London: Chronic diseases are becoming the main source of death in people over 65 in low- and middle-income nations, with stroke being the leading cause, a new study has revealed.

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 are rapidly replacing communicable diseases as the leading cause of mortality and disability in developing countries," said Professor Martin Prince, who led the study from the 10/66 Dementia Research Group at the Institute of Psychiatry at King's College London
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.

"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," said Professor Prince, who is also co-director of London's Centre for Global Mental Health (CGMH).

"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 per cent of all deaths in middle-income countries, and 33 per cent in low-income countries, compared to 84 per cent in high-income countries, yet there has been little research into the causes and determinants of these deaths.

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 per cent), India (86 per cent), and rural Mexico (65 per cent).

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.

The study has been published in PLoS Medicine.

(Agencies)