Abstract
BackgroundAge-associated disability reduces quality of life in older populations and leads to wide-range implications for social and health policy. The identification of diseases that contribute to the disability burden is crucial to the development of prevention and intervention strategies to reduce disability. In this study, we assessed the contribution of chronic diseases to the prevalence of disability in Belgium.MethodsData from 35,837 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were used. Disability was defined as difficulties in doing at least one of six activities of daily living (transfer in and out of bed, transfer in and out of chair, dressing, washing hands and face, feeding, and going to the toilet) and/or mobility limitations (ability to walk without stopping less than 200 m). Multiple additive regression models were fitted separately for men and women to estimate the age-specific background disability rate (experienced by everyone, independent of the presence of specific diseases) and disease-specific disability rates (disability rate in subjects who reported selected chronic diseases).ResultsMusculoskeletal, cardiovascular, and respiratory diseases were the main contributors to the disability burden in Belgium. Musculoskeletal diseases were the most prevalent diseases in men and women in all age groups. Neurological diseases and stroke were the most disabling diseases, i.e. caused the highest level of disability among the diseased individuals, in all age groups for men and women, respectively. Back pain was the main cause of disability in men aged 15 to 64 years, while heart attack was the major contributor to the disability prevalence in men aged 65 or older. Likewise, arthritis was the main cause of disability among women across all age groups. Depression was also an important contributor in young subjects (15–54 years). Cancer was not an important contributor to the disability prevalence in Belgium.ConclusionsTo reduce the burden of disability in Belgium, interventions should target musculoskeletal, cardiovascular and respiratory diseases especially among elderly. Furthermore, attention should also be given to depression in young individuals.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1574-z) contains supplementary material, which is available to authorized users.
Highlights
Age-associated disability reduces quality of life in older populations and leads to wide-range implications for social and health policy
Analogous to the underlying cause of death, in which one disease is assigned as underlying cause of death according to the death certificate, we aim to attribute each disability case reported in the surveys to a single cause, taking into account that individuals can have more than one disease and that disability can be present in individuals without any disease [4]
It is important to notice that young individuals (15–54 years) already reported disability, the proportion of disabled individuals in this age group was low (Table 1)
Summary
Age-associated disability reduces quality of life in older populations and leads to wide-range implications for social and health policy. The results depend upon the order a cause is removed, which can produce inconsistent results in the presence of comorbidity [11] These methods often rely on a multiplicative model (logistic regression) which does not yield additive contributions of diseases [11]. Nusselder and Looman [10,13] proposed a method based on the use of additive hazards models to attribute the total disability prevalence into cause-specific contributions of diseases and background in the presence of comorbidity [11]. In this approach, the background represents causes of disability not included in the analysis
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