Locomotor disability in a cohort of British men: the impact of lifestyle and disease

Abstract

Increasing life expectancy has brought public health concern about the increase in prevalence of disability in old age. Reducing the prevalence of disability in older age requires the identification of preventable or modifiable risk factors earlier in life. We have examined the relationship between lifestyle and other potential risk factors in men aged 40-59 years at screening and locomotor disability 12-14 years later to assess whether any of these factors have direct and independent roles in influencing disability in later life. In 1978-1980, a longitudinal study of cardiovascular disease was initiated in 7735 men aged 40-59 years drawn from one general practice in each of 24 British towns. The present study concerns 5717 men, 88% of the surviving men who were available to follow-up (i.e. were registered with a GP and had an address) and who satisfactorily completed the disability section of a follow-up postal questionnaire in 1992 (Q92). The main endpoint from the questionnaire was locomotor disability based on self-reported inability in any one or more of the following: to get outdoors, walk 400 m, climb stairs, maintain balance, bend down, or straighten up. In the 5717 men (mean age 63 years) who provided information on disability status, 25.0% reported locomotor disability and the majority of these men recalled a doctor-diagnosed disease of which cardiovascular disease was most strongly associated with locomotor disability. Lifestyle factors at screening (smoking, physical inactivity, obesity and heavy drinking) and manual social class were strongly and independently associated with increased odds of locomotor disability 12-14 years later. By contrast, baseline blood pressure and serum total cholesterol showed little relationship with locomotor disability. Among men with diagnosed major cardiovascular disease (stroke, myocardial infarction, angina or aortic aneurysm) those with locomotor disability showed significantly higher adverse lifestyle factors at screening than those who were able. Similarly, adverse lifestyle factors were also seen more frequently among disabled men with respiratory disease and among disabled men with other non-cardiovascular conditions than among their able counterparts. Smoking, obesity, physical inactivity and heavy drinking in middle age are strong predictors of locomotor disability in later life independent of the presence of diagnosed disease. Leading a healthy lifestyle improves survival and reduces the incidence of disease. It also reduces the risk of locomotor disability and increases the odds of being disability-free even in the event of developing major cardiovascular disease.