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Chen MZ, Lee L, Fellinghauer C, Cieza A, Chatterji S. Demographic and environmental factors associated with disability in India, Laos, and Tajikistan: a population-based cross-sectional study. BMC Public Health 2022; 22:607. [PMID: 35351052 PMCID: PMC8962048 DOI: 10.1186/s12889-022-12846-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background The number of people experiencing functional limitations due to health conditions (capacity) is expected to increase in low and middle-income countries as populations age and rates of non-communicable disease rise. This trend could raise the prevalence and levels of disability worldwide. Understanding the demographic and environmental factors associated with disability can inform the design of policy interventions to make societies more accessible and inclusive for all. Methods Approximately 2,500–3,000 participants in each of India, Laos, and Tajikistan responded to the Gallup World Poll and the World Health Organization’s Brief Model Disability Survey through face-to-face interviews. For each country, random forest regression was performed to explore the associations of demographic and environmental factors with disability while controlling for capacity. Using the variable importance measures generated by the random forest models, linear regression models were built in a stepwise manner for each country to predict disability level based on these contextual factors. Results Capacity was strongly associated with disability in all three countries. Most of the variance in disability was explained by minimally adjusted linear models that included only capacity, sex, and age. Inclusion of additional demographic factors and environmental factors explained slightly more of the variance in disability score. Across all three countries, the level of basic infrastructure, public services, and financial stability were moderately associated with disability. Age, sex, employment status, the use of assistive technologies, and other factors had associations with disability that were highly variable across countries. Conclusion While capacity was the main determinant of disability, individual demographic and environmental factors were associated with disability in a country-specific manner while controlling for the effects of capacity. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12846-1.
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Affiliation(s)
- Michael Zhu Chen
- Sensory Functions, Disability and Rehabilitation, Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Lindsay Lee
- Sensory Functions, Disability and Rehabilitation, Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Carolina Fellinghauer
- Sensory Functions, Disability and Rehabilitation, Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland.
| | - Alarcos Cieza
- Sensory Functions, Disability and Rehabilitation, Department of Noncommunicable Diseases, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
| | - Somnath Chatterji
- Department of Data and Analytics, World Health Organization, Avenue Appia 20, 1211, Geneva, Switzerland
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Lee L, Mou F, Um Boock A, Fellinghauer C, Kohls M, Cieza A, Sabariego C. Identifying key environmental barriers experienced by persons with mild, moderate, or severe disability in Bankim Health District, Cameroon: a policy-targeted secondary analysis of data obtained with the World Bank and WHO model disability survey. Arch Public Health 2021; 79:95. [PMID: 34099049 PMCID: PMC8183069 DOI: 10.1186/s13690-021-00619-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Comprehensive data is key for evidence-informed policy aiming to improve the lives of persons experiencing different levels of disability. The objective of this paper was to identify the environmental barriers - including physical, social, attitudinal, and political barriers - that might become priorities for cross-cutting policies and policies tailored to the needs of persons experiencing severe disability in Cameroon. METHODS A secondary analysis of data obtained with the WHO Model Disability Survey was completed in the Bankim Health District (N = 559) using random forest regression to determine and compare the impact of the environmental factors on the experience of disability. RESULTS The physical environment had by far the highest influence on disability, with transportation, toilet of the dwelling, and the dwelling itself being the most important factors. Factors inside one's own home (toilet of the dwelling, and the dwelling itself) were the most important for persons with moderate and severe disability, followed by attitudes of others and issues with accessing health care. CONCLUSION Our study provides country policy makers with evidence for setting priorities and for the development of evidence-informed policies for the Bankim Health District in Cameroon.
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Affiliation(s)
- Lindsay Lee
- Sensory Functions, Disability and Rehabilitation (SDR), World Health Organization, Geneva, Switzerland
| | | | | | - Carolina Fellinghauer
- Sensory Functions, Disability and Rehabilitation (SDR), World Health Organization, Geneva, Switzerland.
| | - Mirjam Kohls
- Sensory Functions, Disability and Rehabilitation (SDR), World Health Organization, Geneva, Switzerland
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Alarcos Cieza
- Sensory Functions, Disability and Rehabilitation (SDR), World Health Organization, Geneva, Switzerland
| | - Carla Sabariego
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, University of Lucerne, Lucerne, Switzerland
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de la Fuente J, Caballero FF, Sánchez-Niubó A, Panagiotakos DB, Prina AM, Arndt H, Haro JM, Chatterji S, Ayuso-Mateos JL. Determinants of Health Trajectories in England and the United States: An Approach to Identify Different Patterns of Healthy Aging. J Gerontol A Biol Sci Med Sci 2019; 73:1512-1518. [PMID: 29346518 DOI: 10.1093/gerona/gly006] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Indexed: 12/31/2022] Open
Abstract
Background Aging is a multidimensional process with a remarkable interindividual variability. This study is focused on identifying groups of population with similar aging patterns, and to define the health trajectories of these groups. Sociodemographic and health determinants of these trajectories are also identified. Methods Data from the English Longitudinal Study of Aging (ELSA) and the Health and Retirement Study (HRS) were used. A set of self-reported health items and measured tests were used to generate a latent health metric by means of a Bayesian multilevel IRT model, assessing the ability of the metric to predict mortality. Then, a Growth Mixture Model (GMM) was conducted in each study to identify latent classes and assess health trajectories. Kaplan-Meier survival curves were obtained for each class and a multinomial logistic regression was used to identify determinants of these trajectories. Results The health score generated showed an adequate ability to predict mortality over 10 years in ELSA (AUC = 0.74; 95% CI: 0.72, 0.75) and HRS (AUC = 0.74; 95% CI: 0.73, 0.75). By means of GMM, four latent classes were identified in ELSA and five in HRS. Chronic conditions, no qualification and low level of household wealth were associated to the classes which showed a higher mortality in both studies. Conclusion The method based on the creation of a common metric of health and the use of GMM to identify similar patterns of aging, allows for the comparison of trajectories of health across longitudinal surveys. Multimorbidity, educational level, and household wealth could be considered as determinants associated to these trajectories.
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Affiliation(s)
| | - Francisco Félix Caballero
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain.,CIBER of Mental Health, Madrid, Spain.,Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
| | | | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - A Matthew Prina
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | | | - Josep Maria Haro
- CIBER of Mental Health, Madrid, Spain.,Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Somnath Chatterji
- Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - José Luis Ayuso-Mateos
- Department of Psychiatry, Universidad Autónoma de Madrid, Spain.,CIBER of Mental Health, Madrid, Spain.,Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS Princesa), Madrid, Spain
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Madden RH, Bundy A. The ICF has made a difference to functioning and disability measurement and statistics. Disabil Rehabil 2018; 41:1450-1462. [PMID: 29433362 DOI: 10.1080/09638288.2018.1431812] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIMS Fifteen years after the publication of the International Classification of Functioning, Disability and Health (ICF), we investigated: How ICF applications align with ICF aims, contents and principles, and how the ICF has been used to improve measurement of functioning and related statistics. METHODS In a scoping review, we investigated research published 2001-2015 relating to measurement and statistics for evidence of: a change in thinking; alignment of applications with ICF specifications and philosophy; and the emergence of new knowledge. RESULTS The ICF is used in diverse applications, settings and countries, with processes largely aligned with the ICF and intended to improve measurement and statistics: new national surveys, information systems and ICF-based instruments; and international efforts to improve disability data. Knowledge is growing about the components and interactions of the ICF model, the diverse effects of the environment on functioning, and the meaning and measurement of participation. CONCLUSION The ICF provides specificity and a common language in the complex world of functioning and disability and is stimulating new thinking, new applications in measurement and statistics, and the assembling of new knowledge. Nevertheless, the field needs to mature. Identified gaps suggest ways to improve measurement and statistics to underpin policies, services and outcomes. Implications for Rehabilitation The ICF offers a conceptualization of functioning and disability that can underpin assessment and documentation in rehabilitation, with a growing body of experience to draw on for guidance. Experience with the ICF reminds practitioners to consider all the domains of participation, the effect of the environment on participation and the importance of involving clients/patients in assessment and service planning. Understanding the variability of functioning within everyday environments and designing interventions for removing barriers in various environments is a vital part of rehabilitation planning.
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Affiliation(s)
- Rosamond H Madden
- a Faculty of Health Sciences , University of Sydney , Sydney , Australia
| | - Anita Bundy
- a Faculty of Health Sciences , University of Sydney , Sydney , Australia.,b Department of Occupational Therapy , Colorado State University , Fort Collins , CO , USA
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Kamenov K, Cabello M, Ballert CS, Cieza A, Chatterji S, Rojas D, Cerón G, Bickenbach J, Ayuso-Mateos JL, Sabariego C. What makes the difference in people's lives when they have a mental disorder? Int J Public Health 2017; 63:57-67. [PMID: 29177711 DOI: 10.1007/s00038-017-1047-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 07/17/2017] [Accepted: 10/14/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES The objective of this study was to identify which environmental factors are the most responsible for the disability experienced by persons with mental disorders and whether they differ (1) from those in cardiovascular diseases, chronic respiratory conditions, diabetes, and cancer, and (2) depending on the capacity level-a proxy for the impact of health conditions on the health state of individuals. METHODS Nationally representative data from 12,265 adults in Chile collected in 2015 with the WHO Model Disability Survey was analyzed. RESULTS The availability of personal assistance, frequency of receiving personal assistance, and assistive devices for mobility were the most important environmental factors across mental and other non-communicable diseases. Perception of discrimination and use of health services were also prominent factors. There was a huge overlap between the factors found relevant for mental and other non-communicable diseases, but a substantial variability depending on the intensity of difficulties in capacity. CONCLUSIONS This study challenges the appropriateness of disease-specific approaches and suggests that considering intrinsic capacity levels is more informative than focusing on diagnosis alone when comparing needs and barriers that affect the performance in daily life of specific groups of individuals.
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Affiliation(s)
- Kaloyan Kamenov
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBER, Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Cabello
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBER, Madrid, Spain.,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Alarcos Cieza
- Faculty of Social and Human Sciences, University of Southampton, Southampton, UK.,Department of Medical Informatics, Biometry and Epidemiology-IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität München, Munich, Germany.,Blindness and Deafness Prevention, Disability and Rehabilitation (BDD), World Health Organization, Geneva, Switzerland
| | - Somnath Chatterji
- Department for Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Diego Rojas
- Department of Studies, Servicio Nacional de Discapacidad (Senadis), Ministerio de Desarrollo Social, Santiago, Chile
| | - Gloria Cerón
- Department of Studies, Servicio Nacional de Discapacidad (Senadis), Ministerio de Desarrollo Social, Santiago, Chile
| | | | - José Luis Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red, CIBER, Madrid, Spain. .,Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain. .,Instituto de investigación de la Princesa, (IIS-IP), Hospital Universitario de la Princesa, C/Diego de León 62, 28006, Madrid, Spain.
| | - Carla Sabariego
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität München, Munich, Germany
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Mosallanezhad Z, Sotoudeh GR, Jutengren G, Salavati M, Harms-Ringdahl K, Wikmar LN, Frändin K. A structural equation model of the relation between socioeconomic status, physical activity level, independence and health status in older Iranian people. Arch Gerontol Geriatr 2017; 70:123-129. [PMID: 28131051 DOI: 10.1016/j.archger.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/29/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM Health status is an independent predictor of mortality, morbidity and functioning in older people. The present study was designed to evaluate the link between socioeconomic status (SES), physical activity (PA), independence (I) and the health status (HS) of older people in Iran, using structural equation modelling. METHODS Using computerized randomly selection, a representative sample of 851 75-year-olds living in Tehran (2007-2008), Iran, was included. Participants answered questions regarding indicators of HS, SES and also PA and I through interviews. Both measurement and conceptual models of our hypotheses were tested using Mplus 5. Maximum-likelihood estimation with robust standard errors (MLR estimator), chi-square tests, the goodness of fit index (and degrees of freedom), as well as the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RSMEA) were used to evaluate the model fit. RESULTS The measurement model yielded a reasonable fit to the data, χ2=110.93, df=38; CFI=0.97; RMSEA=0.047, with 90% C.I.=0.037-0.058. The model fit for the conceptual model was acceptable; χ2=271.64, df=39; CFI=0.91; RMSEA=0.084, with 90% C.I.=0.074-0.093. SES itself was not a direct predictor of HS (β=0.13, p=0.059) but it was a predictor of HS either through affecting PA (β=0.31, p<0.001) or I (β=0.57, p<0.001). CONCLUSION Socioeconomic status appeared to influence health status, not directly but through mediating some behavioral and self-confidence aspects including physical activity and independence in ADL.
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Affiliation(s)
- Zahra Mosallanezhad
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Iranian Research Centre on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
| | - Gholam Reza Sotoudeh
- Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden; Sina Trauma and Surgery Research Center (STSRC), Sina General Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Göran Jutengren
- Department of Work Life and Social Welfare, University of Borås, Sweden
| | - Mahyar Salavati
- Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Karin Harms-Ringdahl
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lena Nilsson Wikmar
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Academic Primary Healthcare Centre, Stockholm County Council, Stockholm, Sweden
| | - Kerstin Frändin
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Neuropsychiatric Epidemiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Coenen M, Sabariego C, Cieza A. Empfehlungen zur Erhebung und Aufbereitung von Daten zu Teilhabe und Behinderung aus der Perspektive der Weltgesundheitsorganisation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59:1060-7. [DOI: 10.1007/s00103-016-2412-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Loidl V, Oberhauser C, Ballert C, Coenen M, Cieza A, Sabariego C. Which Environmental Factors Have the Highest Impact on the Performance of People Experiencing Difficulties in Capacity? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:416. [PMID: 27077872 PMCID: PMC4847078 DOI: 10.3390/ijerph13040416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/05/2016] [Accepted: 04/07/2016] [Indexed: 11/16/2022]
Abstract
Disability is understood by the World Health Organization (WHO) as the outcome of the interaction between a health condition and personal and environmental factors. Comprehensive data about environmental factors is therefore essential to understand and influence disability. We aimed to identify which environmental factors have the highest impact on the performance of people with mild, moderate and severe difficulties in capacity, who are at risk of experiencing disability to different extents, using data from a pilot study of the WHO Model Disability Survey in Cambodia and random forest regression. Hindering or facilitating aspects of places to socialize in community activities, transportation and natural environment as well as use and need of personal assistance and use of medication on a regular basis were the most important environmental factors across groups. Hindering or facilitating aspects of the general environment were the most relevant in persons experiencing mild levels of difficulties in capacity, while social support, attitudes of others and use of medication on a regular basis were highly relevant for the performance of persons experiencing moderate to higher levels of difficulties in capacity. Additionally, we corroborate the high importance of the use and need of assistive devices for people with severe difficulties in capacity.
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Affiliation(s)
- Verena Loidl
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Ludwig-Maximilians-University (LMU), Munich 81377, Germany.
| | - Cornelia Oberhauser
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Ludwig-Maximilians-University (LMU), Munich 81377, Germany.
| | | | - Michaela Coenen
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Ludwig-Maximilians-University (LMU), Munich 81377, Germany.
| | - Alarcos Cieza
- Blindness and Deafness Prevention, Disability and Rehabilitation (BDD), World Health Organization, Geneva 1211, Switzerland.
| | - Carla Sabariego
- Department of Medical Informatics, Biometry and Epidemiology-IBE, Ludwig-Maximilians-University (LMU), Munich 81377, Germany.
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