Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey

Summary Background Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical...

Full description

Saved in:
Bibliographic Details
Published in:The Lancet (British edition) 2009-11, Vol.374 (9704), p.1821-1830
Main Authors: Sousa, Renata M, MSc, Ferri, Cleusa P, PhD, Acosta, Daisy, MD, Albanese, Emiliano, PhD, Guerra, Mariella, PhD, Huang, Yueqin, Prof, Jacob, KS, Prof, Jotheeswaran, AT, MSc, Rodriguez, Juan J Llibre, Prof, Pichardo, Guillermina Rodriguez, Lic, Rodriguez, Marina Calvo, MD, Salas, Aquiles, MD, Sosa, Ana Luisa, MSc, Williams, Joseph, MD, Zuniga, Tirso, MSc, Prince, Martin, Prof
Format: Article
Language:English
Subjects:
Age Factors
Aged
Biological and medical sciences
China - epidemiology
Chronic Disease - epidemiology
Chronic illnesses
Cross-Sectional Studies
Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases
Dementia
Dementia - complications
Dementia - economics
Dementia - epidemiology
Developing countries
Disability
Disabled Persons - statistics & numerical data
Dominican Republic - epidemiology
Eye diseases
Field study
General aspects
Health care access
Health services
Health Surveys
Humans
India - epidemiology
Internal Medicine
International agreements
LDCs
Medical sciences
Mexico - epidemiology
Miscellaneous
Musculoskeletal diseases
Neurology
Peru - epidemiology
Physical examinations
Poverty - statistics & numerical data
Public health. Hygiene
Public health. Hygiene-occupational medicine
Regression Analysis
Sample size
Socioeconomic Factors
Venezuela - epidemiology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary Background Disability in elderly people in countries with low and middle incomes is little studied; according to Global Burden of Disease estimates, visual impairment is the leading contributor to years lived with disability in this population. We aimed to assess the contribution of physical, mental, and cognitive chronic diseases to disability, and the extent to which sociodemographic and health characteristics account for geographical variation in disability. Methods We undertook cross-sectional surveys of residents aged older than 65 years (n=15 022) in 11 sites in seven countries with low and middle incomes (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Disability was assessed with the 12-item WHO disability assessment schedule 2.0. Dementia, depression, hypertension, and chronic obstructive pulmonary disease were ascertained by clinical assessment; diabetes, stroke, and heart disease by self-reported diagnosis; and sensory, gastrointestinal, skin, limb, and arthritic disorders by self-reported impairment. Independent contributions to disability scores were assessed by zero-inflated negative binomial regression and Poisson regression to generate population-attributable prevalence fractions (PAPF). Findings In regions other than rural India and Venezuela, dementia made the largest contribution to disability (median PAPF 25·1% [IQR 19·2–43·6]). Other substantial contributors were stroke (11·4% [1·8–21·4]), limb impairment (10·5% [5·7–33·8]), arthritis (9·9% [3·2–34·8]), depression (8·3% [0·5–23·0]), eyesight problems (6·8% [1·7–17·6]), and gastrointestinal impairments (6·5% [0·3–23·1]). Associations with chronic diseases accounted for around two-thirds of prevalent disability. When zero inflation was taken into account, between-site differences in disability scores were largely attributable to compositional differences in health and sociodemographic characteristics. Interpretation On the basis of empirical research, dementia, not blindness, is overwhelmingly the most important independent contributor to disability for elderly people in countries with low and middle incomes. Chronic diseases of the brain and mind deserve increased prioritisation. Besides disability, they lead to dependency and present stressful, complex, long-term challenges to carers. Societal costs are enormous. Funding Wellcome Trust; WHO; US Alzheimer's Association; Fondo Nacional de Ciencia Y Tecnologia, Consejo de Desarrollo Cientifico Y Humanistico,
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(09)61829-8