On the Association Between Social Determinants of Health and Disability in Stroke-Free Older Adults Living in Rural Settings. The Three Villages Study

Abstract

Background High social risk, as quantified by the social determinants of health (SDH), may lead to disability. This association has not been well explored in remote settings. Using the three Villages Study cohort, we assessed the association between SDH and disability among stroke-free older adults living in a rural Ecuadorian community. Methods SDH were measured by the use of the Gijon Scale and disability by the Functional Activities Questionnaire. All participants had a brain MRI to assess subclinical biomarkers of cerebral small vessel disease. Multivariate models were fitted to assess the association between components of SDH and disability, after adjusting for covariates of interest. Results The mean age of 478 enrolled individuals was 70.1 ± 8 years (59% women). High social risk was observed in 220 (46%) individuals and disability in 222 (46%). There was an almost direct linear relationship between SDH and disability, after taking into account the effect of age. A generalized linear model, adjusted for all included covariates, showed an independent association between social risk and disability ( P < .001). In addition, multivariate models showed that independent SDH components more strongly associated with disability were worse support networks and social relationships. In contrast, the single SDH component not associated with disability was the economic status. Conclusions This study showed a robust association between SDH and disability. Economic needs were surpassed by other components of SDH. This knowledge will help to develop strategies for the control of factors that may be in the path for disability among older adults living in rural settings.

High Social Risk Influence Progression of White Matter Hyperintensities of Presumed Vascular Origin: A Prospective Study in Community-Dwelling Older Adults

“…Findings of the present work, as well as those of other studies conducted in similar rural communities, underline the importance of selecting the proper field instrument to investigate SDH in underserved populations. 3,24 SDH assessment is not a matter of “one-size-fits-all”, and must be tailored according to the specific characteristics of the study population. SDH vary according to the level of development of a given community and their assessment must be adapted consequently.…”

“…1 SDH have a substantial impact on health status (particularly in vulnerable populations) and may result in the occurrence or progression of chronic conditions and diseases. 2,3 Moreover, SDH have been associated to increased stroke incidence and worse outcomes after a stroke. [4][5][6][7][8] However, specific cerebrovascular consequences of SDH have not been well evaluated to date.…”

Social determinants of health and cognitive performance of older adults living in rural communities: The Three Villages Study

“…Unfortunately, heterogeneity of designs across studies preclude valid conclusions on its prevalence, but the burden of cognitive decline in these settings is probably on the rise 16–19 . Likewise there is no information on the role of SDH in cognitive performance, although a previous study from our group found a significant association between high social risk (as measured by SDH) and disability in rural Ecuadorian settings 7 . Taking advantage of an already established observational cohort of community‐dwellers living in rural villages located in coastal Ecuador, 20 the present study examines the association between SDH and cognitive performance in older adults residing in these villages.…”

“…These determinants have a significant impact on the development of functional independence and on the health status of individuals, including the occurrence and progression of several chronic conditions and diseases 2–5 . SDH are of particular importance in fragile populations, such as older adults, who are prone to develop depression, increased cognitive complaints or disability in the setting of high social risk 6,7 . Indeed, several studies have suggested a link between SDH and poor cognitive performance, including dementia 8–10 .…”

“…Most of the available information on this subject comes from developed countries, where lifestyles and risk factors differ from those encountered in more remote settings of Low‐ and Middle‐Income Countries (LMIC). As a result, SDH vary according to the level of development of a given community and their assessment must take this variation into account 7,13–15 …”