Mortality of people with disabilities in China: a prospective cohort study

Abstract

BackgroundIncreased life expectancy is accompanied by an increased burden of disability. However, few large-scale studies have assessed mortality in people with disabilities, especially in developing countries. Here we describe mortality patterns in a nationally representative cohort of people with disabilities and identify factors that contribute to survival. MethodsWe randomly selected people with disabilities from the Chinese population in 2006 and monitored them until 2010. We calculated age-standardised mortality rates using the 2006 national survey population as the standard population. Standardised mortality ratios were calculated using 2008 age-specific and sex-specific Chinese national mortality rates as the referent. Kaplan-Meier survival curves and Cox regression were used to estimate survival risks. The follow-up survey study was approved by the China Disabled Persons' Federation, and all survey respondents provided consent to participate to the Chinese government. FindingsOf the 23 837 people with disabilities who were randomly selected from the Chinese population in 2006, 2263 were lost to follow-up. 3833 (17·8%) deaths were registered among 21 574 people with disabilities who were followed until 2010. The age-standardised cumulative 4-year mortality was 19·4 per 1000 person-years (95% CI 19·1–19·6]). The mortality rate was five-times higher among people with disabilities than in the general population (standardised mortality ratio 5·4, 95% CI 5·2–5·5), with the highest mortality ratio in people with mental disabilities (9·9, 8·4–11·5). People aged 70 years or older and people with severe or profound disabilities had the highest mortality rates across all disability types. InterpretationThis study is the first to describe a nationally representative profile of mortality in the Chinese population of disabled people and further enriches existing knowledge about mortality among the disabled population in developing countries. The elevated mortality rates among Chinese people with disabilities highlight the importance of increasing their life expectancy in China. With the increasing burden of disability worldwide, initiatives that provide better support for disabled persons are necessary. FundingState Key Funds of Social Science Project (Research on Disability Prevention Measurement in China, No. 09&ZD072), National Yang Zi Scholar Program, the Research Special Fund for Public Welfare Industry of Health (No. 201302008), the National Action Plan for Disability Prevention, and National Key Project (973) (No. 2007CB5119001).