Respective contribution of chronic conditions to disability in France: Results from the national disability-health survey

Abstract

Background: Representative national data on disability are becoming increasingly important in helping policymakers decide on public health strategies. We assessed the respective contribution of chronic health conditions to disability for three age groups (18–40, 40–65, and .65 years old) using data from the 2008–2009 Disability-Health Survey in France. Methods: Data on 12 chronic conditions and on disability for 24,682 adults living in households were extracted from the Disability-Health Survey results. A weighting factor was applied to obtain representative estimates for the French population. Disability was defined as at least one restriction in activities of daily living (ADL), severe disability as the inability to perform at least one ADL alone, and self-reported disability as a general feeling of being disabled. To account for comorbidities, we assessed the contribution of each chronic disorder to disability by using the average attributable fraction (AAF). Findings: We estimated that 38.8 million people in France (81.7% [95% CI 80.9;82.6]) had a chronic condition: 14.3% (14.0;14.6) considered themselves disabled, 4.6% (4.4;4.9) were restricted in ADL and 1.7% (1.5;1.8) were severely disabled. Musculoskeletal and sensorial impairments contributed the most to self-reported disability (AAF 15.4% and 12.3%). Neurological and musculoskeletal diseases had the largest impact on disability (AAF 17.4% and 16.4%, respectively). Neurological disorders contributed the most to severe disability (AAF 31.0%). Psychiatric diseases contributed the most to disability categories for patients 18–40 years old (AAFs 23.8%–40.3%). Cardiovascular conditions were also among the top four contributors to disability categories (AAFs 8.5%–11.1%). Conclusions: Neurological, musculoskeletal, and cardiovascular chronic disorders mainly contribute to disability in France. Psychiatric impairments have a heavy burden for people 18–40 years old. These findings should help policymakers define priorities for health-service delivery in France and perhaps other developed countries. Citation: Palazzo C, Ravaud J-F, Trinquart L, Dalichampt M, Ravaud P, et al. (2012) Respective Contribution of Chronic Conditions to Disability in France: Results from the National Disability-Health Survey. PLoS ONE 7(9): e44994. doi:10.1371/journal.pone.0044994 Editor: Deborah Kado, UCSD School of Medicine, United States of America Received January 25, 2012; Accepted August 15, 2012; Published September 14, 2012 Copyright: 2012 Palazzo et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Funding: This work was supported by the French National Institute of Statistics and Economic Studies (INSEE) and the French Head Office of Research, Studies, Evaluation and Statistics (DREES) of the Social Affairs Ministry (contract PA 11/R 10100LL). The French National Institute of Statistics and Economic Studies (INSEE) and the French Head Office of Research, Studies, Evaluation and Statistics (DREES) of the Social Affairs Ministry had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The authors received a grant from Pfizer France, which had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing Interests: The authors have read the journal’s policy and have the following conflict: S. Poiraudeau received fees from Pfizer for consultancy. This does not alter the authors’ adherence to all the PLoS ONE policies on sharing data and materials. The other authors have declared that no competing interests exist. There is no patent, product in development or marketed product,... etc., associated with Pfizer. * E-mail: clemence.palazzo@cch.aphp.fr