Key result
High social risk is linked to functional disability, driven primarily by poor support networks.
Why the study?
High social risk may lead to disability, but this association has not been well explored in remote settings.
Does high social risk correlate with increased disability in stroke-free older adults living in rural settings?
Cross-Sectional (n=478)
No
Does high social risk correlate with increased disability in stroke-free older adults living in rural settings?
Effect estimate: β 0.442 (95% CI 0.258-0.625)
p-value: p=<0.001
Adverse social determinants of health, especially poor support networks and social relationships, are strongly associated with physical disability among rural older adults, surpassing the impact of economic status alone.
Social risk screening may aid identification of rural elders at disability risk; leaves open causality and intervention effects.
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.
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Brutto et al. (2020) conducted a cross-sectional in Stroke-free older adults in rural settings (n=478). Social determinants of health (SDH) / High social risk vs. Low social risk / varying levels of SDH was evaluated on Disability (Functional Activities Questionnaire score >=9) (β 0.442, 95% CI 0.258-0.625, p=<0.001). High social risk was independently associated with an increased likelihood of functional disability (β 0.442, 95% CI 0.258-0.625, p<0.001), primarily driven by poor support networks and social relationships.
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