Disability trends in Europe by age-period-cohort analysis: Increasing disability in younger cohorts

Trends over time in the deficit of (instrumental) activities of daily living in the Austrian population aged 65 years and older : Results from the Austrian Health Interview Survey series

BACKGROUND

Difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL) in older adults are associated with diminished quality of life and increased demand for long-term care. The present study examined the prevalence of disability among individuals aged 65 years and older in Austria, using data from the Austrian Health Interview Surveys (ATHIS).

METHODS

The ATHIS 2014 and 2019 surveys were used (N = 5853) for the analysis. Binary logistic regression was performed to measure the association between disability in at least one ADL or IADL limitation and independent variables adjusted for sociodemographic, health-related behavior and survey year.

RESULTS

The prevalence of ADL or IADL limitations increased in both sexes during the 5‑year follow-up period. For ADL limitations, the prevalence rose from 12.8% to 17.9% in men (p < 0.001) and from 19.2% to 25.7% in women (p < 0.001). The IADL limitations increased from 18.9% to 35.1% in men (p < 0.001) and from 38.2% to 50.8% in women (p < 0.001). Women reported significantly higher odds for ADL (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.93-1.26) and IADL limitations (OR: 1.74, 95% CI: 1.53-1.98). In both sexes, participants aged 80 years and older reported higher odds for ADL (OR: 4.37, 95% CI:3.77-5.07) and IADL limitations (OR: 4.43, 95% CI: 3.86-5.09) compared to the younger group. Participants with at least one chronic disease reported higher odds for ADL (OR: 4.00, 95% CI: 3.41-4.70) and IADL limitations (OR: 4.37, 95% CI: 3.85-4.96). Primary education, single status, being born in non-EU/EFTA countries, and residing in Vienna were associated with higher odds of ADL and IADL limitations.

CONCLUSION

Gender, age, education, country of birth, residence, partnership status, number of chronic diseases, noncompliance with physical activity, and nutrition recommendations had a strong association with increased vulnerability to disability. Public health policy must address these factors for disability prevention strategies.

Physical working conditions over time: a repeated cross-sectional study in German employees

BACKGROUND

This study aimed to examine time trends in physical working conditions across and within occupational groups in Germany between 2006 and 2018.

METHODS

Logistic regression analyses were conducted using data from the BIBB/BAuA Employment Surveys in 2006, 2012, and 2018, with a total sample size of 59,006 participants. The study investigated changes in various self-reported occupational exposure measures over time, along with demographic shifts in the workforce.

RESULTS

The results showed overall improvements in most occupational exposure measures during the study period, alongside an aging and upskilling workforce. However, exposure to awkward postures, microorganisms, and, to a lesser extent, noise increased. Substantial variation was observed between occupational groups, with more favourable trends among white-collar high-skilled and blue-collar low-skilled workers, and less favourable trends among white-collar low-skilled and blue-collar high-skilled workers.

CONCLUSIONS

While trends in physical working conditions in Germany are partly promising, some exposures are worsening, and substantial inequalities between occupations persist. As occupational exposures remain common, there is still a need for targeted interventions to improve working conditions, particularly in higher-risk occupations.

Type 2 diabetes in the employed population: do rates and trends differ among nine occupational sectors? An analysis using German health insurance claims data

BACKGROUND

Socioeconomic inequalities in type 2 diabetes (T2D) are well established in the literature. However, within the background of changing work contexts associated with digitalization and its effect on lifestyle and sedentary behavior, little is known on T2D prevalence and trends among different occupational groups. This study aims to examine occupational sector differences in T2D prevalence and trends thereof between 2012 and 2019.

METHODS

The study was done on 1.683.644 employed individuals using data from the German statutory health insurance provider in Lower Saxony, the "Allgemeine Ortskrankenkasse Niedersachsen" (AOKN). Predicted probabilities for T2D prevalence in four two-year periods between 2012 and 2019 were estimated based on logistic regression analyses for nine occupational sectors. Prevalence ratios were calculated to illustrate the effect of time period on the prevalence of T2D among the nine occupational sectors. Analyses were stratified by gender and two age groups.

RESULTS

Results showed differences among occupational sectors in the predicted probabilities for T2D. The occupational sectors "Transport, logistics, protection and security" and "Health sector, social work, teaching & education" had the highest predicted probabilities, while those working in the sector "Agriculture" had by far the lowest predicted probabilities for T2D. Over all, there appeared to be a rising trend in T2D prevalence among younger employed individuals, with gender differences among occupational sectors.

CONCLUSION

The study displayed different vulnerability levels among occupational sectors with respect to T2D prevalence overall and for its rising trend among the younger age group. Specific occupations within the vulnerable sectors need to be focused upon in further research to define specific target groups to which T2D prevention interventions should be tailored.

Trends in severe functional limitations among working and non-working adults in Germany: Towards an (un)-healthy working life?

We examined trends in severe functional limitations among working and non-working adults in Germany (ages 40-65). Four population-based samples of 11,615 participants were used, spanning the time periods 2002-2021. The overall prevalence of severe limitations was found to be 12.8% in the sample, but also varied from 10 to 20% according to occupational group. Over time, severe limitations were found to have increased, from 10.6% in 2002 to 13.2% in 2021. Logistic regression analysis showed that severe limitations increased significantly in certain subgroups, including working women with a low skilled white collar occupational group, working men with a low skilled blue collar occupational group and, particularly, among the whole non-working population, whereas limitations remained largely the same in the other groups, including most of the working population. In terms of expectancies, overall working life expectancy increased. Along with this increase, healthy (non-severely limited) working life expectancy increased, but this trend was accompanied by a clear increase in unhealthy working life expectancy (severely limited). Thus, although severe limitations have increased in some groups in the working-age adults, people today can expect to work more years free from severe limitations than before. In the future, potentials to increase working life expectancy may come to an end, as severe limitations increased strongly in the non-working population, which could limit the prospects for a further increase in the proportion of the population in employment. Further studies are needed to investigate the potential impact of the increasing prevalence of severe limitations on the population's ability to work.

Time trends in limited lung function among German middle-aged and older adults

Limited lung function represents a serious health impairment. However, studies investigating changes in limited lung function over time are rare. Thus, the current study investigates time-related changes in limited lung function and potential social inequalities. Data from the 2008 and 2017 waves of the population-based German Aging Survey were used in a repeated cross-sectional study design (N = 8778), including participants aged 40 years and older. Lung function was assessed by the peak flow test. Socio-economic indicators included educational attainment, income and occupational group. Additionally, smoking history, occupational exposure to fumes and gases, and physical exercise were used as potentially explanatory variables for the observed changes. We found that the prevalence of limited lung function decreased strongly over time on a descriptive level from 9.0 to 5.4%. In line with these results, a decreasing trend emerged (OR = 0.48) when controlling for age and gender differences. When additionally controlling for changes in socio-economic indicators and explanatory variables there were still significant decreases over time, but the decline was slightly reduced (OR = 0.57). Moreover, similar significant relative decreases over time occurred for middle-aged and older participants, female and male participants, and those belonging to the different socio-economic groups. Thus, limited lung function generally decreased over time. This decrease could partially be explained by beneficial developments in socio-economic indicators, smoking, occupational exposures, and physical exercise. Future studies might investigate how changes in medicinal treatment and prevention efforts have contributed to the observed beneficial trends in lung health.

Work ability trends 2000-2020 and birth-cohort projections until 2040 in Finland

Aims: To examine age-group and birth-cohort trends in perceived work ability in Finland in 2000-2020 and make projections of perceived work ability up to 2040 based on the observed birth-cohort development. Methods: Ten population-representative cross-sectional surveys conducted in Finland between 2000 and 2020 were used (overall N = 61,087, range 817-18,956). Self-reported estimates of current work ability in relation to the person's lifetime best on a scale from zero to ten (0-10) were classified into three groups: limited (0-5), intermediate (6-7), and good (8-10). Multiple imputation was used in projecting work ability. Results: Examining past trends by 5-year birth-cohorts born between 1961 and 1995 showed that work ability has declined steadily over time among older birth-cohorts, while in the two younger cohorts a stable development before 2017 and a steep decline between 2017 and 2020 was seen. Trends by 5-year age groups showed a declining trend of good work ability among 20-44-year-olds, a stable trend among 45-54-year-olds, and an improving trend among 55-year-olds and older was observed for the period 2000-2020. Among the under 55-year-olds the prevalence of good work ability ended up around 75% and at 68% among the 55-59-year-olds, 58% among the 60-69-year-olds and 49% among the 70-74-year-olds in 2020. Birth-cohort projections suggested a declining work ability in the future among all age groups included (30-74 years). By 2040, the prevalence of good work ability is projected to decline by 10 to 15 percentage points among 45-74-year-olds. Conclusions: The projections suggest declining work ability in the future. Efforts to counteract the decline in work ability are needed.

Trends in disability in activities of daily living and instrumental activities of daily living among Chinese older adults from 2011 to 2018

AIM

This study aimed to assess the trends in disabilities in activities of daily living (ADL) and instrumental activities of daily living (IADL) among older Chinese adults and explore the influence of multimorbidity and unhealthy behaviors on ADL/IADL disability over time.

METHODS

Data were obtained from four waves (2011-2018) of the China Health and Retirement Longitudinal Study. Disability in ADL/IADL was defined as inability to perform any ADL/IADL task. Latent class analysis was used to identify multimorbidity patterns. The generalized estimating equation was used to test disability trends. Logistic regression was used to investigate the factors influencing disability.

RESULTS

The prevalence of IADL and ADL disability showed significant increasing trends among older Chinese adults from 2011 to 2018 (ptrend < 0.001). The negative association between alcohol intake more than once per month and IADL disability strengthened over time (ptrend < 0.05). The influence of the "arthritis/digestive diseases" pattern, "cardiometabolic disease" pattern and "high multimorbidity" pattern on ADL disability weakened over time (ptrend < 0.05).

CONCLUSIONS

The prevalence of IADL and ADL disability among Chinese older adults increased over time. The "arthritis/digestive diseases" pattern, "cardiometabolic disease" pattern and "high multimorbidity" pattern appeared to be less disabling in ADL over time. Improving the prevention and treatment of multimorbidity and developing age-friendly living conditions could be helpful to reduce the risks of disability.

Are Protective Activities and Limitations in Practical Skills of Daily Living Associated with the Cognitive Performance of People with Mild Cognitive Impairment? Baseline Results from the BrainFit-Nutrition Study

Limitations in daily living have not yet been described adequately for mild cognitive impairment (MCI). In this study, we investigated first, time spent on protective activities (social, mental, and physical) and second, limitations in practical skills of daily living, both for people with MCI. We used baseline data from 270 individuals who participated in the randomized controlled trial BrainFit-Nutrition. The Montreal Cognitive Assessment (MoCA) was used to identify people with MCI. Participants were asked how much time they spent engaged in social, mental, and physical activities each week. Furthermore, the Bayer-ADL scale was used to quantify deficits in activities of daily living (ADLs). Regarding protection, the number of hours spent engaged in the three activity areas was significantly correlated with the cognitive performance in people with MCI. Social activities were positively associated with current cognitive performance. Concerning the limitations in practical skills of daily living, older and more cognitively impaired individuals were affected. Memory and orientation appear to be among the first practical skills of daily living that become impaired in people with MCI. Treatment recommendations for people with MCI include an increase in social, mental, and physical activities as well as the promotion of a healthy lifestyle.

Changes in disability over time among older working-age adults: Which global and specific limitations are increasing in Germany using the SHARE-data from 2004 to 2015?

Objectives

Previous studies have observed increasing limitations among the middle-aged, including those aged 40-64, raising the question how healthy work participation has changed. Helping answer this question, we ask: How have general and specific limitations changed in working and non-working adults in Germany?

Methods

We used population-based data of older working-age adults, aged 50-64 years old, from Germany provided by the Survey of Health Aging and Retirement (SHARE) study from 2004 to 2014 (N = 3522). Multiple logistic regression analyses were used to study changes in limitations over time.

Results

We found that employment rates generally increased over time, whereas limitation rates mostly increased among participants aged 50-54 and mostly decreased among participants aged 60-64 in both the working and non-working population. Regarding type of disability, increases were more pronounced with movement-related and general activity-related limitations.

Conclusion

Therefore, if the comparatively younger more-limited cohorts age and replace the older less-limited cohorts, a larger part of the working and non-working life might be expected to be spent with limitations in the future, and it seems questionable whether further substantial increases in healthy work participation can be achieved. Further prevention efforts and assistance should be directed at current middle-aged cohorts to improve and maintain their health, including adapting current working conditions to a work force with more limitations.

Cohort-specific disability trajectories among older women and men in Europe 2004-2017

As the population of Europe grows older, one crucial issue is how the incidence and prevalence of disabilities are developing over time in the older population. In this study, we compare cohort-specific disability trajectories in old age across subsequent birth cohorts in Europe, during the period 2004-2017.We used data from seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE). Mixed effects logistic regression models were used to model trajectories of accumulation of ADL limitations for subsequent birth cohorts of older women and men in different European regions. The results showed that there were sex differences in ADL and IADL limitations in all regions for most cohorts. Women reported more limitations than men, particularly in Eastern and Southern rather than Northern and Western Europe. Among men in Eastern, Northern and Western Europe, later born cohorts reported more disabilities than did earlier born birth cohorts at the same ages. Similar patterns were observed for women in Northern and Western Europe. In contrast, the risk of disabilities was lower in later born cohorts than in earlier born birth cohorts among women in Eastern Europe. Overall, results from this study suggest that disability trajectories in different cohorts of men and women were by and large similar across Europe. The trajectories varied more depending on sex, age and region than depending on cohort.

Trends in activities of daily living disability among Chinese older adults from 1998 to 2018: an age-period-cohort analysis

This study aims to investigate the age, period, and cohort effects on trends in activities of daily living (ADL) disability among Chinese older adults; and to explore these three temporal effects on gender and residence disparities in disability. We utilized multiple cross-sectional waves of the Chinese Longitudinal Healthy Longevity Survey data (1998-2018), including 89,511 participants aged above 65 years old. Our measurement of disability is the number of ADL items (dressing, bathing, indoor transferring, toileting, eating, and continence) participants can't perform independently. Hierarchical age-period-cohort cross-classified random effects models were conducted to investigate age, period and cohort trends in ADL disability. Results showed that ADL disability increased with age at an increasing rate. A V-shaped cohort trend and a fluctuated period trend were identified. Females and urban residents were associated with more ADL limitations. When age increased, the gender and residence gaps in disability further increased. The cohort-based gender and residence inequalities in ADL limitations converged with successive cohorts. The period-based residence gap in ADL limitations diverged throughout the 20-year period, while the corresponding period-based change in gender disparity was not significant. These findings suggested that age, period, and cohort had different and independent effects on ADL disability among Chinese older adults. The age effect on trends in ADL is stronger compared to period and cohort effects. The gender and residence disparities in disability increased with age and decreased with successive cohorts. These patterns might help inform healthcare planning and the priorities for medical resource allocation accordingly.

Age-period-cohort analysis of depression trends: are depressive symptoms increasing across generations in Germany?

Several studies have examined trends in depression, but only few have explicitly considered possible generational differences. I examined changes in the burden of depressive symptoms between 2002 and 2017 according to age, time period and birth cohort in Germany. I used population-based data drawn from the German Aging Survey (N = 33,723, 54% female, ages 40 +) from 2002, 2008, 2011, 2014, and 2017. Depressive symptoms were measured via the CES-D 15. Hierarchical age-period-cohort models were used to examine trends in depression. I found that depressive symptoms changed across age, time period and birth cohorts. While there was a general decrease across time periods, strong evidence for a U-shaped cohort effect was also found: Younger generations, beginning with cohorts born after the World War II, increasingly report more depressive symptoms than older generations. This U-shaped cohort trend appeared most pronounced for the somatic symptoms subscale. Contrarily, only minimal cohort differences were found regarding the positive affect subscale. Therefore, depressive symptoms, and especially somatic symptoms, seem to increase in more recent birth cohorts in Germany, who might thus be at risk to experience more mental health problems in the future. Potential reasons for these trends and the generalizability of the results to other countries should be investigated by future studies.

Trends in Activity Limitations From an International Perspective: Differential Changes Between Age Groups Across 30 Countries

Objectives: Examine trends in limitations among young (15–39), middle-aged (40–64) and older age-groups (>=65) and their socioeconomic differences. Methods: Population-based European Social Survey data ( N = 396,853) were used, covering 30 mostly European countries and spanning the time-period 2002–2018. Limitations were measured using a global activity limitations indicator. Results: Age-differential trends in limitations were found. Activity limitations generally decreased in older adults, whereas trends varied among younger and middle-aged participants, with decreasing limitations in some countries but increasing limitations in others. These age-differential trends were replicated across limitation severity and socioeconomic groups; however, stronger limitation increases occurred regarding less-severe limitations. Discussion: Functional health has improved in older adults. Contrarily, the increasing limitations in younger and middle-aged individuals seem concerning, which were mostly observed in Western and Northern European countries. Given its public health importance, future studies should investigate the reasons for this declining functional health in the young and middle-aged.

Compression and Expansion of Morbidity

BACKGROUND

Morbidity is said to be compressed when the interval from the onset of a disease or disability to death becomes shorter over time, or when the incidence of the disease or disability declines over time. In the reverse situation, morbidity is said to be expanded.

METHODS

This review is based on national and international studies retrieved by a selective literature search on secular trends in morbidity and mortality. The findings were derived from data from surveys and registries, and from the routine data of health insurance carriers.

RESULTS

Three different types of secular trends in morbidity were seen. For some diseases (e.g., lung cancer, stroke, and dementia), morbidity among the elderly was compressed over time. On the other hand, for multimorbidity and type 2 diabetes including comorbidities, morbidity expanded over time. Unexpectedly, a double development was seen in certain other conditions, with both compression among the elderly and expansion among the middle-aged: this was particularly so for myo - cardial infarction, grip strength, and indicators of general health.

CONCLUSION

The notion of morbidity being reduced by compression seems less tenable in view of the double development just mentioned. The findings suggest that the observed secular trend toward better health among the elderly has not persisted among the more recently born cohorts. This can have negative effects on social security systems, particularly with respect to retirement ages being deferred or made more flexible, as well as the cost of health care.

Functional Capacity and Difficulties in Activities of Daily Living From a Cross-National Perspective

Objectives: This study investigated whether physical and cognitive functioning predicts developing difficulties in basic or instrumental activities of daily living (ADL/IADL), and whether country-level factors moderated the associations. Methods: 69,227 adults aged 50+ from 19 countries were followed for up to 14 years. Cox regression and meta-regression analyses were used. Results: Higher grip strength was associated with a 45% lower risk of developing ADL limitations and a 47% lower risk of IADL limitations. The corresponding values were 22% and 23% for peak flow, 20% and 23% for word recall, and 20% and 24% for temporal orientation. The associations were similar and statistically significant in most countries, but some associations were weaker in countries with lower GDP and lower service coverage. Discussion: Good physical and cognitive functional capacity protects from ADL and IADL limitations consistently across Western countries. The associations may be stronger in countries with more resources.

Getting a Grip on Secular Changes: Age-Period-Cohort Modeling of Grip Strength in the English Longitudinal Study of Ageing

BACKGROUND

Grip strength is a popular and valuable measure in studies of physical functional capabilities in old age. The influence of historical trends and differential period-specific exposures can complicate the interpretation of biomarkers of aging and health and requires careful analysis and interpretation of aging, birth cohort, and period effects. This study evaluates the effects of aging, period, and cohort on grip strength in a population of adults and older adults.

METHODS

We use more than 27 000 observations for individuals at least 50 years of age, born in approximately 1910-1960, from the English Longitudinal Study of Ageing to examine a variety of multilevel and cross-classified modeling approaches to evaluate age, period, and cohort effects. Our results extended Hierarchical Age-Period-Cohort modeling and compared our results with a set of 9 submodels with explicit assumptions to determine the most reliable modeling approach.

RESULTS

Findings suggest grip strength is primarily related to age, with minimal evidence of either period and/or cohort effects. Each year's increase in a person's age was associated with a 0.40-kg decrease in grip strength, though this decline differs by gender.

CONCLUSIONS

We conclude that as the population ages, grip strength declines at a systematic and predictable rate equal to -0.40 kg per year (approximately -0.50 kg for men and -0.30 kg for women) in residents of England aged 50 and older. Age effects were predominant and most consistent across methodologies. While there was some evidence for cohort effects, such effects were minimal and therefore indicative that grip strength is a consistent physiological biomarker of aging.

Health and study dropout: health aspects differentially predict attrition

Background

Participant dropout poses significant problems in longitudinal survey studies. Although it is often assumed that a participant’s health predicts future study dropout, only a few studies have examined this topic, with conflicting findings. This study aims to contribute to the literature by clarifying the relationship between different aspects of health and study dropout.

Methods

The 2008 baseline sample of the German Aging Survey was used to predict study dropout (N = 4442). Indicators of health included physical health using the number of chronic conditions, physical functioning using the SF-36 Physical Functioning subscale, cognitive functioning using the digit symbol substitution test, and depression using the CESD-15.

Results

It was found that different aspects of health had differential associations with survey dropout: Worse physical functioning and in part worse cognitive functioning predicted increased dropout rates; contrarily, worse physical health predicted decreased dropout when controlling for other health aspects and covariates. Depression was not significantly related to study dropout.

Conclusions

Therefore, participants with chronic conditions, but minimal physical and cognitive disability were most likely to participate in the future. These findings suggest that health has a complex relationship with survey dropout and must be accounted for in longitudinal studies. Neglecting this systematic attrition due to health problems bears the risk of severely under- or overestimating health-related effects and trends.

Secular Improvements in Cognitive Aging: Contribution of Education, Health, and Routine Activities

Objectives

Limited evidence exists regarding the reasons for secular changes in cognitive functioning over historical time. Thus, we examined potential explanatory factors for changes in cognitive speed, a central dimension of cognitive functioning.

Methods

Population-based data of middle-aged and older adults from Germany (N = 5443) was used with baseline participants from 2002 to 2014, comparing the time periods 2002–2014.

Results

Cognitive speed improved in middle-aged adults (40–65) and older adults (66+). In both age groups, increases were partly explained by education, employment status, volunteering status, routine activities, and physical functioning. Changes in education were more important in explaining increases in older than in middle-aged adults, whereas changes in health were more important for explaining increases in middle-aged adults.

Conclusions

Cognitive speed increased in both age groups over historical time. Education, employment, volunteering, routine activities, and health were all important in explaining these changes, but their importance differed between age groups.

Morbidity profiles in Europe and Israel: international comparisons from 20 countries using biopsychosocial indicators of health via latent class analysis

Aim

I examined health/morbidity profiles across 20 countries, determined their associated demographic characteristics and risk factors and compared the distribution of these health/morbidity profiles across countries.

Subject and methods

I used population-based data drawn from the European Social Survey (N = 20092, 52% female, ages 40+) covering 20 mostly European countries (Austria, Belgium, Czechia, Denmark, Finland, France, Germany, Great Britain, Hungary, Ireland, Israel, Lithuania, Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden and Switzerland) from 2014. Diverse indicators of health/morbidity were used, including self-rated health, self-rated disability, self-reported health problems and mental health symptoms using the CES-D. Latent class analysis was conducted to determine health/morbidity profiles across countries.

Results

I found that four distinct health profiles best describe overall health/morbidity status in the international sample, each associated with specific demographic and behavioural risk factors: ‘healthy’ profile (62% of participants), ‘unhappy but healthy’ profile (14%), ‘high morbidity, mostly physical’ profile (16%) and ‘high morbidity, mostly psychological’ profile (8%). With few exceptions, participants from Northern Europe and Western Europe were more likely to belong to the ‘healthy’ and the ‘unhappy but healthy’ profiles, whereas participants from Eastern Europe were more likely to belong to the ‘high morbidity, mostly physical’ profile. Distribution of the ‘high morbidity, mostly psychological’ profile appeared to be more uniform across regions.

Conclusions

Distinct morbidity/health profiles could be identified across countries, and countries varied regarding the relative distribution of these profiles. Specific prevention and treatment consequences associated with each profile are discussed. Future studies should further investigate the patterns of overall health and morbidity in Europe’s populations.

Association of disability with mortality in the Spanish adult non-institutionalised population

BACKGROUND

There are scant studies focused on measuring the association between disability and all-cause mortality based on large representative national samples of the community-dwelling adult population; moreover, the number of such studies which also include cause-specific mortality is yet lower.

METHODS

Longitudinal cohort study that used baseline data from 162 381 adults who participated in a countrywide disability survey (2008). A nationally representative sample was selected and interviewed in their homes. We present data on people ≥18 years. Disability was considered as any substantial limitation found on a list of 44 life activities that have lasted or are expected to last more than 1 year and originate from an impairment. Cause-specific mortality data were obtained from the Spanish Statistical Office. Subjects contributed follow-up time from baseline interview until death or the censoring date (31 December 2017). We computed standardised rate ratios (SRRs), with age, sex, living with a partner and education level distribution of the total group as standard population.

RESULTS

Adults with disability (11%) had an adjusted mortality rate more than twice as high as adults without disability (SRR 2.37, 95% CI 2.24 to 2.50). The increased mortality risk remained over the 10-year follow-up period. Mortality due to diseases of the nervous system (SRR 4.86, 95% CI 3.93 to 6.01), diseases of the musculoskeletal system (SRR 3.45, 95% CI 2.18 to 5.47), infectious diseases (SRR 3.38, 95% CI 2.27 to 5.01) and diabetes mellitus (SRR 3.56, 95% CI 2.71 to 4.68) was particularly high in those with disability.

CONCLUSIONS

All-cause mortality rates are markedly higher among adults with disability. Preventive measures and health promotion initiatives are needed to reduce mortality risk in this population. Special attention should be paid to disabled people with certain specific diseases.

Development of comorbidities in type 2 diabetes between 2005 and 2017 using German claims data

Against the background of increasing life expectancy over time, several hypotheses have been proposed on the way morbidity has been developing. In type 2 diabetes (T2D), previous research suggests that morbidity compression could be ruled out due to increasing prevalence and life expectancy with T2D over time. Understanding how the health state in individuals with T2D is developing would help identify whether morbidity expansion or a dynamic equilibrium pattern applies for this disease. This study aims to answer the following questions: (1) How do the number and the prevalence of T2D concordant comorbidities develop over time? (2) What does this imply in terms of morbidity development in T2D in Germany? The study used claims data from a statutory health insurance provider in Lower Saxony, Germany. Period prevalence of T2D concordant comorbidities was examined for the periods 2005–2007, 2010–2012 and 2015–2017 in 240,241, 295,868 and 308,134 individuals with T2D respectively. The effect of time period on the number and prevalence of comorbidities was examined by means of (ordered) logistic regression. The age-adjusted predicted probabilities of more severe cardiovascular diseases (CVDs) decreased over the three periods while those of less severe CVDs and other vascular diseases increased significantly in men and women and among all examined age-groups. Predicted probability of having at least one more comorbidity over time also increased significantly among all examined groups. While less and more severe CVDs exhibited different developmental patterns, the results of the study point towards morbidity expansion in T2D. Future studies should focus on mechanisms that contribute to these trends.

Common Mental Disorders, Functional Limitation and Diet Quality Trends and Related Factors among COPD Patients in Spain, 2006-2017: Evidence from Spanish National Health Surveys

Certain conditions such as common mental disorders (CMDs), functional limitation (FL) and poor diet quality may affect the lives of individuals who suffer from chronic obstructive pulmonary disease (COPD). This study sought to examine time trends in the prevalence of CMDs, FL and diet quality among male and female COPD patients living in Spain from 2006 to 2017 and to identify which factors were related to CMDs, FL and a poor/improvable diet quality in these patients. We performed a cross-sectional study among COPD patients aged ≥ 40 years old using data from the Spanish National Health Surveys conducted in 2006, 2011 and 2017, identifying a total of 2572 COPD patients. Binary logistic regressions were performed to determine the characteristics related to CMDs, FL and poor/improvable diet quality. Over the years of the study, the prevalence of FL among female COPD patients increased (p for trend <0.001). In addition, CMDs were associated to body mass index (BMI), educational level, physical activity, smoking status, occupation, chronic conditions and alcohol consumption; FL was related to age, living with a partner, educational level, physical activity and chronic conditions; and poor/improvable diet quality was associated to age, smoking status, BMI and physical activity.

Sociodemographic characteristics associated with physical activity barrier perception among manual wheelchair users

BACKGROUND

Individuals with disabilities are sub-optimally active and at increased risk for chronic diseases. Limited knowledge exists about how differences among wheelchair-dependent individuals may affect their perception of physical activity barriers.

OBJECTIVE

We examined whether the perception of physical activity barriers are associated with wheelchair user sociodemographic characteristics.

METHODS

Danish manual wheelchair users (MWCUs) (N = 181; 52.5% females, mean ± SD: age 48 ± 14 yrs) completed the 'Barriers to Physical Activity Questionnaire for People with Mobility Impairments' (BPAQ-MI) online. The BPAQ-MI queries physical activity barriers in four domains (intrapersonal, interpersonal, organizational, and community) and eight subdomains. Participant characteristics evaluated as potentially associated with physical activity barriers included age, sex, years in chair, body mass index (BMI), spinal cord injury (SCI) (if any), education, employment, and resident city size. Simple linear regression (step 1) and multiple regression models (step 2) were created to assess associations between MWCU characteristics and barriers.

RESULTS

Multiple regression models revealed that MWCUs who were obese, who did not complete high school, or were unemployed rated physical activity barriers higher across several subdomains (all r²≤0.226, p<0.05). Resident city size was associated with safety subdomain barrier impact (r²=0.039, p<0.05). Sex, age, years in chair and SCI were not associated with any barrier domains (all p ≥ 0.064).

CONCLUSIONS

Our results provide new evidence that MWCUs with BMI ≥30; who are not employed; or who only have completed high school, may need special consideration and resources to overcome distinct physical activity barriers. Behavioral strategies and interventions focusing on reducing physical activity barriers should be tailored to the individuals above.

Decline of depressive symptoms in Europe: differential trends across the lifespan

PURPOSE

We examined changes in the burden of depressive symptoms between 2006 and 2014 in 18 European countries across different age groups.

METHODS

We used population-based data drawn from the European Social Survey (N = 64.683, 54% female, age 14-90 years) covering 18 countries (Austria, Belgium, Denmark, Estonia, Finland, France, Germany, Great Britain, Hungary, Ireland, The Netherlands, Norway, Poland, Portugal, Slovenia, Spain, Sweden, Switzerland) from 2006 to 2014. Depressive symptoms were measured via the CES-D 8. Generalized additive models, multilevel regression, and linear regression analyses were conducted.

RESULTS

We found a general decline in CES-D 8 scale scores in 2014 as compared with 2006, with only few exceptions in some countries. This decline was most strongly pronounced in older adults, less strongly in middle-aged adults, and least in young adults. Including education, health and income partially explained the decline in older but not younger or middle-aged adults.

CONCLUSIONS

Burden of depressive symptoms decreased in most European countries between 2006 and 2014. However, the decline in depressive symptoms differed across age groups and was most strongly pronounced in older adults and least in younger adults. Future studies should investigate the mechanisms that contribute to these overall and differential changes over time in depressive symptoms.

Loneliness and Health: The Moderating Effect of Cross-Cultural Individualism/Collectivism

Objectives: The adverse health effects of loneliness are well documented, but less is known about cultural moderators of this relationship. Contributing to the literature, we examined whether cross-cultural differences in individualism moderate the effect of loneliness on health. Methods: We used population-based longitudinal data of 14 countries (N = 40,797), as provided by the Survey of Health, Ageing, and Retirement in Europe data. Multilevel regression analyses were employed. Moderating effects were analyzed for multiple health outcomes: activities of daily living, instrumental activities of daily living, grip strength, life satisfaction, depression, memory performance, verbal fluency, and numeracy. Results: Cultural individualism significantly moderated the effect of loneliness on health regarding most health outcomes. In general, the effect of loneliness on health became stronger in less individualistic/more collectivistic countries. Discussion: Cultural individualism proved to be one important moderator of the loneliness-health relationship. As previous studies mostly used samples from highly individualistic countries, the current literature might severely underestimate the global public health burden of loneliness.