Disability and all-cause mortality in the older population: evidence from the English Longitudinal Study of Ageing.

Benedetta Pongiglione,George B Ploubidis,Bianca L De Stavola,Hannah Kuper

doi:10.1007/s10654-016-0160-8

Abstract

Despite the vast body of literature studying disability and mortality, evidence to support their association is scarce. This work investigates the role of disability in explaining all‐cause mortality among individuals aged 50+ who participated in the English Longitudinal Study of Aging. The aim is to explain the gender paradox in health and mortality by analysing whether the association of disability with mortality differs between women and men. Disability was conceived following the International Classification of Functioning, Disability and Health (ICF), proposed by the WHO, that conceptualizes disability as a combination of three components: impairment, activity limitation and participation restriction. Latent variable models were used to identify domain-specific factors and general disability. The association of the latter with mortality up to 10 years after enrolment was estimated using discrete-time survival analysis. Our work confirms the validity of the ICF framework and finds that disability is strongly associated with mortality, with a time-varying effect among men, and a smaller constant effect for women. Adjusting for demographic, socioeconomic and behavioural factors attenuated the association for both sexes, but overall the effects remained high and significant. These findings confirm the existence of gender paradox by showing that, when affected by disability, women survive longer than men, although if men survive the first years they appear to become more resilient to disability. Sensitivity analyses suggested that the gender paradox cannot be solely explained by gender-specific health conditions: there must be other mechanisms acting within the pathway between disability and mortality that need to be explored.Electronic supplementary materialThe online version of this article (doi:10.1007/s10654-016-0160-8) contains supplementary material, which is available to authorized users.

Highlights

IntroductionAdjusting for demographic, socioeconomic and behavioural factors attenuated the association for both sexes, but overall the effects remained high and significant
Sensitivity analyses suggested that the gender paradox cannot be solely explained by gender-specific health conditions: there must be other mechanisms acting within the pathway between disability and mortality that need to be explored
The ICF conceives difficulties with human functioning as three interconnected areas. This and empirically test with a measurement model the construct validity of the World Health Organization (WHO)’s ICF. Based on this comprehensive interpretation of disability, we apply discretetime survival analysis (DTSA) to study the impact of disability measured at baseline on mortality observed over the course of a decade, and assess whether and how this association changes over time, stratifying the analysis by gender

Summary

Introduction

Adjusting for demographic, socioeconomic and behavioural factors attenuated the association for both sexes, but overall the effects remained high and significant These findings confirm the existence of gender paradox by showing that, when affected by disability, women survive longer than men, if men survive the first years they appear to become more resilient to disability. The ICF conceives difficulties with human functioning as three interconnected areas (see Fig. 1) This and empirically test with a measurement model the construct validity of the WHO’s ICF. The gender paradox in health and mortality is well known in the literature It was first observed in the mid-1970s [3, 4] and reflects the finding that women live longer than men, but tend to have more disability than males.

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Conclusion