INVESTIGACION EN

EPIDEMIOLOGIA DE CURSO DE
VIDA:
ESTUDIO IMIAS

JOS FERNANDO GMEZ MONTES

PROGRAMA DE I NVESTIGACIONES EN GERONTOLOGA Y GERIATRA
UNIVERSIDAD DE CALDAS
MANI ZALES

CONTENIDOS:
Teoras de la distribucin de la salud.
Epidemiologa de curso de vida.
Estudio IMIAS: discapacidad de
movilidad.
Hiptesis sobre la transicin de la
discapacidad.
Conclusiones

TEORIAS INTEGRADORAS DE LAS

CAUSAS DE ENFERMEDAD (TEORIAS DE
LA DISTRIBUCION DE LA ENFERMEDAD)
Por qu algunos individuos tienen la hipertensin? es diferente
a Por qu algunas poblaciones tienen mucha hipertensin,
mientras que en otras es rara?
1. PRODUCCION SOCIAL DE LA ENFERMEDAD /
ECONOMIA POLITICA DE LA SALUD. Determinantes
sociales de la salud.
2. TEORIA ECOSOCIAL Y PERSPECTIVAS DINAMICAS
RELACIONADAS MULTI-NIVEL. Disparidades
(desigualdades) de la salud.
3. TEORIA PSICO-SOCIAL. Estresores mltiples. De la
etiologa especfica a la susceptibilidad generalizada.
Moiso A. Determinantes de salud. Fundamentos de Salud Pblica

Early determinants of the ageing trajectory. Best Practice & Research Clinical Endocrinology & Metabolism 26 (2012) 613626

EPIDEMIOLOGIA DEL CURSO DE

VIDA
ES EL ESTUDIO DE LOS EFECTOS A LARGO PLAZO EN LA
SALUD O EL RIESGO DE ENFERMEDAD POR EXPOSICIONES
FISICAS O SOCIALES DURANTE LA GESTACION, LA INFANCIA,
LA ADOLESCENCIA, LA ADULTEZ TEMPRANA Y EN LA VEJEZ.
Su objetivo es dilucidar los procesos biolgicos, conductuales y
psicosociales que operan a travs del curso de vida individual, o a
travs de generaciones, que influencian el desarrollo del riesgo de
enfermar.

Kuh D, Ben-Shlomo Y, Lynch J, Hallqvist J. J Epidemiol Community Health 2003 57:778-783

MODELO SOBRE LOS EFECTOS DE LA

NUTRICIN EN LA SALUD DE LOS ANCIANOS.

LOS MODELOS
Acumulacin de riesgos (Hiptesis de la acumulacin)
Cadena de riesgos
Periodos crticos (critical periods)
Movilidad social (social mobility)

Independiente

Acumulacin de
riesgos
Acumulacin con
agrupacin de riesgos

Factores mediadores

Efecto aditivo

Cadenas de riesgo

Factores modificadores

Efecto disparador

MODELO DE PERIODOS
CRTICOS
Un periodo crtico en el desarrollo es una ventana de
tiempo durante la que ocurren cambios de forma
rpida en la organizacin de los sistemas biolgicos
Durante estos periodos, la organizacin puede ser
modificada de forma favorable o desfavorable.
Biological programming, Latency model
El modelo postula que los cambios durante los
periodos crticos pueden causar enfermedades ms
tarde en la vida.
Variacin critical period with later modifiers
effects= interacciones entre los factores iniciales y
posteriores = el efecto de una exposicin al inicio de
la vida vara segn los niveles de exposicin
posteriores

MODELO DE PERIODOS
CRTICOS
Exposicin
A
Factor modificador
B
Tiempo

Periodo
crtico
Induccin

Latencia
deteccin
Inicio de la
enfermedad

Periodo crtico= el sistema es plstico y sensible al medio ambiente

E
N
F
E
R
M
E
D
A
D

MODELO DE PERIODO CRITICO

(MODELO LATENTE)
EXPOSICION A
INFECCIONES
Hepatitis B
Tuberculosis
Poliomielitis
H. Pilory
Fiebre reumtica
Enfermedad de Chagas
Malaria

EXPOSICIONES
MEDIOAMBIENTALES
Plomo
Deficiencia de yodo
Polucin dentro de la
casa
Malnutricin proteico energtica
Trauma al nacer

MOVILIDAD
SOCIAL
Las exposiciones en la infancia pueden
ser revertidas en la edad adulta

CONDICIONES TEMPRANAS EN LA INFANCIA Y SALUD

EN ANCIANOS: PAISES DE BAJO Y MEDIO INGRESO

CONCLUSIONES

Exposiciones en tero/infancia y enfermedad cardiovascular y

DM.
Pobre nutricin y mortalidad, dificultades de cognicin y DM.
Enfermedades especficas (Fiebre Reumtica/malaria) y
enfermedad cardiovascular y mortalidad.
Pobre salud y discapacidad/limitacin funcional y
enfermedades crnicas.
SES pobre y mortalidad, discapacidad/limitacin funcional y
cognicin.
Sobrevivencia de los padres y discapacidad/limitacin
funcional y cognicin.
Journal of Developmental Origins of Health and Disease (2013), 4(1), 1029.

DIFERENCIAS DE GENERO EN MOVILIDAD:

QU SE PUEDE APRENDER PARA MEJORAR
LA MOVILIDAD AL ENVEJECER?

Natal, Brazil

Manizales, Colombia

Kingston, Ontario

St Hyacinthe , Quebec

FOLLOW-UP (AGE 65-74)

5th
year

Baseline

Mobility; life
course,
Gender,
Neighborhood and
social networks,
biological
pathways,
Chronic conditions

3rd year
Mobility;
Violence,
chronic
conditions

Mobility;
Violence,
chronic
conditions

PERDIDA DE MOVILIDAD

Source: IMIAS, 2012

PERDIDA DE MOVILIDAD: ACTIVIDADES

DE VIDA DIARIA
50
44.86

45

38.24

38.1

40
35

32.5
MEN

30
25

23.44

22.84

22.16

WOMEN

24.3925.48

20
15

14.2

10
5
0

Vafaei A, Zunzunegui MV, Guralnik J, Curcio CL, Gomez F, Guerra R, Alvarado BE. Evaluation of the late life disability instrument
(LLDI) in low income older populations. (Manuscript in revision)

PERDIDA DE MOVILIDAD
(OBJETIVA)
Figure 1. Low physical performance (SPPB < 8)
30
26.17
24.29

25

MEN

WOMEN

20

15

15.63

15.1

11.76
10

8.25
6.17

Source: IMIAS, 2012

4.94

7.32

7.64

VAS EXPLICATIVAS DE LA
DISCAPACIDAD DE LA
MOVILIDAD AL ENVEJECER

1. Vas biolgicas.
2. Perspectiva de curso de vida.
3. Medioambiental: perspectiva
ecosocial.
4. Clnica: condiciones crnicas
especficas.

LATINOAMERICA
DE CADA 100 ANCIANOS:

77 al menos 1 enfermedad
44 al menos 2 enfermedades
19 al menos 1 discapacidad
17 al menos 1 enfermedad y 1 discapacidad
12 al menos 1 discapacidad y 2 enfermedades
21 ni discapacidad ni enfermedad

Rose AMC. et al. Public Health 2008; 8:124

PREVALENCIA DE LIMITACIONES DE
MOVILIDAD, AJUSTADA POR EDAD

Lifting and carrying 10 pounds, walking several

blocks, climbing a flight of stairs, kneeling /
stooping / crouching, and getting up from a chair

OR=2.34
Heterogeneity: p= 0.04

CONDICIONES SOCIALES Y LIMITACION

DE MOVILIDAD EN ANCIANAS EN LAC

Pobreza en la
infancia
Salud pobre
Hambre antes
15 aos
Falta de
escolaridad
Ingreso
insuficiente
Comorbilidad
Alvarado
B, Guerra R, Zunzunegui MV.
Deterioro
cognoscitivo

OR

95% CI

1.28

1.12- 1.46

1.17

1.04- 1.31

1.47

1.23 1.76

1.39

1.17- 1.64

1.54

1.35- 1.74

3.16

2.80- 3.52

J of Aging
and Health 2007
3.90

2.26-6.74

SYMPOSIUM
THE SEX GAP OF MOBILITY
DISABILITY: THE EMBODIMENT
OF GENDER
CHAIR: JACK GURALNIK
CO-CHAIR: MARIA VICTORIA
ZUNZUNEGUI
DISCUSSANT: K MARKIDES

THE INTERNATIONAL MOBILITY IN AGING STUDY (IMIAS) IS A LONGITUDINAL

STUDY OF AGING CONDUCTED IN CANADA (KINGSTON, ST HYACINTHE), ALBANIA
(TIRANA), BRAZIL (NATAL) AND COLOMBIA (MANIZALES) TO EXPLAIN THE SEX
GAP IN MOBILITY USING A LIFE-COURSE AND GENDER PERSPECTIVE. IT IS
FINANCED BY THE CANADIAN INSTITUTES FOR HEALTH RESEARCH.
THE HYPOTHESIS IS THAT THE GAP IN MOBILITY DISABILITY BETWEEN MEN AND
WOMEN DIMINISHES AS GENDER EQUALITY INCREASES IN THE MAINSTREAM
SOCIETIES
OF
DIFFERENT
COUNTRIES.

FACTORES TEMPRANOS
Pobre nutricin
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restriccin espacio de vida
Depresin

Medio ambiente
Espacio de vida

FACTORES EN LA VIDA MEDIA

SES adulto
Embarazos a temprana edad
Restriccin espacio de vida
Depresin
Ejercicio fsico limitado
Dietas no saludables

CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metablico
Diabetes M. Enf. cardiovascular

Limitacin funcional
Discapacidad

CHILDHOOD SOCIAL AND ECONOMIC ADVERSITIES

AND PHYSICAL PERFORMANCE IN PEOPLE AGED 65-74
LIVING IN CANADA, BRAZIL, COLOMBIA AND ALBANIA.
Ricardo Guerra, Dimitri Taurino Guedes, Fernando Gomez, Mai Thanh Tu,
Georges Kon Karna, Alban Ylli, Jack Guralnik
In IMIAS, we examined associations of physical performance Short Physical
Performance Battery, SPPB) with social (parental death, drug/alcohol abuse,
witness violence and experience physical abuse) and economic (low socioeconomic status, hunger, parental unemployment and fathers manual
occupation) adversities during the first 15 years of life.
Cumulative index of social and economic adversity varied from 0 to 4
according to the number of reported adverse events. Poor function (SPPB<8)
was present in 7.8% of the Kingston sample (Ontario), 6.7% in St Hyacinthe
(Quebec), 20.8% in Tirana (Albania), 18.4% in Manizales (Colombia) and
19.9% in Natal (Brazil). Logistic regression analyses revealed poor function in
old age was associated with high exposure to childhood social adversities
(OR=3.49, CI: 2.0;6.0) and high exposure to economic adversity (OR=1.80, CI:
1.0;3.2), adjusting for research site, age and sex.

FACTORES TEMPRANOS
Pobre nutricin
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restriccin espacio de vida
Depresin

Medio ambiente
Espacio de vida

FACTORES EN LA VIDA MEDIA

SES adulto
Embarazos a temprana edad
Restriccin espacio de vida
Depresin
Ejercicio fsico limitado
Dietas no saludables

CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metablico
Diabetes M. Enf. cardiovascular

Limitacin funcional
Discapacidad

EARLY AGE AT FIRST BIRTH IS ASSOCIATED

WITH LOW PHYSICAL PERFORMANCE IN OLD
AGE.
Catherine Pirkle, Beatriz Alvarado, Ricardo Guerra, Carmen-Lucia Curcio, Alban
Ylli, Jack Guralnik.
Early age at first birth (EAFB) is a risk factor for obstetrical complication, because
physiological development is often incomplete, and it may have long-term
implications for physical performance and mobility.
We examine the relationship between early age at first birth, defined as 18 years of
age, poor physical performance (Short Physical Performance Battery8) and selfreported mobility disability in community representative samples of women between
65 and 74 years of age from Canada, Albania, Columbia, and Brazil (N=919). EAFB
was significantly associated with poor physical performance and mobility disability.
Adjusting for the study site, age, education and lifetime births, women who gave birth
at a young age had 1.78(95% CI 1.19-2.65) the odds of poor SPPB and 2.31 (95%CI
1.52-3.53) the odds of mobility disability. These relationships were stronger in Canada
and weaker in Albania, Colombia and Brazil, which may be attributable to decreased
survival in women who would have gone on to have mobility problems had they
survived.

FACTORES TEMPRANOS
Pobre nutricin
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restriccin espacio de vida
Depresin

Medio ambiente
Espacio de vida

FACTORES EN LA VIDA MEDIA

SES adulto
Embarazos a temprana edad
Restriccin espacio de vida
Depresin
Ejercicio fsico limitado
Dietas no saludables

CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metablico
Diabetes M. Enf. cardiovascular

Limitacin funcional
Discapacidad

SOCIAL TIES, SOCIAL ACTIVITIES AND INCOME

INFLUENCE LIFE SPACE ASSESSMENTS (LSA) IN
BEATRIZ ALVARADO, CARMEN-LUCIA CURCIO, RICARDO GUERRA, ALBAN
OLD AGE:
YLLI, ELLEN FREEMAN, JACK GURALNIK.

IN IMIAS, WE EXAMINED THE ASSOCIATIONS OF LSA SCORE WITH INCOME AND

SOCIAL TIES AND ACTIVITIES ACROSS RESEARCH SITES BY FITTING SEX SPECIFIC
REGRESSIONS CONTROLLING FOR AGE, SELF-RATED HEALTH, DEPRESSION
SCORE AND PHYSICAL PERFORMANCE.
RESULTS: BOTH IN WOMEN AND MEN, A POSITIVE GRADIENT IN LSA
ACCORDING TO INCOME WAS OBSERVED; BEING MARRIED WAS NOT
ASSOCIATED WITH LSA. AMONG WOMEN, HAVING FRIENDS AND CHILDREN AND
BEING INVOLVED IN SOCIAL ACTIVITIES WERE SIGNIFICANTLY ASSOCIATED WITH
HIGHER LSA. AMONG MEN, NO SOCIAL TIES OR ACTIVITIES WERE ASSOCIATED
WITH LSA. SITE-SPECIFIC ANALYSES SHOWED DIFFERENCES IN THE NATURE OF
SOCIAL TIES RELEVANT FOR LSA: STRONGEST ASSOCIATIONS WERE FOR
FRIENDS IN TIRANA, BROTHERS AND SISTERS IN MANIZALES, SOCIAL ACTIVITIES
IN NATAL AND CHILDREN IN ST HYACINTHE. SOCIAL TIES WERE NOT ASSOCIATED
WITH LSA IN KINGSTON. WHILE POVERTY IMPACTS LIFE SPACE IN ALL SITES,
SOCIAL RELATIONSHIPS MAY INCREASE LIFE SPACE ONLY IN WOMEN AND MORE
OUTSIDE CANADA THAN IN CANADA.

FACTORES TEMPRANOS
Pobre nutricin
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restriccin espacio de vida
Depresin

Medio ambiente
Espacio de vida

FACTORES EN LA VIDA MEDIA

SES adulto
Embarazos a temprana edad
Restriccin espacio de vida
Depresin
Ejercicio fsico limitado
Dietas no saludables

CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metablico
Diabetes M. Enf. cardiovascular

Limitacin funcional
Discapacidad

SELF REPORTED MOBILITY AND DEPRESSION IN

OLDER MEN AND WOMEN OF FIVE COUNTRIES:
THE IMIAS STUDY
ALBAN YLLI, NANDINI DESHPANDE, SUSAN PHILLIPS, FERNANDO
GOMEZ, RICARDO GUERRA, JACK GURALNIK.

IN IMIAS, WE EXAMINED WHETHER THE ASSOCIATION BETWEEN MOBILITY AND

DEPRESSION REMAINED BEYOND POOR PHYSICAL PERFORMANCE.
METHOD: DIFFICULTY WALKING 400 METERS OR CLIMBING STAIRS WAS USED
FOR MOBILITY DISABILITY(MD); CES-D FOR DEPRESSION, THE SHORT PHYSICAL
PERFORMANCE BATTERY (SPPB) FOR PHYSICAL PERFORMANCE.
RESULTS: TWENTY SEVEN PERCENT HAD CESD SCORES OF 16 OR OVER,
RANGING FROM 39% IN TIRANA TO 10% IN KINGSTON; 38.3% HAD MD, RANGING
FROM 55.3% IN TIRANA TO 20.2% IN KINGSTON. ADJUSTING FOR SPPB, AGE,
EDUCATION, INCOME AND STUDY SITE, MD WAS HIGHER AMONG PEOPLE WITH
DEPRESSION (58.6% VS. 30.8%, P<0.001); THIS ASSOCIATION WAS STRONG (OR
2.2; 1.7;2.9) AND SIMILAR FOR MEN (OR=1.9; 1.3;2.8) AND WOMEN (OR=2.3;
1.7;3.1). SITE-SPECIFIC MOBILITY DISABILITY OR FOR DEPRESSION WERE 3.8
(1.7;8.5) IN KINGSTON;2.8 (1.5;5.3) IN NATAL; 2.3 (1.4;3.7)IN TIRANA; 2.3(1.3;4.1)
IN MANIZALES AND 1.4 (0.8;2.5) IN ST HYACINTHE.
DISCUSSION: DEPRESSED PEOPLE ARE LIKELY TO HAVE MOBILITY DISABILITY
REGARDLESS OF THEIR CONTEXT, SEX AND PHYSICAL PERFORMANCE.

FACTORES TEMPRANOS
Pobre nutricin
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restriccin espacio de vida
Depresin

Medio ambiente
Espacio de vida

FACTORES EN LA VIDA MEDIA

SES adulto
Embarazos a temprana edad
Restriccin espacio de vida
Depresin
Ejercicio fsico limitado
Dietas no saludables

CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metablico
Diabetes M. Enf. cardiovascular

Limitacin funcional
Discapacidad

EXCESS IN PREVALENCE OF METABOLIC SYNDROME

TO SHOW
THATMIDDLE
THAT AN EXCESS
IN PREVALENCE
OF METABOLIC SYNDROME IS
INOBJECTIVE:
WOMEN
FROM
INCOME
COUNTRIES
OBSERVED IN WOMEN FROM ALBANIA, BRAZIL AND COLOMBIA COMPARED WITH CANADIAN
WOMEN WHILE NO VARIATIONS IN THIS PREVALENCE ARE OBSERVED IN MEN FROM THOSE
COUNTRIES. WE INVESTIGATED THE PREVALENCE OF METABOLIC SYNDROME (METS) IN
DIFFERENT SOCIETIES (CANADA, BRAZIL, COLOMBIA AND ALBANIA) AND ACROSS GENDERS,
AMONG REPRESENTATIVE COMMUNITY SAMPLES OF 1728 SUBJECTS, 65 - 74 YEARS-OLD,
USING DATA FROM THE INTERNATIONAL MOBILITY IN AGING STUDY (IMIAS).
METHODS: METS WAS DEFINED BY THE NCEP-ATPIII CRITERIA, WITH THE PRESENCE OF AT
LEAST THREE OF THESE CONDITIONS: ABDOMINAL OBESITY, HYPERTENSION, HIGH
TRIGLYCERIDES, HYPERGLYCAEMIA AND HIGH LDL. PREVALENCE OF METS IN MEN AND
WOMEN AND SEX ODDS RATIO FOR METS WERE ESTIMATED AT EACH SITE.
RESULTS: METS PREVALENCE VARIED IN WOMEN ACROSS SOCIETIES BUT NOT IN MEN:
FROM 23.7% IN KINGSTON, ONTARIO, TO 63.1% IN TIRANA, ALBANIA AMONG WOMEN AND
FROM 22.1% IN SAINT HYACINTHE, QUEBEC TO 33.5% IN TIRANA AMONG MEN. TAKING
KINGSTON MEN AS REFERENCE, NO SIGNIFICANT DIFFERENCES IN THE ODDS OF METS WERE
OBSERVED AMONG MEN OF DIFFERENT SITES. TAKING KINGSTON WOMEN AS REFERENCE,
THE METS ODDS RATIO FOR WOMEN AT TIRANA WAS 5.62 (95%CI 3.51; 9.01); THE
CORRESPONDING OR AT NATAL WAS 3.59 (95% CI 1.97;6.55), AT MANIZALES 1.51 (0.85;2.68)
AND AT SAINT HYACINTHE 1.21 (95%CI 0.74;1.98).
IN CANADA NO GENDER DIFFERENCE IN PREVALENCE OF METS WAS OBSERVED.

DISCUSSION: THESE RESULTS PROVIDE EVIDENCE FOR WIDE VARIATIONS OF

THE RELATIONSHIP BETWEEN VISION AND LIFE

SPACE BY SEX AND GLOBAL SITE
ELLEN E. FREEMAN, NANDINI DESHPANDE, CARMEN-LUCIA CURCIO, HANEN
HARRABI, RICARDO GUERRA, JACK GURALNIK.

PREVIOUSRESEARCHDONEINTHEUNITEDSTATESHASFOUNDARELATIONSHIP
BETWEENWORSEVISIONANDMORERESTRICTEDLIFESPACE.
WEDETERMINEDWHETHERTHERELATIONSHIPBETWEENVISIONANDLIFESPACE
VARIEDBYSEXANDACROSSFIVEDIVERSEGLOBALSITES.
HABITUALVISUALACUITYWASMEASUREDBINOCULARLYUSINGTHETUMBLINGE
CHARTAT2METERS.MOBILITYWASMEASUREDUSINGTHECOMPOSITESCOREOF
THELIFESPACEASSESSMENTWHICHRANGEDFROM0-120.MULTIPLELINEAR
REGRESSIONWASUSEDTOADJUSTFORAGE,EDUCATION,GENERALHEALTHSTATUS,
NUMBEROFCOMORBIDITIES,ANDINCOMEWHILESTRATIFYINGBYSEXANDSITE.
INPOOLEDANALYSES,WORSEVISUALACUITYWASASSOCIATEDWITHMORE
RESTRICTEDLIFESPACE(P<0.001).STRATIFYINGBYSEX,VISIONWASONLY
ASSOCIATEDWITHLIFESPACEINWOMEN(P<0.001).SITEDIFFERENCESWEREFOUND.

THELOSSOFVISIONAPPEARSTOBEMOREDETRIMENTALTOMOBILITYINWOMEN
ANDINSOMEENVIRONMENTSTHANINOTHERS.REASONSFORTHISSHOULDBE
FURTHEREXPLORED.

FACTORES TEMPRANOS
Pobre nutricin
Sobrevivencia de los padres
Pobre salud
SES pobre
FACTORES AL ENVEJECER
Peso / obesidad
Restriccin espacio de vida
Depresin

Medio ambiente
Espacio de vida

FACTORES EN LA VIDA MEDIA

SES adulto
Embarazos a temprana edad
Restriccin espacio de vida
Depresin
Ejercicio fsico limitado
Dietas no saludables

CONDICIONES DE SALUD
OA rodilla problemas articulares
Mayor prevalencia sx metablico
Diabetes M. Enf. cardiovascular

Limitacin funcional
Discapacidad

THE MOBILITY GAP BETWEEN OLDER MEN AND

WOMEN FROM DIVERSE POPULATIONS: THE
EMBODIMENT OF GENDER
MARIA-VICTORIA ZUNZUNEGUI, SUSAN PHILLIPS, GEORGES KARNA, MAI THANH
TU, GENTIANA QIRJAKO, RICARDO GUERRA, FERNANDO GOMEZ.

WE EXAMINE SEX GAPS IN MOBILITY, ACTIVITIES OF DAILY LIVING DISABILITY AND PHYSICAL
PERFORMANCE (SHORT PHYSICAL PERFORMANCE BATTERY, SPPB) ACROSS DIVERSE
POPULATIONS AND FORMULATE HYPOTHESES TO EXPLAIN DIFFERENCES BETWEEN MEN AND
WOMEN RELATING TO THE EMBODIMENT OF GENDER-RELATED LIFE COURSE CONDITIONS.
AGE-ADJUSTED PREVALENCE RATES OF LOW SPPB, SELF-REPORTED MOBILITY DISABILITY
AND ADL DISABILITY AT EACH SITE WERE SIGNIFICANTLY HIGHER IN WOMEN THAN IN MEN
EXCEPT FOR KINGSTON (ONTARIO). FEW DIFFERENCES IN PHYSICAL FUNCTION OR MOBILITY
WERE OBSERVED BETWEEN MEN AT DIFFERENT RESEARCH SITES. SITE DIFFERENCES
BETWEEN MEN AND WOMEN ARE THEREFORE DRIVEN BY DIFFERENCES BETWEEN WOMEN
ACROSS SITES. AMONG WOMEN, AND TAKING KINGSTON AS THE REFERENCE SITE, AGEADJUSTED ODDS RATIOS FOR POOR SPPB, MOBILITY AND ADL DISABILITY WERE HIGHER FOR
ST HYACINTHE, MANIZALES, NATAL AND TIRANA.
THE MOBILITY-SEX GAP IS SMALL OR DISAPPEARS IN THE MORE EGALITARIAN SITES
(ONTARIO) WHILE IT REMAINS LARGE IN SEX-SEGREGATED SOCIETIES (BRAZIL, COLOMBIA,
ALBANIA).

CONCLUSIONES
1. La perspectiva de curso de vida se enfoca en
comprender como experiencias tempranas en la vida
pueden formar la salud a travs de la via entera y
potencialmente a travs de generaciones.
2. Se debe dirigir la mirada hacia el papel del contexto,
incluyento el contexto social y fsico junto con
factores biolgicos. Todos ellos a travs del tiempo.
3. La perspectiva de curso de vida permitira entender
los determinantes y las disparidades en salud.