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Uphononongo lufumene ukuba kwiqela elidala le-50 iminyaka nangaphezulu, isimo esisezantsi sentlalo zentlalo sasinxulumene kakhulu nomngcipheko wokwanda kokudakumba; Phakathi kwabo, ukuthatha inxaxheba ephantsi kwimisebenzi yentlalo kunye nesizungu kudlala indima yokudibanisa kwi-causal association phakathi kwezi zibini. Iziphumo zophando zityhila okokuqala ngqa indlela yokusebenza phakathi kwezinto zokuziphatha kwengqondo kunye nesimo sentlalo-qoqosho kunye nomngcipheko wokudakumba kubantu abadala, kunye nokubonelela ngobungqina obubalulekileyo besayensi yenkxaso yokuqulunqwa kongenelelo olubanzi lwempilo yengqondo kubantu abadala, ukupheliswa kwezinto ezibonisa impilo yentlalo, kunye nokukhawulezisa ukufezekiswa kweenjongo zokuguga ezinempilo yehlabathi.

Ukudakumba yeyona ngxaki iphambili yempilo yengqondo enegalelo kumthwalo wehlabathi wezifo kunye noyena nobangela wokufa phakathi kweengxaki zempilo yengqondo. ISicwangciso sokuSebenza esiBanzi seMpilo yeNgqondo 2013-2030, esamkelwe yi-WHO kwi-2013, sigxininisa amanyathelo abalulekileyo okubonelela ngokungenelela okufanelekileyo kubantu abaneengxaki zengqondo, kubandakanywa nabanokudandatheka. Ukudakumba kuxhaphakile kubantu abadala, kodwa ubukhulu becala ayikafunyaniswa kwaye ayinyangwa. Uphononongo lufumene ukuba ukudakumba ebudaleni kunxulunyaniswa kakhulu nokuncipha kwengqondo kunye nomngcipheko wesifo senhliziyo. Isimo sentlalo-ntle, umsebenzi wentlalo, kunye nesizungu ziye zadibaniswa ngokuzimeleyo nokuphuhliswa kokudakumba, kodwa iziphumo zabo ezidibeneyo kunye neendlela ezithile azicacanga. Kwimeko yokuguga kwehlabathi, kukho imfuneko engxamisekileyo yokucacisa imimiselo yempilo yentlalo yokudakumba ekugugeni kunye neendlela zabo.

Olu phononongo lusekelwe kuluntu, uphando lweqela elinqumla ilizwe lisebenzisa idatha esuka kuvavanyo oluhlanu lwabameli besizwe lwabantu abadala kumazwe angama-24 (olwenziwa ukusuka ngoFebruwari 15, 2008 ukuya kuFebruwari 27, 2019), kubandakanywa iSifundo seMpilo kunye noMhlalaphantsi, iSifundo sezempilo sesizwe kunye neSifundo soMhlalaphantsi. I-HRS, i-English Longitudinal Study of Ageing, i-ELSA, i-Survey of Health, Ukuguga kunye noMhlalaphantsi eYurophu, uPhando lwezeMpilo, ukuguga kunye noMhlalaphantsi eYurophu, i-China Health and Retirement Longitudinal Study, i-China Health and Retirement Longitudinal Study, CHARLS kunye ne-Mexican Health and Aging Study (MHAS). Uphononongo lubandakanya abathathi-nxaxheba abaneminyaka eyi-50 ubudala nangaphezulu kwisiseko abachaze ulwazi malunga nesimo sabo sentlalontle, imisebenzi yentlalo, kunye neemvakalelo zodwa, kwaye baxoxwa ubuncinane kabini; Abathathi-nxaxheba ababeneempawu ezixinzelelekileyo kwisiseko, abo babengekho idatha kwiimpawu ezixinzelelekileyo kunye ne-covariates, kunye nabo balahlekileyo babengabandakanywa. Ngokusekwe kumvuzo wekhaya, imfundo kunye nobume bengqesho, indlela yocazululo yodidi olusisiseko isetyenziselwe ukuchaza ubume boqoqosho lwentlalo njengephezulu nephantsi. Ukudakumba kwavavanywa kusetyenziswa i-Mexican Health and Aging Study (CES-D) okanye i-EURO-D. Unxulumano phakathi kwemeko yentlalo-ntle kunye nokudakumba kwaqikelelwa kusetyenziswa imodeli yengozi elinganayo ye-Cox, kwaye iziphumo ezidityanisiweyo zophando ezintlanu zifunyenwe kusetyenziswa imodeli yeziphumo ezingahleliwe. Olu phononongo luphinde lwahlalutya imiphumo edibeneyo kunye nentsebenziswano yobume bentlalo-ntle, imisebenzi yentlalo kunye nesithukuthezi sokudakumba, kwaye yaphonononga iziphumo zokulamla kwimisebenzi yentlalo kunye nesithukuthezi kwisimo sentlalo zoqoqosho kunye nokudakumba ngokusebenzisa uhlalutyo lwe-causal mediation.

Emva kokulandelelana okuphakathi kweminyaka eyi-5, abathathi-nxaxheba be-20,237 bahlakulela ukudakumba, kunye nesantya sesiganeko se-7.2 (i-95% yexesha lokuzithemba 4.4-10.0) kwi-100 iminyaka yomntu. Emva kokulungelelaniswa kwezinto ezahlukeneyo eziphazamisayo, uhlalutyo lufumene ukuba abathathi-nxaxheba besimo esisezantsi sentlalo zentlalo banomngcipheko ophezulu wokudakumba xa kuthelekiswa nabathathi-nxaxheba bezinga eliphezulu lentlalontle yezoqoqosho (i-HR = 1.34; 95% CI: 1.23-1.44). Kwimibutho phakathi kwemeko yentlalontle kunye nokudandatheka, kuphela i-6.12% (1.14-28.45) kunye ne-5.54% (0.71-27.62) yaxutywa ngemisebenzi yentlalo kunye nesizungu, ngokulandelanayo.

Kuphela ukusebenzisana phakathi kwemeko yentlalontle kunye nesithukuthezi kwabonwa ukuba kunempembelelo ebalulekileyo ekudakaleni (i-HR = 0.84; 0.79-0.90; Xa kuthelekiswa nabathathi-nxaxheba bemeko ephezulu yentlalontle ababesebenza kwintlalontle kwaye bengenaso isithukuthezi, abathathi-nxaxheba bemeko ephantsi yentlalontle ababengasebenzi kwaye babenesizungu babenomngcipheko ophezulu wokudakumba (i-HR = 2.45; 2.08-2.82).

Ukungakhathali kwezentlalo kunye nesithukuthezi sidibanisa kuphela umbutho phakathi kwemeko yentlalontle kunye nokudakumba, ebonisa ukuba ukongeza kumanyathelo okungenelela okujoliswe kwintlalontle kunye nesithukuthezi, amanye amanyathelo asebenzayo ayafuneka ukunciphisa umngcipheko wokudakumba kubantu abadala. Ngaphezu koko, iziphumo ezidityanisiweyo zesimo sentlalo-ntle, umsebenzi wentlalo, kunye nesithukuthezi zigxininisa iinzuzo zokungenelela okuhlangeneyo ngaxeshanye ukunciphisa umthwalo wehlabathi wokudakumba.