Mortality of older people in Latin America, India and China: Causes and prevention

Stroke is the leading cause of death in people over 65 in low- and middle-income countries, according to new research published this week. Deaths of people over 65 represent more than a third of all deaths in developing countries yet, until now, little research has focused on this group. The study was led by researchers King's College London and is published in PLoS Medicine. The study also finds that education and social protection are as important in prolonging people's lives as economic development.

2 march 2012--Professor Martin Prince, who led the study from the 10/66 Dementia Research Group at the Institute of Psychiatry at King's says: 'Chronic diseases are rapidly replacing communicable diseases as the leading cause of mortality and disability in developing countries. Since stroke is the leading cause of death in older people, and education is a strong protective factor, prevention may be possible, adding years to life and life to years.

Professor Prince, who is also co-director of London's Centre for Global Mental Health (CGMH), adds: 'The current global health chronic disease agenda is largely focused on reducing mortality among working age adults. The concept of 'premature mortality' applied in such cases, is essentially ageist. I hope our findings will help highlight the lack of information about end of life among older people in developing countries, both regarding potential for prevention, and support and care of the dying, who, in the poorest settings, may not receive timely or effective medical intervention.'

In 2005, deaths of people aged 60 and over accounted 61 percent of all deaths in middle-income countries, and 33 percent in low-income countries, compared to 84 percent in high-income countries, yet there has been little research into the causes and determinants of these deaths.

Researchers surveyed 12,373 people aged 65 and over between 2003 and 2005 in a total of 10 urban and rural sites in Cuba, the Dominican Republic, Venezuela, Peru, Mexico, China and India, documenting over 2,000 deaths over a three to five year follow-up period.

Chronic diseases – particularly stroke, heart disease and diabetes – were the leading causes of death in all sites other than rural Peru. Overall, stroke was the most common cause of death (21.4 percent), ranking first in all sites other than rural Peru and rural Mexico. The authors found that education, more than occupational status and wealth in late-life, had a strong effect in reducing mortality risk in later life.

Most deaths occurred at home, with a particularly high proportion in rural China (91 percent), India (86 percent), and rural Mexico (65 percent). Other than in India, most received medical care for their final illness, but this was usually at home rather than in the hospital or clinic.

More information: Ferri CP, Acosta D, Guerra M, Huang Y, Llibre-Rodriguez JJ, et al. (2012) Socioeconomic Factors and All Cause and Cause-Specific Mortality among Older People in Latin America, India, and China: A Population-Based Cohort Study. PLoS Med 9(2): e1001179. doi:10.1371/journal.pmed.1001179