 2.3 (1.5 -3.7) | |
Cognitive Impairment (MV = 0)
| χ2 = 37.4, df(1),p = <0.001 | |||
Cognitively healthy | 122/672 (18.2%) | Ref | Ref | |
Mild Cognitive Impairment | 7/26 (26.9%) | 1.9 (0.9-4.0) | 1.9 (0.9 -4.2) | |
CDR questionable dementia | 15/34 (44.1%) | 2.8 (1.6-4.8) | 2.1 (1.2 -3.7) | |
CDR mild moderate & severe dementia | 10/16 (62.5%) | 5.1 (2.7-9.7) | 4.1 (2.1 -7.9) | |
Depression (MV = 0)
| χ2 = 9.2, df(1), p = 0.002 | |||
No depression | 81/446 (18.2%) | Ref | Ref | |
Depression subcase | 65/277 (23.5%) | 1.5 (1.1-2.2) | 1.6 (1.2-2.3) | |
ICD 10 depression case | 8/25 (32.0%) | 2.2 (1.1 -4.5) | 2.1 (1.0 -4.3) | |
Hypertension (MV = 0)
| χ2 = 0.8, df(1),p = 0.59 | |||
No | 69/294 (23.4%) | Ref | Ref | |
Yes | 85/454 (18.7%) | 0.8 (0.6 -1.1) | 0.9 (0.6 -1.3) | |
Chronic Obstructive Pulmonary Disease
| χ2 = 0.20, df(1),p = 0.65 | |||
No | 151/734 (20.5%) | Ref | Ref | |
Yes | 3/13 (23.1%) | 1.3 (0.4-4.0) | 1.6 (0.5 -5.2) | |
Self-reported physician diagnosis
| ||||
Stroke (MV = 1)
| χ2 = 1.87, df(1),p = 0.17 | |||
No | 149/731 (20.3%) | Ref | Ref | |
Yes | 5/16 (31.2%) | 1.8 (0.7-4.5) | 1.6 (0.6 -4.1) | |
Diabetes (MV = 1)
| χ2 = 0.57, df(1), p = 0.44 | |||
No | 138/655 (21.0%) | Ref | Ref | |
Yes | 16/92 (17.4%) | 0.8 (0.4 -1.3) | 0.7 (0.4 -1.3) | |
Ischaemic heart disease (MV = 1)
| χ2 = 0.08, df(1),p = 0.78 | |||
No | 147/709 (20.7%) | Ref | Ref | |
Yes | 7/38 (18.4%) | 0.8(0.4 -1.9) | 0.9 (0.4 -1.9) | |
Number of self-reported limiting physical impairments (MV = 1)
| χ2 = 3.65, df(2),p = 0.16 | |||
None | 89/479 (18.5%) | Ref | Ref | |
One or two | 58/238 (24.3%) | 1.3(0.9-1.9) | 1.4 (1.0 -1.9) | |
More than three | 7/30 (23.3%) | 1.3(0.6-2.8) | 1.1(0.4 -2.6) | |
Time taken to walk 10 metres (per second) (MV = 6)
| - | 1.02 (1.01-1.03) | 1.02 (1.01-1.04) | χ2 = 5.5, df(1) p = 0.02 |
Subjective global health (MV = 1)
| χ2 = 11.0, df(3),p = 0.01 | |||
Very healthy | 63/321 (19.6%) | Ref | Ref | |
Good | 51/269(18.9%) | 0.9(0.6 -1.3) | 0.9(0.6-1.3) | |
Moderate | 27/126(21.4%) | 1.0(0.6 -1.6) | 1.0(0.7 -1.7) | |
Not very healthy | 13/31 (41.9%) | 2.5(1.3-4.5) | 2.9 (1.6 -5.4) | |
WHODAS 12 disability score (per unit) | - | 1.023 (1.015-1.030) | 1.024 (1.015-1.032) | χ2 = 37.3, df(1) p < 0.001 |
A parsimonious model to predict mortality
Model 1 | Model 2 | |||
---|---|---|---|---|
Risk exposure | Hazard Ratio (95% CI) adjusted for all variables in the model (n = 727) | Adjusted Population Attributable Risk Fraction (95% CI) | Hazard Ratio (95% CI) adjusted for all variables in the model (n = 726) | Adjusted Population Attributable Risk Fraction (95% CI) |
Male sex
| 2.0 (1.4-2.8) | 0.55 (0.30-0.71) | 2.1 (1.5-3.0) | 0.59 (0.36-0.74) |
Arm circumference
| 0.90 (0.85-0.95) | 0.43 (0.19-0.60) | 0.90 (0.86-0.95) | 0.44 (0.21-0.60) |
Age | 0.45 (0.27-0.59) | 0.41 (0.21-0.56) | ||
65-69 | 1 (ref) | 1 (ref) | ||
70-74 | 1.4 (0.9-2.1) | 1.4 (0.9-3.6) | ||
75-79 | 1.9 (1.2-3.1) | 1.7 (1.1-2.8) | ||
80+ | 2.7 (1.7-1.7) | 2.5 (1.5-4.0) | ||
Cognitive Impairment/Dementia
| 0.10 (0.06-0.13) | 0.07 (0.04-0.10) | ||
Cognitively healthy | 1 (ref) | 1 (ref) | ||
Mild Cognitive Impairment | 1.4 (0.9-2.1) | 1.7 (0.8-3.6) | ||
CDR questionable dementia | 1.9 (1.2-3.1) | 1.5 (0.8-2.7) | ||
CDR mild dementia | 3.2 (1.6-6.4) | 2.4 (1.2-4.8) | ||
WHODAS disability score
| Not included | Not included | 1.02 (1.01-1.03) | 0.21 (0.14-0.28) |
Total Population Attributable risk fraction | - | 0.87 (0.74-0.93) | - | 0.90 (0.79-0.95) |
Global test of proportional hazards assumption | Chi squared = 6.1,9 df, p = 0.73 | Chi squared = 7.1, 10 df, p = 0.72 |