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

Brutto, Oscar H. Del; Mera, Robertino; Rumbea, Denisse A.; Recalde, Bettsy Y.; Sedler, Mark J.

doi:10.1002/gps.5671

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…Multivariate imputation of the missing scores was utilized according to prior research on the matter. 18 …”

Section: Resultsmentioning

confidence: 99%

The Impact of Biological and Social Factors on Mortality in Older Adults Living in Rural Communities

Del Brutto,

Mera,

Rumbea

et al. 2024

J Prim Care Community Health

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Background: Information on factors that increase mortality in remote settings is limited. This study aims to estimate the independent and joint role of several factors on mortality risk among older adults living in rural Ecuador. Methods: Participants were selected from community-dwelling older adults who were included in previous studies targeting mortality risk factors in the study population. Generalized structural equation modeling (GSEM) was utilized to evaluate prior causal assumptions, to redraw causal links, and to introduce latent variables that may help to explain how the independently significant variables are associated with mortality. Results: The study included 590 individuals (mean age: 67.9 ± 7.3 years; 57% women), followed for a median of 8.2 years. Mortality rate was 3.4 per 100 person-years. Prior work on separate multivariate Poisson and Cox models was used to build a tentative causal construct. A GSEM containing all variables showed that age, symptoms of depression, high social risk, high fasting glucose, a history of overt stroke, and neck circumference were directly associated with mortality. Two latent variables were introduced, 1 representing the impact of biological factors and another, the impact of social factors on mortality. The social variable significantly influenced the biological variable which carried most of the direct effect on mortality. Conclusions: Several factors contributed to mortality risk in the study population, the most significant being biological factors which are highly influenced by social factors. High social risk interact with biological variables and play an important role in mortality risk.

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“…Multivariate imputation of the missing scores was utilized according to prior research on the matter. 18 …”

Section: Resultsmentioning

confidence: 99%

The Impact of Biological and Social Factors on Mortality in Older Adults Living in Rural Communities

Del Brutto,

Mera,

Rumbea

et al. 2024

J Prim Care Community Health

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“…Both are reliable field instruments for assessment of cognitive function and sleep quality, respectively, and have been previously used and validated by our group in the same population. 31,32 Using a MoCA score of ≤19 points (the cutoff for poor cognitive performance based on previous studies in the study population), 338 (61%) had normal cognitive performance and the remaining 214 (39%) were cognitively impaired. Mean volumes of CPCs were 685.5 ± 392.8 µL in participants with normal cognition and 679.8 ± 365.6 µL in those with impaired cognition ( p = .865).…”

Section: Discussionmentioning

confidence: 99%

Choroid plexus calcifications are not associated with putative markers of glymphatic dysfunction: A population study in middle-aged and older adults

Castillo,

Patel,

Mera

et al. 2024

Neuroradiol J

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Background and Purpose Recent studies have suggested an association between dysfunction of the choroid plexus and the glymphatic system. However, information is inconclusive. Following a population-based study design, we aimed to assess the association between choroid plexus calcifications (CPCs)—as a surrogate of choroid plexus dysfunction—and severity and progression of putative markers of glymphatic dysfunction, including white matter hyperintensities (WMH) of presumed vascular origin and abnormally enlarged basal ganglia perivascular spaces (BG-PVS). Methods This study recruited community-dwellers aged ≥40 years living in neighboring Ecuadorian villages. Participants who had baseline head CTs and brain MRIs were included in cross-sectional analyses and those who additional had follow-up MRIs (after a mean of 6.4 ± 1.5 years) were included in longitudinal analyses. Logistic and Poisson regression models, adjusted for demographics and cardiovascular risk factors, were fitted to assess associations between CPCs and WMH and enlarged BG-PVS severity and progression. Results A total of 590 individuals were included in the cross-sectional component of the study, and 215 in the longitudinal component. At baseline, 25% of participants had moderate-to-severe WMH and 27% had abnormally enlarged BG-PVS. At follow-up, 36% and 20% of participants had WMH and enlarged BG-PVS progression, respectively. Logistic regression models showed no significant differences between CPCs volumes stratified in quartiles and severity of WMH and enlarged BG-PVS. Poisson regression models showed no association between the exposure and WMH and enlarged BG-PVS progression. Baseline age remained significant in these models. Conclusions Choroid plexus calcifications are not associated with putative markers of glymphatic system dysfunction.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Brutto

Mera

Recalde

et al. 2022

Stroke

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BACKGROUND: Information on cerebrovascular consequences of high social risk, as determined by the social determinants of health, is limited. We sought to evaluate the impact of high social risk on the progression of white matter hyperintensities (WMHs) of presumed vascular origin. METHODS: Following a longitudinal prospective study design, participants of the Atahualpa Project Cohort received baseline social risk determinations by means of social determinants of health components included in the Gijon’s Social-Familial Evaluation Scale together with clinical interviews and brain magnetic resonance imagings. Those who also received follow-up brain magnetic resonance imaging at the end of the study were included. We used Poisson regression models adjusted for demographics, education levels and traditional cardiovascular risk factors to assess the incidence rate ratio of WMH progression according to the Gijon’s Social-Familial Evaluation Scale score. RESULTS: The study included 263 individuals aged ≥60 years (mean age, 65.7±6.2 years; 57% women). The Gijon’s Social-Familial Evaluation Scale mean score was 8.9±2.2 points. Follow-up magnetic resonance imagings revealed WMH progression in 103 (39%) individuals after a mean follow-up of 6.5 years (SD±1.4 years). Poisson regression models showed increased WMH progression rate among individuals in the third tertile of the Gijon’s Social-Familial Evaluation Scale score compared with those in the first tertile (incidence rate ratio, 1.65 [95% CI, 1.05–2.61]; P =0.032). Separate Poisson regression models using individual social determinants of health components showed that poor social relationships (incidence rate ratio, 1.39 [95% CI, 1.10–1.77]; P =0.006) and deficient support networks (incidence rate ratio, 1.79 [95% CI, 1.19–2.69]; P =0.005) were independently associated with WMH progression, whereas family situation, economic status, and housing did not. CONCLUSIONS: Poor social relationships and deficient support networks were significantly associated with WMH progression in community-dwelling older adults living in a rural setting. Our findings may help planning cost-effective preventive policies to reduce progression of cerebral small vessel disease among vulnerable populations.

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

Cited by 8 publications

References 34 publications

The Impact of Biological and Social Factors on Mortality in Older Adults Living in Rural Communities

The Impact of Biological and Social Factors on Mortality in Older Adults Living in Rural Communities

Choroid plexus calcifications are not associated with putative markers of glymphatic dysfunction: A population study in middle-aged and older adults

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

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