Contribution of Chronic Conditions to the Disability Burden across Smoking Categories in Middle-Aged Adults, Belgium

Health-related factors leading to disabilities in Korea: Survival analysis

The purpose of this study is to analyze (a) population and socioeconomic factors affecting disability, excluding the occurrence of disability due to accidents and congenital diseases, and (b) health-related behavioral factors and factors that can prevent and reduce the cause of disability due to disease in Korea. This study was a longitudinal research. Data were obtained from The 2018 Korean Health Panel (KHP) is a survey jointly conducted by the Korea Institute of Health and Social Affairs and the National Health Insurance Service. A total of 7, 372 (Mage = 52.14, SD = 21.39; Male = 47.52%) were analyzed in this study. People with Higher education attainments and more income levels were associated with lower hazard of developing new disabilities (all p < 0.05). In this study, the health factors that could be related to the occurrence of new disabilities were smoking, alcohol consumption, physical activity, and stress (all p < 0.0001). However, physical activity was negatively associated with the risk of developing a disability at all follow-ups (p < 0.05). Higher scores on the number of chronic diseases (valid scores = 0, 1, 2, 3, or more) represented a greater level of newly developing disability present at all follow-ups (all p < 0.0001). This longitudinal study confirmed the relationship between health-related factors and specific chronic diseases. Its findings can be used as a crucial foundation for establishing healthcare policies and services that can lower and prevent disability by preventing and reducing specific negative health behaviors and unhealthy behavioral factors, and alleviating chronic diseases in Korea.

Contribution of chronic conditions to gender disparities in health expectancies in Belgium, 2001, 2004 and 2008

Background

We aimed to investigate the contribution of chronic conditions to gender differences in disability-free life expectancy (DFLE) and life expectancy with disability (LED) in Belgium in 2001, 2004 and 2008.

Methods

Data on disability and chronic conditions from participants of the 2001, 2004 and 2008 Health Interview Surveys in Belgium were used to estimate disability prevalence by cause using the attribution method. Disability prevalence was applied to life tables to estimate DFLE and LED using the Sullivan method. Decomposition techniques were used to assess the contribution of mortality and disability and further of causes of death and disability to gender disparities in DFLE and LED.

Results

Higher LE, DFLE and LED were observed for women compared with men in all years studied. A decrease in the gender gap in LE (2001: 5.9; 2004: 5.6; 2008: 5.3) was observed in our cross-sectional approach followed by a decrease in gender differences in DFLE (2001: 1.9; 2004: 1.3; 2008: 0.5) and increase in LED (2001: 4.0; 2004: 4.4; 2008: 4.8). The higher LED in women was attributed to their lower mortality due to lung/larynx/trachea cancer, ischaemic heart diseases, and external causes (2001 and 2004) and higher disability prevalence due to musculoskeletal conditions (2008). Higher DFLE was observed in women owing to their lower mortality from lung/larynx/trachea cancer, ischaemic heart diseases, digestive cancer and chronic respiratory diseases.

Conclusion

To promote healthy ageing of populations, priority should be given to reduce the LED disadvantage in women by targeting non-fatal diseases, such as musculoskeletal conditions.

Contribution of chronic conditions to smoking differences in life expectancy with and without disability in Belgium

Background

Smoking is the leading cause of premature mortality and morbidity. This study aimed at assessing the impact of smoking on life expectancy (LE) and LE with (LED) and without disability (DFLE). We further estimated the contribution of disability and mortality and their causes to differences in LED and DFLE by smoking.

Methods

Data on disability, chronic conditions, and smoking from 17 148 participants of the 1997, 2001, 2004 Belgian Health Interview Surveys were used to estimate causes of disability using the attribution method. A 10-year mortality follow-up of survey participants was used. The Sullivan method was applied to estimate LED and DFLE. The contribution of disability and mortality and of causes of disability and death to smoking differences in LED and DFLE was assessed using decomposition methods.

Results

Never smokers live longer than daily smokers. DFLE advantage at age 15 of +8.5/+4.3 years (y) in men/women never compared with daily smokers was the result of lower mortality (+6.2y/+3y) and lower disability (2.3y/1.3y). The extra 0.3y/1.6y LED in never smokers was due to lower mortality (+2.6y/+2.9y) and lower disability (-2.3y/-1.3y). Lower mortality from lung/larynx/trachea cancer, chronic respiratory, and ischaemic heart diseases was the main contributor to higher LED and DFLE in never smokers. Lower disability from musculoskeletal conditions in men and chronic respiratory diseases in women increased LED and DFLE in never smokers.

Conclusions

Mortality and disability advantage among never smokers contributed to longer DFLE, while mortality advantage contributed to their longer LED.

Lifestyle and work ability in a general working population in Norway: a cross-sectional study

OBJECTIVES

The aim of this study was to investigate the association between multiple lifestyle-related risk factors (unhealthy diet, low leisure-time physical activity, overweight/obesity and smoking) and self-rated work ability in a general working population.

SETTING

Population-based cross-sectional study, in Telemark County, Norway, 2013.

PARTICIPANTS

A random sample of 50 000 subjects was invited to answer a self-administered questionnaire and 16 099 responded. Complete data on lifestyle and work ability were obtained for 10 355 participants aged 18-50 years all engaged in paid work during the preceding 12 months.

OUTCOME MEASURE

Work ability was assessed using the Work Ability Score (WAS)-the first question in the Work Ability Index. To study the association between multiple lifestyle risk factors and work ability, a lifestyle risk index was constructed and relationships examined using multiple logistic regression analysis.

RESULTS

Low work ability was more likely among subjects with an unhealthy diet (ORadj 1.3, 95% CI 1.02 to 1.5), inactive persons (ORadj 1.4, 95% CI 1.2 to 1.6), obese respondents (ORadj 1.5, 95% CI 1.3 to 1.7) and former and current smokers (ORadj 1.2, 95% CI 1.1 to 1.4 and 1.3, 95% CI 1.2 to 1.5, respectively). An additive relationship was observed between the lifestyle risk index and the likelihood of decreased work ability (moderate-risk score: ORadj 1.3; 95% CI 1.1 to 1.6; high-risk score: ORadj 1.9; 95% CI 1.6 to 2.2; very high risk score: ORadj 2.4; 95% CI 1.9 to 3.0). The overall population attributable fraction (PAF) of low work ability based on the overall risk index was 38%, while the PAFs of physical activity, smoking, body mass index and diet were 16%, 11%, 11% and 6%, respectively.

CONCLUSIONS

Lifestyle risk factors were associated with low work ability. An additive relationship was observed. The findings are considered relevant to occupational intervention programmes aimed at prevention and improvement of decreased work ability.

The Long-Term Impact of Functional Disability on Hospitalization Spending in Singapore

Singapore is one of the fastest-aging populations due to increased life expectancy and lowered fertility. Lifestyle changes increase the burden of chronic diseases and disability. These have important implications for social protection systems. The goal of this paper is to model future functional disability and healthcare expenditures based on current trends. To project the health, disability and hospitalization spending of future elders, we adapted the Future Elderly Model (FEM) to Singapore. The FEM is a dynamic Markov microsimulation model developed in the US. Our main source of population data was the Singapore Chinese Health Study (SCHS) consisting of 63,000 respondents followed up over three waves from 1993 to 2010. The FEM model enables us to investigate the effects of disability compounded over the lifecycle and hospitalization spending, while adjusting for competing risk of multi-comorbidities. Results indicate that by 2050, 1 in 6 elders in Singapore will have at least one ADL disability and 1 in 3 elders will have at least one IADL disability, an increase from 1 in 12 elders and 1 in 5 elders respectively in 2014. The highest prevalence of functional disability will be in those aged 85 years and above. Lifetime hospitalization spending of elders aged 55 and above is US$24,400 (30.2%) higher among people with functional disability compared to those without disability. Policies that successfully tackle diabetes and promote healthy living may reduce or delay the onset of disability, leading to potential saving. In addition, further technological improvements may reduce the financial burden of disability.

Contribution of chronic conditions to disability in men and women in France

Background

Women report more disability than men perhaps due to gender differences in the prevalence of diseases and/or in their disabling impact. We compare the contribution of chronic diseases to disability in men and women in France, using a disability survey conducted in both private households and institutions, and we also examine the effect of excluding the institutionalized population.

Methods

Data comprised 17 549 individuals age 50+, who participated in the 2008-09 French Disability Health Survey including people living in institutions. Disability was defined by limitations in activities people usually do due to health problems (global activity limitation indicator). Additive regression models were fitted separately by gender to estimate the contribution of conditions to disability taking into account multi-morbidity.

Results

Musculoskeletal diseases caused most disability for both men (10.1%, CI: 8.1-12.0) and women (16.0%, CI 13.6-18.2). The second contributor for men was heart diseases (5.7%, CI: 4.5-6.9%), and for women anxiety-depression (4.0, CI 3.1-5.0%) closely followed by heart diseases (3.8%, CI 2.9-4.7%). Women's higher contribution of musculoskeletal diseases reflected their higher prevalence and disabling impact; women's higher contribution of anxiety-depression and lower contributions of heart diseases reflected gender differences in prevalence. Excluding the institutionalized population did not change the overall conclusions.

Conclusions

The largest contributors to the higher disability of women than men are moderately disabling conditions with a high prevalence. Whereas traditional disabling conditions such as musculoskeletal diseases are more prevalent and disabling in women, fatal diseases such as cardiovascular disease are also important contributors in women and men.

Contribution of chronic diseases to educational disparity in disability in France: results from the cross-sectional "disability-health" survey

Background

This study aimed 1) to assess whether the contribution of chronic conditions to disability varies according to the educational attainment, 2) to disentangle the contributions of the prevalence and of the disabling impact of chronic conditions to educational disparities.

Methods

Data of the 2008–09 Disability Health Survey were examined (N = 23,348). The disability indicator was the Global Activity Limitation Indicator (GALI). The attribution method based on an additive hazard model was used to estimate educational differences in disabling impacts and in the contributions of diseases to disability. Counterfactual analyses were used to disentangle the contribution of differences in disease prevalence vs. disabling impact.

Results

In men, the main contributors to educational difference in disability prevalence were arthritis (contribution to disability prevalence: 5.7% (95% CI 5.4–6.0) for low-educated vs. 3.3% (3.0–3.9) for high-educated men), spine disorders (back/neck pain, deformity) (3.8% (3.6–4.0) vs. 1.9% (1.8–2.1)), chronic obstructive pulmonary diseases (2.4% (2.3–2.6) vs. 0.6% (0.5–0.7)) and ischemic heart /peripheral artery diseases (4.1% (3.9–4.3) vs. 2.4% (2.2–3.0)). In women, arthritis (9.5% (9.1–9.9) vs. 4.5%, (4.1–5.2)), spine disorders (4.5% (4.3–4.7) vs. 2.1% 1.9–2.3) and psychiatric diseases (3.1% (3.0–3.3) vs. 1.1% (1.0–1.3)) contributed most to education gap in disability. The educational differences were equally explained by differences in the disease prevalence and in their disabling impact.

Conclusions

Public health policies aiming to reduce existing socioeconomic disparities in disability should focus on musculoskeletal, pulmonary, psychiatric and ischemic heart diseases, reducing their prevalence as well as their disabling impact in lower socioeconomic groups.

Electronic supplementary material

The online version of this article (10.1186/s13690-018-0326-9) contains supplementary material, which is available to authorized users.

Changes in health in Belgium, 1990-2016: a benchmarking analysis based on the global burden of disease 2016 study

BACKGROUND

Despite increasing of the Belgian health expenditures, several indicators related to population health showed poor results. The objectives of this study were to perform an in-depth analysis of the secular trend of Belgian health status using the Global Burden of Disease (GBD) 2016 study results for Belgium, and to compare these results with other European countries.

METHODS

We collected results of the Global Burden of Disease 2016 study through the GBD results and visualization tools. We benchmarked Belgian GBD results with the other initial members of the European Union (EU15).

RESULTS

Belgium performed significantly better in 2016 than in 1990 in terms of age-standardized (AS) Year of Life Lost (YLL) rates but not significantly different in terms of AS Year Lived with Disability (YLD) and Disability-Adjusted Life Year (DALY) rates. The contribution of AS YLDs to total of AS DALYs increased from 1990 (42%) to 2016 (54%). Although AS YLD and DALY rates did not seem to differ between Belgium and the EU15 from 1990 to 2016, the ranking of Belgium among the EU15 in terms of AS DALY and YLL rates was worse in 2016 than in 1990. Belgium had significantly higher AS YLL rates for lower respiratory infections (B: 264 AS YLLs [95% uncertainty interval [UI] 231-301] per 100,000; EU15: 188 AS YLLs [95%UI 168-212] per 100,000), chronic obstructive pulmonary disease (B: 368 AS YLLs [95%UI 331-407] per 100,000; EU15: 285 AS YLLs [95%UI 258-316] per 100,000) and tracheal, bronchus, and lung cancer (B: 785 AS YLLs [95%UI 699-879] per 100,000; EU15: 613 AS YLLs [95%UI 556-674] per 100,000).

CONCLUSION

Belgium's ranking among the EU15 in terms of AS YLL and DALY rates decreased from 1990 to 2016. Significant health gains appear possible by acting on risk factors directly linked to a significant part of the Belgian burden of diseases, i.e., alcohol and tobacco consumption, and high body mass index. National burden of disease estimates can help defining Belgian health targets and are necessary as external validity of GBD results is not always guaranteed.

Explaining the increasing disability prevalence among mid-life US adults, 2002 to 2016

Several recent studies have documented an alarming upward trend in disability and functional limitations among US adults. In this study, we draw on the sociomedical Disablement Process framework to produce up-to-date estimates of the trends and identify key social and medical precursors of the trends. Using data on US adults aged 45-64 in the 2002-2016 National Health Interview Surveys, we estimate parametric and semiparametric models of disability and functional limitations as a function of interview time. We also determine the impact of socioeconomic resources, health behaviors, and health conditions on the trends. Our results show increasing prevalence of disability and functional limitations. These trends reflect the net result of complex countervailing forces, some associated with increases in functioning problems (unfavorable trends in economic well-being, especially income, and psychological distress) while other factors have suppressed the growth of functioning problems (favorable trends in educational attainment and some health behaviors, such as smoking and alcohol use). The results underscore that disability prevention must expand beyond medical interventions to include fundamental social factors and be focused on preventing or delaying the onset of chronic health problems and functional limitations.

Contribution of chronic conditions to functional limitations using a multinomial outcome: results for the older population in Belgium and Brazil

Background

The global phenomenon of population ageing is creating new challenges in both high and middle income countries, as functional limitations are expected to increase with age. The attribution method has been proposed to identify which conditions contribute most to disability using cross-sectional data. Although the original method was based on binary outcomes, we recently proposed an extension to multinomial responses, since different disability levels are often investigated in surveys. This is the first application of the extended method to evaluate differences in the contribution of chronic conditions to functional limitations in the older population of Brazil and Belgium.

Methods

Representative data from individuals aged ≥65 years who participated in the 2008 or 2013 Health Interview Surveys in Belgium (N = 4521) or in the 2008 National Household Sample Survey in Brazil (N = 28,437) were analysed. Individuals were classified as without, moderate or severe functional limitations, based on three activities of daily living: eating, showering, and toileting. Six chronic conditions common to the surveys – diabetes, heart diseases, musculoskeletal conditions, depression, chronic respiratory diseases, and cancer – were included in the analysis. Separate multinomial additive hazards models by gender for each country were fitted.

Results

The prevalence of moderate functional limitations was larger in men in Brazil (8.4%) compared to Belgium (6.0%) and similar in women (approximately 12.0%). Conversely, the severe prevalence in men was similar in the two countries (around 8.0%) and higher in women from Belgium (16.6%) than from Brazil (9.1%). Musculoskeletal conditions were the main contributors to the prevalence of functional limitations in men and women in Belgium but only in men and women with moderate functional limitations in Brazil. Depression and heart diseases contributed most to the severe prevalence of functional limitations in men and women in Brazil, respectively.

Conclusions

Our findings provide a better understanding of differences in the prevalence of different levels of functional limitations in Brazil and Belgium. These differences can be related to differences in socioeconomic conditions, health care access and quality, disease diagnosis, stage of epidemiology transition, life expectancy, and the prevalence of lifestyle risk factors in the two countries.

Electronic supplementary material

The online version of this article (10.1186/s13690-017-0235-3) contains supplementary material, which is available to authorized users.