Is the association between late-life morbidity and disability attenuated over time? : Exploring the dynamic equilibrium of morbidity hypothesis

Context: There is evidence suggesting that the prevalence of disability in late life has declined over time while the prevalence of disabling chronic diseases has increased. The dynamic equilibrium of morbidity hypothesis suggests that these seemingly contradictory trends are due to the attenuation of the morbidity-disability link over time. The aim of this study was to empirically test this assumption.Methods: Data were drawn from three repeated cross-sections of SWEOLD, a population-based survey among the Swedish men and women ages 77 and older. Logistic regression models were fitted to assess the trends in the prevalence of Activities of Daily Living (ADL) disability, Instrumental ADL (IADL) disability, and selected groups of chronic conditions. The changes in the associations between chronic conditions and disabilities were examined in both multiplicative and additive models.Results: Between 1992 and 2011, the odds of ADL disability significantly declined among women whereas the odds of IADL disability significantly declined among men. During the same period, the prevalence of most chronic morbidities including multimorbidity went up. Significant attenuations of the morbidity-disability associations were found for cardiovascular diseases, metabolic disorders, poor lung function, psychological distress, and multimorbidity.Conclusion: In agreement with the dynamic equilibrium hypothesis, this study concludes that the associations between chronic conditions and disability among the Swedish older adults have largely waned over time.

Education and Development : A spatial-econometric approach on spatial change and permanence in southern Brazil

The Brazilian state of Paraná exhibits a violent geography of inequality and duality, hosting both the most developed city in the country, internationally recognized by its urban and environmental innovations, and southern Brazil’s most concentrated cluster of poverty and underdevelopment. Over the course of the past decades, the state underwent a major economic transformation, modernizing and increasing its industrial structure and shifting to the service sector with a larger participation of the knowledge economy. This study is concerned on the interplay between formal education and socioeconomic development during this process, and above all its spatial character. It attempts make sense of the rich literature on education and growth and/or development, discussing it through the lenses of human geography and planning. In order for the analysis to be possible, this study created a consistent database of municipal scores of education over the course of 40 years, dealing with changing census methodologies and municipal boundaries. Making use of modern exploratory spatial data analysis combined with spatial regressions, the study identifies a clustered, time-persistent interplay between education and development that is stronger for low and basic levels of education. Moreover, it provides evidence that not only education is a predictor of future development, but also that analyses of this kind must take into consideration spatial autocorrelation in order to be accurate.