Educational Differences in Cognitive Life Expectancy Among Older Adults in Brazil

Abstract

Objectives To investigate the differences in life expectancy with and without cognitive impairment (CI) by educational levels and sex in Brazil. Design Longitudinal observational study. Setting The sample was drawn from three waves (2000, 2006, and 2010) of the Health, Well‐Being, and Aging Study (Saúde, bem‐estar e envelhecimento; SABE) collected in São Paulo, Brazil. Participants Adults aged 60 years and older (N = 2116). Measurements Educational levels were estimated in the baseline wave (2000), cognition was assessed in all waves, and mortality data were obtained through the state and municipal mortality system in Brazil. Interpolation of Markov chain methods was used to estimate life expectancy with and without CI by education and sex. Results Life expectancy without CI at the age of 60 years was 13.0 years among men with no education and 17.6 years among their counterparts with 8 years of schooling. On the other hand, life expectancy with CI was higher among men with no education than those with more education (3.2 and 0.6 years, respectively). Among 60‐year‐old women without education, life expectancy without CI reached 16.2 years, but it was considerably higher among more educated women (22.7 years). Life expectancy with CI reached 4.5 years among women aged 60 years with no education, vs 1.0 year among women with 8 years of schooling. Conclusions Adults older than 60 years with no education live shorter lives and with longer periods of CI than those with education. Women in São Paulo live longer lives than men, but they live with CI for a greater number of years.

Edentulism‐free life expectancy among older Brazilian adults: SABE study, 2006‐2016

“…Despite the increase in EFLE for most groups from 2006 to 2016, sex and education inequalities remained significant in the studied period. Inequalities in healthy life expectancy were suggested in studies using other general health [2][3][4][5][6][7] and oral health 23 measures, and might be explained by the worse health and living conditions of the most vulnerable groups. 36,37 The pro-rich inequalities in tooth loss 38 and dental care may be explained by the higher use of dental services, especially for preventive reasons, among the higher educated.…”

“…37 Consistent with previous studies, women expect to live longer but with more disabilities and diseases. [2][3][4][5][6][7]23 Higher male mortality at early ages, in addition to contributing to a decrease in TLE, could allow the composition of a more homogeneous and healthier group of older men due to a selection mechanism. 2,7 Furthermore, tooth loss seems to be more prevalent 10,32 and to occur at an early age among women, 32 which in part can be explained by financial, social and health conditions.…”

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Concerns about health conditions of the older adults have emerged with the increase in longevity and the rise of the ageing population since ageing is accompanied by an increase of non-communicable diseases and disabilities, reducing quality of life. [1][2][3][4][5][6][7] In this context, oral impairments may be significant as they are among the most prevalent diseases worldwide. Edentulism affects 3.3% of the population 8 and is highly prevalent among older adults.

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“…10 Tooth loss, when not accompanied by coping and adaptive strategies, 11 could impair masticatory ability, nutrition 12 and quality of life, 13 being the latter conditions closely related to morbidity, 12-16 mortality 17 and healthy life expectancy. [2][3][4][5][6]…”

“…Furthermore, this could be especially important in an unequal upper-middle-income country, such as Brazil, where social inequalities affect the prevalence and distribution of oral impairments 10,11,25 and life expectancy. [1][2][3][4][5][6] Thus, this study estimated edentulism-free life expectancy among older adults of São Paulo from 2006 to 2016 and assessed the existence of inequalities by sex and schooling, as well as changes in edentulism-free life expectancy in the period.…”