Journal Article

Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey

Rodriguez, Juan J Llibre, Albanese, Emiliano, Jotheeswaran, AT, Prince, Martin, Acosta, Daisy, Huang, Yueqin, Salas, Aquiles, Ferri, Cleusa P, Zuniga, Tirso, Rodriguez, Marina Calvo, Sousa, Renata M, Sosa, Ana Luisa, Pichardo, Guillermina Rodriguez, Williams, Joseph, Guerra, Mariella, Jacob, KS

2009

Overview

Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability. We undertook cross-sectional surveys of residents aged older than 65 years (n=15 022) in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Disability was assessed with the 12-item WHO disability assessment schedule 2.0. Dementia, depression, hypertension, and chronic obstructive pulmonary disease were ascertained by clinical assessment; diabetes, stroke, and heart disease by self-reported diagnosis; and sensory, gastrointestinal, skin, limb, and arthritic disorders by self-reported impairment. Independent contributions to disability scores were assessed by zero-inflated negative binomial regression and Poisson regression to generate population-attributable prevalence fractions (PAPF). In regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25·1% [IQR 19·2–43·6]). Other substantial contributors were stroke (11·4% [1·8–21·4]), limb impairment (10·5% [5·7–33·8]), arthritis (9·9% [3·2–34·8]), depression (8·3% [0·5–23·0]), eyesight problems (6·8% [1·7–17·6]), and gastrointestinal impairments (6·5% [0·3–23·1]). Associations with chronic diseases accounted for around two-thirds of prevalent disability. When zero inflation was taken into account, between-site differences in disability scores were largely attributable to compositional differences in health and sociodemographic characteristics. On the basis of empirical research, dementia, not blindness, is overwhelmingly the most important independent contributor to disability for elderly people in countries with low and middle incomes. Chronic diseases of the brain and mind deserve increased prioritisation. Besides disability, they lead to dependency and present stressful, complex, long-term challenges to carers. Societal costs are enormous. Wellcome Trust; WHO; US Alzheimer's Association; Fondo Nacional de Ciencia Y Tecnologia, Consejo de Desarrollo Cientifico Y Humanistico, Universidad Central de Venezuela.

• Publisher: Elsevier Ltd,Elsevier,Elsevier Limited,Lancet Publishing Group
• Subject: Age Factors / Aged / Biological and medical sciences / Cardiovascular diseases / China - epidemiology / Chronic Disease - epidemiology / Chronic illnesses / Chronic obstructive pulmonary disease / Cross-Sectional Studies / Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases / Dementia / Dementia - complications / Dementia - economics / Dementia - epidemiology / Dementia disorders / Developing countries / Disability / Dominican Republic - epidemiology / Eye diseases / Field study / General aspects / Health care access / Health services / Health Surveys / Humans / Hypertension / India - epidemiology / Internal Medicine / International agreements / LDCs / Medical sciences / Mexico - epidemiology / Miscellaneous / Musculoskeletal diseases / Neurology / Persons with Disabilities - statistics & numerical data / Peru - epidemiology / Physical examinations / Poverty - statistics & numerical data / Public health. Hygiene / Public health. Hygiene-occupational medicine / Regression Analysis / Sample size / Socioeconomic Factors / Venezuela - epidemiology