Impact of Combined Hypertension and Diabetes on the Prevalence of Disability in Brazilian Older People—Evidence from Population Studies in 2013 and 2019
Abstract
1. Introduction
2. Materials and Methods
3. Results
3.1. Sample Description
3.2. Brazilian National Health Survey (2013 PNS) Sample Description
3.3. Brazilian National Health Survey (PNS 2019) Sample Description
3.4. Disability Prevalences
3.5. Association Between T2DM/SAH and BADL/IADL
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
95%CI | 95% Confidence Interval |
BADL | Basic Activities of Daily Living |
DALY | Disability-Adjusted Life Years |
GBD | Global Burden of Disease |
IADL | Instrumental Activities of Daily Living |
IBGE | Instituto Brasileiro de Geografia e Estatística |
NCDs | Chronic noncommunicable diseases |
NHS | National Health Survey |
PNS | Pesquisa Nacional de Saúde |
PRa | Prevalence-Ratio-Adjusted (ou conforme sua definição específica) |
Pw | Probability weight |
SAH | Systemic Arterial Hypertension |
T2DM | Type 2 Diabetes Mellitus |
Appendix A
Variable | Definitions in the Original Study | New Categorizations |
---|---|---|
Age | In years | In years |
Sex | Male | Masculine |
Female | Feminine | |
Education | Uneducated | Incomplete elementary education |
Incomplete elementary school | ||
Complete elementary | Completed elementary education | |
Incomplete medium | ||
Complete medium | ||
Incomplete higher education | ||
Completed higher education | ||
Race | White | White |
Yellow | Black | |
Brown | Others | |
Black | ||
Indigenous | ||
Region | Rural | Rural |
Urban | Urban | |
Marital status | Married | Married |
Divorced | Not married | |
Separate | ||
Single | ||
Widower | ||
Type 2 Diabetes Mellitus | Self-reported medical diagnosis | 0—does not have diabetes |
1—has diabetes | ||
Systemic Arterial Hypertension | Self-reported medical diagnosis | 0—no hypertension |
1—has hypertension | ||
No difficulty | 0—cannot, has much difficulty, and has little difficulty | |
There is little difficulty | ||
It has great difficulty | 1—No difficulty | |
Cannot | ||
IADL | No difficulty | 0—Cannot, has much difficulty, and has little difficulty |
There is little difficulty | ||
It has great difficulty | 1—No difficulty | |
Cannot |
Item No. | STROBE Recommendation | Location in the Manuscript (Page, Paragraph) |
---|---|---|
1(a) | Indicate the study’s design with a commonly used term in the title or the abstract | Title (p. 1, 1) |
1(b) | Provide in the abstract an informative and balanced summary of what was carried out and what was found | Abstract (p. 1,1) |
2 | Explain the scientific background and rationale for the investigation being reported | Introduction (p. 1, 1–4) |
3 | State-specific objectives, including any prespecified hypotheses | Final of the introduction (p. 2, 4) |
4 | Present key elements of the study design early in the paper | Materials and Methods (p. 2, 1–2) |
5 | Describe the setting, locations, and relevant dates, including periods of recruitment, exposure, follow-up, and data collection | Materials and Methods (p. 3, 3) |
6(a) | Give the eligibility criteria, and the sources and methods of selection of participants | Materials and Methods (p. 3, 4) |
7 | Clearly define all outcomes, exposures, predictors, potential confounders, and effect modifiers. Give diagnostic criteria, if applicable | Materials and Methods (p. 3, 4–6) |
8 | For each variable of interest, give sources of data and details of methods of assessment (measurement). Describe the comparability of assessment methods if there is more than one group | Materials and Methods (p. 3, 5–6) |
9 | Describe any efforts to address potential sources of bias | Does not apply |
10 | Explain how the study size was arrived at | Materials and Methods (p. 2, 2) |
11 | Explain how quantitative variables were handled in the analyses. If applicable, describe which groupings were chosen and why | Materials and Methods (p. 3, 5–6) |
12(a) | Describe all statistical methods, including those used to control for confounding | Materials and Methods (p. 3, 7) |
12(b) | Describe any methods used to examine subgroups and interactions | Does not apply |
12(c) | Explain how missing data were addressed | Materials and Methods (p. 3, 5) |
12(d) | If applicable, describe analytical methods taking account of sampling strategy | Materials and Methods (p. 2, 7) |
12(e) | Describe any sensitivity analyses | Does not apply |
13(a) | Report numbers of individuals at each stage of study (e.g., potentially eligible, examined for eligibility, included, analyzed) | Results (p. 4, 1) |
13(b) | Give reasons for non-participation at each stage | Results (p. 4, 1) |
13(c) | Consider use of a flow diagram | Results (p. 4, 1) |
14(a) | Give characteristics of study participants (e.g., demographic, clinical, and social) and information on exposures and potential confounders | Results (p. 6 and 8) |
14(b) | Indicate number of participants with missing data for each variable of interest | Results (p. 6 and 8) |
15 | Report numbers of outcome events or summary measures | Results (p. 6 and 8) |
16(a) | Give unadjusted estimates and, if applicable, confounder-adjusted estimates and their precision (e.g., 95% confidence interval). Make clear which confounders were adjusted for and why they were included | Results (3 and Table 4) |
16(b) | Report category boundaries when continuous variables were categorized | Methods (p. 3, 4) |
16(c) | If relevant, consider translating estimates of relative risk into absolute risk for a meaningful time period | Does not apply |
17 | Report other analyses completed, e.g., subgroup analyses and sensitivity analyses | Does not apply |
18 | Summarise key results with reference to study objectives | Discussion (p. 13) |
19 | Discuss limitations of the study, taking into account sources of potential bias or imprecision | Discussion (p. 13, 4–5) |
20 | Give a cautious overall interpretation of results considering objectives, limitations, multiplicity of analyses, results from similar studies, and other relevant evidence | Discussion and conclusions (p. 13, 5–6; p. 14, 4) |
21 | Discuss the generalizability (external validity) of the study results | Conclusions (p. 14, 1) |
22 | Give the source of funding and the role of the funders for the present study | p. 15, 2 |
Categories | K001 To Eat | K004 To Bath | K007 Bathroom Use | K010 To Dress Up | K013 To Walk | K016 + K019 Transfer |
---|---|---|---|---|---|---|
No difficulty | 10,667 (95.44) | 10,469 (93.67%) | 10,536 (94.27%) | 10,239 (91.61%) | 10,290 (92.06%) | 20,573 (92.03) |
There is little difficulty | 316 (2.83) | 354 (3.17) | 352 (3.15) | 551 (4.93) | 522 (4.67) | 1161 (5.19) |
It has great difficulty | 125 (1.12%) | 180 (1.61%) | 139 (1.24%) | 215 (1.92%) | 222 (1.99%) | 360 (1.61%) |
Cannot | 69 (0.62%) | 174 (1.56%) | 150 (1.34%) | 172 (1.54%) | 143 (1.28%) | 260 (1.16%) |
Categories | K022 Shopping | K025 Finances | K028 Medicines | K031 Doctor | K034 Transport |
---|---|---|---|---|---|
No difficulty | 9302 (83.22%) | 9891 (88.49%) | 8211 (73.46%) | 8646 (77.36%) | 8732 (78.12%) |
There is little difficulty | 678 (6.07%) | 478 (4.28%) | 391 (3.50%) | 1151 (10.30%) | 921 (8.24%) |
It has great difficulty | 457 (4.09%) | 263 (2.35%) | 205 (1.83%) | 630 (5.64%) | 639 (5.72%) |
Cannot | 740 (6.62%) | 545 (4.88%) | 245 (2.19%) | 750 (6.71%) | 885 (7.92%) |
Does not use medication | - | - | 2125 (19.01%) | - | - |
Categories | K001 To Eat | K004 To Bath | K007 Bathroom Use | K010 To Dress Up | K013 To Walk | K016 + K019 Transfer |
---|---|---|---|---|---|---|
No difficulty | 21,613 (95.09%) | 21,061 (92.67%) | 20,681 (90.99%) | 20,052 (88.23%) | 20,289 (89.27%) | 39,898 (87.77%) |
There is little difficulty | 697 (3.07%) | 936 (4.12%) | 1086 (4.78%) | 1749 (7.70%) | 1405 (6.18%) | 3576 (7.87%) |
It has great difficulty | 250 (1.10%) | 374 (1.65%) | 372 (1.64%) | 590 (2.60%) | 517 (2.27%) | 1.015 (2.23%) |
Cannot | 168 (0.74%) | 357 (1.57%) | 589 (2.59%) | 337 (1.48%) | 517 (2.27%) | 967 (2.13%) |
Categories | K022 Shopping | K025 Finances | K028 Remedy | K031 Doctor | K034 Transport |
---|---|---|---|---|---|
No difficulty | 18,473 (81.28%) | 19,722 (86.77%) | 602 (2.65%) | 16,956 (74.60%) | 16,916 (74.43%) |
There is little difficulty | 1768 (7.78%) | 1293 (5.69%) | 482 (2.12%) | 2578 (11.34%) | 2383 (10.48%) |
It has great difficulty | 963 (4.24%) | 607 (2.67%) | 1295 (5.70%) | 1226 (5.39%) | 1367 (6.01%) |
Cannot | 1524 (6.71%) | 1106 (4.87%) | 16896 (74.34%) | 1968 (8.66%) | 2062 (9.07%) |
Does not use medication | - | - | 3453 (15.19%) | - | - |
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2013 PNS | |||||||
---|---|---|---|---|---|---|---|
BALD | IADL | ||||||
Variable | Total Population | Independent | Moderate | Severe | Independent | Moderate | Severe |
n = 11,177 | n = 9424 | n = 1197 | n = 556 | n = 7893 | n = 1540 | n = 1744 | |
Chronic Disease | |||||||
Diabetes or Hypertension | 4607 (44.3) | 3794 (43.6) | 567 (48.1) | 246 (47.7) | 3091 (42.9) | 677 (46.8) | 839 (48.5) |
Both | 1335 (13.6) | 1021 (12.2) | 208 (20.6) | 106 (21.6) | 786 (15.7) | 242 (15.7) | 307 (18.8) |
None | 4595 (42.1) | 4055 (44.2) | 366 (31.3) | 174 (30.6) | 3543 (18.8) | 536 (37.4) | 516 (32.7) |
NA | 640 | 554 | 56 | 30 | 473 | 85 | 82 |
Age | |||||||
60–69 | 6238 (56.6) | 5590 (60.2) | 512 (44.0) | 136 (22.5) | 5148 (66.2) | 618 (39.5) | 472 (25.6) |
70–79 | 3441 (29.8) | 2859 (29.3) | 391 (32.2) | 191 (34.3) | 2220 (27.0) | 631 (40.4) | 590 (34.2) |
80–89 | 1293 (11.6) | 877 (9.2) | 243 (19.6) | 173 (32.9) | 494 (6.3) | 261 (17.9) | 538 (30.8) |
90+ | 205 (2.0) | 98 (1.3) | 51 (4.2) | 56 (10.3) | 31 (0.5) | 30 (2.2) | 144 (9.4) |
Sex | |||||||
Female | 6622 (56.4) | 5508 (55.7) | 754 (57.9) | 360 (63.6) | 4421 (53.8) | 993 (59.0) | 1208 (66.3) |
Male | 4555 (43.6) | 3916 (44.3) | 443 (42.1) | 196 (36.4) | 3472 (46.2) | 574 (41.0) | 536 (33.7) |
Race | |||||||
White | 5314 (53.8) | 4477 (53.9) | 569 (53.3) | 268 (52.0) | 3816 (54.5) | 696 (53.4) | 802 (50.5) |
Black | 5701 (44.8) | 4807 (44.5) | 615 (46.2) | 279 (47.1) | 3957 (43.8) | 822 (45.5) | 822 (48.7) |
Others | 160 (1.4) | 139 (1.6) | 12 (0.5) | 9 (1.0) | 119 (1.7) | 21 (1.1) | 20 (0.7) |
NA | 0 | 0 | 0 | 0 | 1 | 1 | 0 |
Marital Status | |||||||
With partner | 4808 (53.5) | 4207 (55.4) | 444 (48.9) | 753 (32.7) | 3725 (58.0) | 553 (45.6) | 350 (39.0) |
Without partner | 6369 (46.5) | 5217 (44.6) | 157 (51.1) | 399 (67.3) | 4168 (42.0) | 987 (54.4) | 1214 (61.0) |
Education level | |||||||
Until elementary school | 7738 (70.7) | 6337 (68.4) | 953 (82.2) | 448 (84.2) | 4997 (64.6) | 1,26 (84.4) | 1481 (87.3) |
High school or more | 3439 (29.3) | 3087 (31.6) | 244 (17.8) | 108 (84.2) | 2896 (35.4) | 280 (15.6) | 263 (12.7) |
Region | |||||||
Urban | 8999 (085.2) | 7575 (85.5) | 953 (81.2) | 471 (87.3) | 6401 (86.2) | 1211 (82.8) | 1387 (82.5) |
Rural | 2178 (14.8) | 1849 (14.5) | 244 (18.8) | 85 (12.7) | 1492 (13.8) | 329 (17.2) | 357 (82.5) |
2019 PNS | |||||||
---|---|---|---|---|---|---|---|
BALD | IADL | ||||||
Variable | Total Population | Independent | Moderate | Severe | Independent | Moderate | Severe |
n = 22,728 | n = 18,141 | n = 3040 | n = 1547 | n = 2967 | n = 14,354 | n = 5407 | |
Chronic Disease | |||||||
Diabetes or Hypertension | 10,232 (47.5) | 8053 (47.0) | 1470 (51.4) | 709 (45.0) | 326 (13.0) | 7193 (52.1) | 2713 (51.5) |
Both | 3169 (15.2) | 2176 (13.3) | 628 (20.8) | 365 (26.2) | 37 (1.2) | 1988 (15.3) | 1144 (21.8) |
None | 8567 (37.3) | 7283 (39.7) | 853 (27.7) | 431 (28.8) | 2324 (85.8) | 4827 (32.6) | 1416 (26.7) |
NA | 760 | 629 | 89 | 42 | 280 | 346 | 134 |
Age | |||||||
60–69 | 12,555 (56.3) | 10,756 (60.7) | 1345 (44.9) | 454 (28.7) | 2154 (74.0) | 8788 (62.6) | 1613 (29.7) |
70–79 | 7157 (30.1) | 5584 (29.3) | 1091 (35.2) | 482 (29.5) | 692 (21.8) | 4469 (30.0) | 1996(34.8) |
80–89 | 2580 (11.5) | 1652 (9.2) | 508 (16.8) | 420 (27.2) | 115 (3.9) | 1036 (7.1) | 1429 (27.6) |
90+ | 436 (2.1) | 149 (0.8) | 96 (3.1) | 191 (14.6) | 6 (0.3) | 61 (0.3) | 369 (7.9) |
Sex | |||||||
Female | 12,535 (56.7) | 9654 (54.6) | 1918 (64.5) | 963 (64.6) | 9654 (54.6) | 1918 (64.5) | 963 (64.6) |
Male | 10,193 (43.3) | 8487 (45.4) | 1122 (35.5) | 584 (35.4) | 8487 (45.4) | 1122 (35.5) | 584 (35.4) |
Race | |||||||
White | 9901 (50.5) | 7948 (50.9) | 1287 (48.0) | 666 (50.7) | 1155 (48.5) | 6544 (52.0) | 2202 (47.5) |
Black | 12,456 (47.7) | 9890 (47.1) | 1709 (50.9) | 857 (47.6) | 1755 (49.2) | 7562 (46.1) | 3139 (51.1) |
Others | 369 (1.8) | 301 (1.9) | 44 (1.2) | 24 (1.7) | 56 (2.2) | 247 (1.9) | 66 (1.3) |
NA | 2 | 0 | 0 | 0 | 1 | 1 | 0 |
Marital Status | |||||||
With partner | 9946 (50.7) | 8221 (52.6) | 1233 (45.8) | 492 (37.5) | 1433 (55.4) | 6726 (54.3) | 1787 (38.2) |
Without partner | 12,782 (49.3) | 9920 (47.4) | 1807 (54.2) | 1055 (62.5) | 1534 (44.6) | 7628 (45.7) | 3620 (61.8) |
Education level | |||||||
Until elementary school | 14,987 (63.3) | 11,445 (59.6) | 2307 (76.5) | 1235 (79.1) | 1929 (58.6) | 8612 (57.6) | 4446 (81.4) |
High school or more | 7741 (36.7) | 6696 (40.4) | 733 (23.5) | 312 (20.9) | 1038 (41.4) | 5742 (42.4) | 961 (18.6) |
Region | |||||||
Urban | 17,313 (85.5) | 13,750 (85.4) | 2361 (86.2) | 1202 (84.7) | 2066 (81.6) | 11,228 (87.3) | 4019 (82.5) |
Rural | 5415 (14.5) | 4391 (14.6) | 679 (13.8) | 345 (15.3) | 901 (18.4) | 3126 (12.7) | 1388 (17.5) |
BALD | 2013 PNS | 2019 PNS | ||||||
---|---|---|---|---|---|---|---|---|
Variables | Moderate | Severe | Moderate | Severe | ||||
PrAdj (CI 95%) | p Value | PrAdj (CI95%) | p Value | PrAdj (CI 95%) | p Value | PrAdj (CI95%) | p Value | |
Chronic Disease | ||||||||
Only one | 1 | 1 | 1 | 1 | ||||
Both | 1.39 (1.01–1.91) | 0.04 | 1.45 (0.85–2.47) | 0.16 | 1.20 (1.07–1.36) | <0.001 | 1.82 (1.59–2.07) | <0.001 |
None | 0.70 (0.58–0.85) | <0.001 | 0.79 (0.51–1.11) | 0.15 | 0.75 (0.66–0.84) | <0.001 | 0.92 (0.82–1.04) | 0.20 |
Elementary vs. High school or more | 1.64 (1.29–2.11) | <0.001 | 1.63 (1.15–4.02) | 0.005 | 1.72 (1.56–1.91) | <0.001 | 1.52 (1.32–1.74) | <0.001 |
Female vs. Male | 0.97 (0.80–1.18) | 0.82 | 1.01 (0.65–1.56) | 0.95 | 1.29 (1.19–1.40) | <0.001 | 1.08(0.95–1.24) | 0.21 |
Not married vs. married | 1.05 (0.85–1.30) | 0.60 | 1.73(1.06–2.83) | 0.02 | 1.00 (0.91–1.09) | 0.94 | 1.27 (1.11–1.45) | <0.001 |
Urban vs. rural | 0.77 (0.62–0.95) | 0.01 | 1.11 (0.70–1.76) | 0.63 | 1.15 (1.14–1.45) | 0.01 | 0.96 (0.86–1.07) | 0.54 |
Age (in years) | ||||||||
60–69 | 1 | 1 | 1 | 1 | ||||
70–79 | 1.27 (1.03–1.57) | 0.02 | 2.53 (1.59–4.02) | <0.001 | 1.28 (0.89–0.90) | <0.001 | 1.69 (1.46–1.96) | <0.001 |
80–89 | 1.99 (1.58–2.52) | <0.001 | 5.63 (3.36–9.43) | <0.001 | 1.58 (1.39–1.79) | <0.001 | 3.84 (3.26–4.53) | <0.001 |
90+ | 2.47 (1.78–3.43) | <0.001 | 10.41 (6.68–16.21) | <0.001 | 1.56 (1.22–1.99) | <0.001 | 11.1 (9.64–12.8) | <0.001 |
IADL | PNS 2013 | PNS 2019 | ||||||
---|---|---|---|---|---|---|---|---|
Variables | Moderate | Severe | Moderate | Severe | ||||
PrAdj (95%CI) | p Value | PrAdj (95%CI) | p Value | PrAdj (95%CI) | p Value | PrAdj (95%CI) | p Value | |
Chronic Disease | ||||||||
Only one | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Both | 1.03 (0.83–1.28) | 0.73 | 1.23 (1.05–1.44) | 0.008 | 0.92 (0.91–0.93) | <0.001 | 1.29 (1.23–1.34) | <0.001 |
None | 0.89 (0.75–1.05) | 0.18 | 0.79 (0.69–0.90) | 0.006 | 0.76 (0.75–0.77) | <0.001 | 0.77 (0.73–0.81) | <0.001 |
Female vs. Male | 0.97 (0.82–1.14) | 0.71 | 1.32 (1.14–1.53) | <0.001 | 0.96 (0.95–0.97) | <0.001 | 1.34 (1.27–1.42) | <0.001 |
Urban vs. Rural | 0.96 (0.79–1.16) | 0.69 | 0.89 (0.79–1.00) | 0.055 | 1.08 (1.07–1.10) | <0.001 | 0.87(0.84–0.90) | <0.001 |
Elementary vs. High school or more | 2.00 (1.64–2.44) | <0.001 | 2.04 (1.77–2.37) | <0.001 | 0.85 (0.85–0.86) | <0.001 | 1.82 (1.71–1.94) | <0.001 |
Not married vs. married | 1.32 (1.10–1.60) | 0.003 | 1.22(1.06–1.41) | 0.005 | 0.93 (0.92–0.94) | <0.001 | 1.19 (1.14–1.26) | <0.001 |
Black race | 0.92 (0.79–1.08) | 0.22 | 1.14 (1.00–1.29) | 0.04 | 0.95 (0.94–0.96) | <0.001 | 1.06 (1.03–1.10) | <0.001 |
Other races | 0.79 (0.54–0.1.15) | 0.35 | 0.65 (0.45–0.92) | 0.01 | 0.98 (0.94–1.01) | 0.24 | 0.73 (0.58–0.98) | 0.04 |
Age (in years) | ||||||||
60–69 | 1 | 1 | 1 | 1 | ||||
70–79 | 1.71 (1.42–2.07) | <0.001 | 2.28 (1.91–2.72) | <0.001 | 0.90 (0.88–0.90) | <0.001 | 1.88 (1.76–2.00) | <0.001 |
80–89 | 1.88 (1.52–2.32) | <0.001 | 5.07 (4.33–5.94) | <0.001 | 0.57 (0.55–0.59) | <0.001 | 3.69 (3.47–3.92) | <0.001 |
90+ | 1.34 (0.75–2.39) | 0.30 | 8.52 (7.36–9.87) | <0.001 | 0.12 (0.10–0.15) | <0.001 | 5.65 (5.32–6.00) | <0.001 |
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Ribeiro-Lucas, R.G.; Goulart, B.N.G.d.; Ziegelmann, P.K. Impact of Combined Hypertension and Diabetes on the Prevalence of Disability in Brazilian Older People—Evidence from Population Studies in 2013 and 2019. Int. J. Environ. Res. Public Health 2025, 22, 1157. https://doi.org/10.3390/ijerph22071157
Ribeiro-Lucas RG, Goulart BNGd, Ziegelmann PK. Impact of Combined Hypertension and Diabetes on the Prevalence of Disability in Brazilian Older People—Evidence from Population Studies in 2013 and 2019. International Journal of Environmental Research and Public Health. 2025; 22(7):1157. https://doi.org/10.3390/ijerph22071157
Chicago/Turabian StyleRibeiro-Lucas, Rafaela Gonçalves, Barbara Niegia Garcia de Goulart, and Patricia Klarmann Ziegelmann. 2025. "Impact of Combined Hypertension and Diabetes on the Prevalence of Disability in Brazilian Older People—Evidence from Population Studies in 2013 and 2019" International Journal of Environmental Research and Public Health 22, no. 7: 1157. https://doi.org/10.3390/ijerph22071157
APA StyleRibeiro-Lucas, R. G., Goulart, B. N. G. d., & Ziegelmann, P. K. (2025). Impact of Combined Hypertension and Diabetes on the Prevalence of Disability in Brazilian Older People—Evidence from Population Studies in 2013 and 2019. International Journal of Environmental Research and Public Health, 22(7), 1157. https://doi.org/10.3390/ijerph22071157