STATUS REPORT: INDEPTH Adult Health & Aging

- with WHO SAGE –

Site scientists, editorial team, mentorsengaged funder R Suzman / NIA

INDEPTH AGM, October 2009

Pune, India

Goals: INDEPTH Adult Health & Aging

-> To establish INDEPTH’s capability to contribute critical insights into the adult health, aging and disease transitions evolving in Africa and Asia;

-> To use this understanding to evaluate interventions of potentially high impact

Background

October 2003, Johannesburg• develop’t of INDEPTH Adult Health & Aging platform• 17 African and Asian sites

April 2005, Johannesburg• collaboration with Evidence, Info & Res for Policy, WHO • development of INDEPTH/WHO short module

2006 – 2007: 8 INDEPTH sites• Fieldwork: short module (8 sites); full SAGE (3 sites)

May 2008, Epidemiol & Global Health, Umeå U, Sweden• Data harmonization and analysis workshop

Paper drafting, internal review

INDEPTH-WHO collaboration

Aims to:• conduct a summary physical & cognitive function module

that is integrated into routine surveillance rounds• [implement the full version of SAGE in a few DSS sites]

Summary function module should: • be repeated regularly to allow measurement of health

transition in older populations • relate health transition to demographic events such as

fatal health outcomes (mortality) • Large samples will be needed to examine associations

with cause-specific mortality.

2008, Umeå workshop

INDEPTH-WHO physical & cognitive function in older adults 2006/7

Site Study population Physical and cognitive evaluation

Site pop Pop 50+ SAGE-INDEPTH summary

Full SAGE survey

AFRICA

Agincourt, South Africa 70 000 8 429 X X

Ifakara, Tanzania 60 000 6 600 X

Nairobi, Kenya 68 746 2 771 X

Navrongo, Ghana 144 187 22 952 X X

ASIA

Filabavi, Vietnam 50 000 8 500 X

Matlab, Bangladesh 212 328 33 797 X

Purworejo, Indonesia 52 500 14 200 X

Vadu, India 68 354 8 754 X X

SAGE Instruments (Summary Modules)

• Health state descriptions– Self reported health status– Difficulty with work/household activities– 8 health domains: mobility, self-care, pain and

discomfort, cognition, interpersonal activities, affect, vision, sleep and energy.

– Set of vignettes for the 8 health domains: 5 scenarios for each domain

• Subjective wellbeing and quality of life

All questions are in categorical ordered response

Analyzing the SAGE data

• Creating composite index– WHO-DAS (Disability Assessment Schedule)– WHO-QOL (Quality of Life)– WHO-Health Score

• Enriching the data with DSS variables

Age at time of interview, sex, education completed, marital status, HH size, number of HH member 50+ in the same household, SES quintile

Health Score: difficulties in conducting activities in eight health domains: affect, cognition, interpersonal activities, mobility, pain, self-care, sleep and energy, and vision.

Quality of Life index: respondent’s thoughts about their life and life situation, satisfaction with themselves, health, ability to perform daily living activities, personal relationships, living conditions, and overall life.

Disability assessment: difficulties in functional assessment and activities in the last 30 days

All questions were posed as five-response scale Results transformed to a continuous cardinal scale from

0 to 100

The composite scoresThe composite scores

Study subjects

Sites Men Women Total

Navrongo-GH* 1,789 2,795 4,584Ifakara-TZ* 2,454 2,677 5,131Nairobi-KE* 1,327 745 2,072Agincourt-SA* 1,012 3,073 4,085Vadu-ID 2,805 2,625 5,430Matlab-BD* 2,016 2,021 4,037Filabavi-VN 3,469 5,066 8,535Purworejo-ID 5,727 6,668 12,395Total 20,599 25,670 46,269

Sample of 50+ (*) vs. All of 50+

010

2030

4050

6070

8090

100

Sco

re

50 55 60 65 70 75 80 85Age in year

Navrongo-GH Ifakara-TZ Nairobi-KE Agincourt-SA

Vadu-ID Matlab-BD Filabavi-VN Purworejo-ID

Mean IRT Health scores by Age

010

2030

4050

6070

8090

100

Sco

re

50 55 60 65 70 75 80 85Age in year

Navrongo-GH Ifakara-TZ Nairobi-KE Agincourt-SA

Vadu-ID Matlab-BD Filabavi-VN Purworejo-ID

Mean WHODAS scores by Age

010

2030

4050

6070

8090

100

Sco

re

50 55 60 65 70 75 80 85Age in year

Navrongo-GH Ifakara-TZ Nairobi-KE Agincourt-SA

Vadu-ID Matlab-BD Filabavi-VN Purworejo-ID

Mean WHOQOL scores by Age

Navrongo Ifakara Nairobi Agincourt-2.18

Sleep/energy-3.28

Pain/discomfort-3.28

Vision-2.35

Sleep/energy-1.96

Mobility-3.1

Mobility-3.09

Pain/discomfort-2.23

Pain/discomfort-1.91Affect

-2.36Vision

-2.82Sleep/energy

-2.13Cognition

-1.84Pain/discomfort

-2.25Sleep/energy

-2.62Affect

-2.05Affect

-1.81Cognition

-2.21Cognition

-2.5Mobility

-1.6Vision

-1.51Interpersonal

-1.91Affect

-2.37Cognition

-1.6Mobility

-1.39Vision

-0.59Interpersonal

-1.91Interpersonal

-1.34Interpersonal

-0.6Self-care

-0.24Self-care

-0.18Self-care

-0.72Self-care

Health score was used as outcome variables, and the regression analyses were adjusted to sex, age, education level, socio-economic quintiles, and marital status in each site.

Vadu Matlab Filabavi Purworejo-2.78

Vision-1.84

Mobility-2.36

Mobility-3.71

Pain/discomfort-2.5

Pain/discomfort-1.69

Pain/discomfort-2.33

Sleep/energy-3.19

Cognition-2.37

Mobility-1.69Affect

-2.24Pain/discomfort

-2.9Vision

-2.33Interpersonal

-1.51Sleep/energy

-1.99Cognition

-2.5Sleep/energy

-2.28Affect

-1.45Vision

-1.68Affect

-2.26Affect

-2.08Cognition

-1.39Cognition

-1.57Vision

-2.23Mobility

-1.45Self-care

-1.31Interpersonal

-1.17Interpersonal

-1.16Interpersonal

-1.44Sleep/energy

-1.11Self-care

-0.27Self-care

0.8Self-care

Health score was used as outcome variables, and the regression analyses were adjusted to sex, age, education level, socio-economic quintiles, and marital status in each site.

Predictors of poor health are being women, older age, lived in Matlab, Agincourt and Navrongo, low SES, and reported disability and poor functioning.A larger difference of health score in men and women than expected.Post-regression decomposition: 87% of the health score difference was attributable to differences of age, education, socio-economic levels, marital status, living arrangement, disability and functioning, quality of life between men and women.

Cross-site highlights

Journal progress update: Global Health Action

CONTRIBUTION STATUS

Foreword Awaited

Editorial To be written once all papers ready

Background/methods paper

1st draft complete

Site-specific papers 7 of 8 ready for peer review Online submission to GHA underwaySenior reviewer/mentor selected

Cross-site comparative paper

Analyses in advanced stage

Commentaries Authors to be invited

Journal launch 2010with release Public accessdataset

Planning ahead…

• Further analyses and writing with enriched dataset (contextual variables, longitudinal data) – Data validity: cross-site comparison

INDEPTH-Harvard workshop 04/2010• Repeat module - 2010• Bring together…

– NCD risk factor module– Work on demogr / epidem transitions– Work on health systems R&D

• Program of intervention / health systems R&D