1
|
Wu J, Wang Y, Li Y, Liu H, Yang S, Zhai H, Wu H. Are physically disabled people at high risk of coronary heart disease among disabled population - Evidence from 7.5-year retrospective cohort study. Ann Epidemiol 2024; 90:42-48. [PMID: 37926391 DOI: 10.1016/j.annepidem.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Previous cross-sectional studies suggested that people with physical disabilities (one of the subgroups of disabled people) are associated with an increased risk of cardiovascular diseases (CVD) than healthy peers. However, a longitudinal cohort of disabled people exhibited a different trend, in which the study populations were similar in health inequalities. We aimed to examine whether physical disability was associated with an increased risk of coronary heart disease (CHD) among disabled people. STUDY DESIGN AND SETTING This retrospective cohort study from the Shanghai Health Examination Program included a total of 6419 disabled adults (50.77 [9.88] age) with complete electronic health records and were free of CHD at baseline (2012) were followed-up for a 7.5-year period until 2019. The physical disability and non-physical disability subgroups were characterized based on the Disability Classification and Grading Standard (GB/T 26341-2010). Multivariable Cox regression analyses were used to evaluate adjusted hazard ratios (HR) for subsequent CHD, while Kaplan-Meier curves was used to assess the proportional hazards assumption. We conducted subgroup analyses based on gender, levels of disability, and baseline blood pressure. RESULTS Kaplan-Meier analysis revealed a higher incidence of CHD in the physical disability group compared to the non-physical disability group during the 7.5-year follow-up period (P < 0.05). Subjects with physical disabilities exhibited an increased risk for subsequent CHD occurrence (HR: 1.12; 95% CI: 1.03-1.31), compared to the non-physical subgroup after adjustments for confounders. The sensitivity analysis conducted on subgroups according to gender and disability severity indicated that moderate physical disability and female physical disability were associated with a higher prevalence of CHD, which was confirmed by multi-adjusted regression analysis. The spline curves of BP and CHD indicated that the physical disability group displayed lower SBP and DBP thresholds of 120 mmHg and SBP, respectively. CONCLUSION Within the disabled population, individuals with physical disability are at higher risk of developing CHD, and it is plausible that their optimal BP threshold for CHD prevention may need to be set at a lower level. Further research is essential to investigate BP management among individuals with physical disabilities and its influence on cardiovascular-related adverse events.
Collapse
Affiliation(s)
- Jing Wu
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yiyan Wang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Yao Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Hui Liu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Shenglan Yang
- School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Hua Zhai
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China.
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China.
| |
Collapse
|
2
|
Han Y, Wang S. Disability risk prediction model based on machine learning among Chinese healthy older adults: results from the China Health and Retirement Longitudinal Study. Front Public Health 2023; 11:1271595. [PMID: 38026309 PMCID: PMC10665855 DOI: 10.3389/fpubh.2023.1271595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023] Open
Abstract
Background Predicting disability risk in healthy older adults in China is essential for timely preventive interventions, improving their quality of life, and providing scientific evidence for disability prevention. Therefore, developing a machine learning model capable of evaluating disability risk based on longitudinal research data is crucial. Methods We conducted a prospective cohort study of 2,175 older adults enrolled in the China Health and Retirement Longitudinal Study (CHARLS) between 2015 and 2018 to develop and validate this prediction model. Several machine learning algorithms (logistic regression, k-nearest neighbors, naive Bayes, multilayer perceptron, random forest, and XGBoost) were used to assess the 3-year risk of developing disability. The optimal cutoff points and adjustment parameters are explored in the training set, the prediction accuracy of the models is compared in the testing set, and the best-performing models are further interpreted. Results During a 3-year follow-up period, a total of 505 (23.22%) healthy older adult individuals developed disabilities. Among the 43 features examined, the LASSO regression identified 11 features as significant for model establishment. When comparing six different machine learning models on the testing set, the XGBoost model demonstrated the best performance across various evaluation metrics, including the highest area under the ROC curve (0.803), accuracy (0.757), sensitivity (0.790), and F1 score (0.789), while its specificity was 0.712. The decision curve analysis (DCA) indicated showed that XGBoost had the highest net benefit in most of the threshold ranges. Based on the importance of features determined by SHAP (model interpretation method), the top five important features were identified as right-hand grip strength, depressive symptoms, marital status, respiratory function, and age. Moreover, the SHAP summary plot was used to illustrate the positive or negative effects attributed to the features influenced by XGBoost. The SHAP dependence plot explained how individual features affected the output of the predictive model. Conclusion Machine learning-based prediction models can accurately evaluate the likelihood of disability in healthy older adults over a period of 3 years. A combination of XGBoost and SHAP can provide clear explanations for personalized risk prediction and offer a more intuitive understanding of the effect of key features in the model.
Collapse
Affiliation(s)
| | - Shaobing Wang
- School of Public Health, Hubei University of Medicine, Shiyan, Hubei, China
| |
Collapse
|
3
|
Li Y, Wu J, Wang Y, Lei H, Jiang C, Zhai H, Wu H. Association of blood pressure trajectories with coronary heart disease among the disabled population in Shanghai, China: a cohort study of 7 years following up. Eur J Med Res 2023; 28:275. [PMID: 37553723 PMCID: PMC10410884 DOI: 10.1186/s40001-023-01240-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/19/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Much less is known about the importance of blood pressure (BP) trajectories concerning the incidence of coronary heart disease (CHD) in people with disabilities. Our aim was to evaluate this association. METHODS This cohort study surveyed 5711 adults from the Shanghai Disability Health Survey from June 2012 to June 2019. The latent class growth mixture model was used to examine distinct BP trajectories. We evaluated the association of BP trajectories with the risk of CHD by Cox proportional hazard models. The model for CHD risk fitted to BP trajectories was compared with models fitted to other BP-related indicators by goodness-of-fit, discrimination, and calibration. RESULTS During a median follow-up of 71.74 months, 686 cases (median age was 49.03 (54.49, 58.55) years, 51.90% female) with CHD were identified, with a cumulative incidence of 12.01%. Systolic BP (SBP) and diastolic BP (DBP) were categorized into three classes, respectively. A statistically significant association was only observed between SBP trajectories and CHD. Compared with the normotensive stable SBP group (n = 1956), the prehypertension-stable group (n = 3268) had a higher risk (adjust hazards ratio (aHR) = 1.266, 95% confidence interval (CI) 1.014-1.581), and the stage 1 hypertension-decreasing group (n = 487) had the highest risk (aHR = 1.609, 95%CI 1.157-2.238). Among the BP-related indicators, the SBP trajectory was the strongest predictor of new-onset CHD. Findings were similar when sensitivity analyses were conducted. CONCLUSIONS SBP trajectory was a more important risk factor for CHD than other BP-related indicators and stringent BP control strategies may be effective for primary CHD prevention in the disabled population.
Collapse
Affiliation(s)
- Yao Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 201619, China
| | - Jing Wu
- Department of Fundamental Nursing, School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yiyan Wang
- Department of Fundamental Nursing, School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Hongmei Lei
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 201619, China
| | - Chenghua Jiang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 201619, China
| | - Hua Zhai
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 201619, China.
| | - Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, 201619, China.
| |
Collapse
|
4
|
Tang Q, Yuan M, Wu W, Wu H, Wang C, Chen G, Li C, Lu J. Health Status and Individual Care Needs of Disabled Elderly at Home in Different Types of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811371. [PMID: 36141656 PMCID: PMC9517395 DOI: 10.3390/ijerph191811371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 05/13/2023]
Abstract
For the disabled, paying attention to their health status is the starting point to discovering their survival problems, while meeting their care needs is the end point to solving their survival problems. As the country with the largest number of disabled elderly in the world, how to ensure this group could obtain appropriate home care is a major public health issue facing China. Thus, we conducted a cross-sectional study from October to December 2020 to explore the basic characteristics and health status of disabled elderly in different types of care who are living at home in 37 streets in Shanghai, as well as the individual care needs and its relevance. We observed the significant differences in the number of diagnoses (p = 0.03), smoking (p = 0.009), drinking (p = 0.016), exercise (p = 0.001), activity of daily living (p < 0.0001), and the quality of life (p < 0.0001) across care types. The care needs of the disabled elderly are diversified, of which a vast majority of them have not been fully guaranteed. The urgent need for improving the identification accuracy of care needs of disabled elderly, as well as the development of elaborate and personalized care programs for them, is needed.
Collapse
Affiliation(s)
- Qi Tang
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Min Yuan
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Wenhui Wu
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Huanyun Wu
- Shanghai Jinshan District Health Service Management Center, Shanghai Jinshan District Municipal Health Commission, Shanghai 200540, China
| | - Cao Wang
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Gang Chen
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Chengyue Li
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
- Correspondence: (C.L.); (J.L.)
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
- Correspondence: (C.L.); (J.L.)
| |
Collapse
|
5
|
Kep K, Kobashi Y, Abarca Lopez EJ, Tsubokura M, Okawada M. Difference of sociodemographic characteristics among the disabled population in Cambodia: a cross-sectional study of the demographic and health survey data. J Rural Med 2022; 17:79-84. [PMID: 35432637 PMCID: PMC8984620 DOI: 10.2185/jrm.2021-012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: There is an urgent need to raise awareness of the significance of
the social security system for vulnerable populations in developing countries and identify
the widening disparities among people with disabilities. This study determined the
sociodemographic characteristics of people with disabilities in Cambodia. Materials and Methods: This was a cross-sectional study. Data from the
Cambodia Demographic and Health Survey were used to determine the association between
disability and sociodemographic characteristics such as age, gender, number of family
members, residence (rural/urban), and economic status. Results: The results showed that the proportion of people with disabilities
greatly increased with age. The rural-urban residence difference affected the disability
proportion in univariate analysis; however, the effect was not significant after adjusting
for covariables in multivariate analysis. The odds of having a disability were 0.85 times
lower for the high economic status group than for the low economic status group. Conclusion: Raising awareness to expand the capacity of social support for
older adults with disabilities, especially those who do not receive care from their
families, may be an urgent issue in Cambodia. Therefore, a well-designed and
disease-specific study is required. This study was the first to determine the
sociodemographic disparities among people with disabilities in Cambodia.
Collapse
Affiliation(s)
- Kanika Kep
- Sunrise Japan Hospital Phnom Penh, Cambodia
| | | | | | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Japan
| | - Manabu Okawada
- Department of Pediatrics, Sunrise Japan Hospital Phnom Penh, Cambodia
| |
Collapse
|
6
|
Wu H, Wu J, Zhang Z, Zheng Y, Niu W, Zheng L, Li J. Prevalence and Associated Risk Factors of Hypertension in Adults with Disabilities: A Cross-Sectional Study in Shanghai, China. Clin Epidemiol 2021; 13:769-777. [PMID: 34475784 PMCID: PMC8408044 DOI: 10.2147/clep.s322791] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/14/2021] [Indexed: 12/03/2022] Open
Abstract
Background Although hypertension is highly prevalent in China, epidemiologic data of hypertension among people with disabilities remain largely unknown. This study aims to examine the prevalence and associated risk factors of hypertension in patients with disabilities. Methods A cross-sectional study was carried out among 7348 adults with disabilities from February to December 2018 in Shanghai, and patient data from physical, imageological and routine blood examinations were collected and analyzed. Logistic regression models were performed to determine the associated risk factors of hypertension in adults with disabilities. Results Among the 7348 disabled patients, the prevalence of hypertension, rate of receiving treatment, and blood pressure control were 42.5%, 85.0% and 46.0%, respectively. Increases in the levels of age, physical disability, body mass index (BMI), fasting plasma glucose (FBG), total triglyceride (TG), hyperuricemia (hyper-UA), serum urea (SU), and estimated creatinine clearance (eCrCl <80 μmol/L) were independently correlated with hypertension. Conclusion Patients with physical disabilities have a significantly higher prevalence of hypertension compared to the normal population. Patients with intellectual or mental disabilities have lower rates of blood pressure control compared to other types of disabilities. Assessment of associated risk factors highlights an increased likelihood of potential renal dysfunction among hypertensive disabled patients.
Collapse
Affiliation(s)
- Hengjing Wu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Jing Wu
- Department of Fundamental Nursing, School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, People's Republic of China
| | - Ziyan Zhang
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Yongtao Zheng
- Department of Infectious Disease, Xiaoshan Center for Disease Control and Prevention, Hangzhou, People's Republic of China
| | - Wenxin Niu
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Liang Zheng
- Research Center for Translational Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Jue Li
- Clinical Center for Intelligent Rehabilitation Research, Shanghai YangZhi Rehabilitation Hospital (Shanghai Sunshine Rehabilitation Center), School of Medicine, Tongji University, Shanghai, People's Republic of China
| |
Collapse
|
7
|
Córdoba J, Bagnato MJ. Characterization of People with Functional Limitations from ICF Components Using the Longitudinal Social Protection Survey (ELPS) of Uruguay. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158012. [PMID: 34360305 PMCID: PMC8345411 DOI: 10.3390/ijerph18158012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022]
Abstract
Characterising people with disabilities at the population level using the ICF approach is a challenge, as it implies that researchers are able to identify variables that can account for the components that make up the multidimensional definition of disability. The purpose of this study is to generate updated information on disability in Uruguay, as there has been no in-depth analysis of how this population lives, how they access the services and benefits that affect their quality of life, and what the significant differences are between those who make up this population. A quantitative analysis was applied to the target population, consisting of participants in the Longitudinal Survey of Social Protection (2016) who reported at least one limitation in performing ADLs and who were in the age range of 18–64 years. Significant differences were found between the different groups in terms of their reported limitations in relation to obtaining necessary services due to their health condition, dropping out of education before completing the compulsory level, low labour market insertion, feelings of loneliness, and low participation. More research needs to be done as it is clear that people with disabilities do not have access to the support they need, which leads to even greater exclusion.
Collapse
|
8
|
Wang X, Sun M, Li X, Lu J, Chen G. Effects of Disability Type on the Association between Age and Non-Communicable Disease Risk Factors among Elderly Persons with Disabilities in Shanghai, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155426. [PMID: 32731459 PMCID: PMC7432529 DOI: 10.3390/ijerph17155426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/20/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022]
Abstract
Little is known about differences in the association between age and risk factors of non-communicable diseases (NCDs), according to the disability type in Chinese elderly persons with disabilities. Thus, we examined the effects of these differences in elderly persons with disabilities in Shanghai, China. We evaluated four NCD risk factors (hypertension, hyperglycemia, hyperlipidemia, and overweight) using health data obtained from 20,471 elderly persons with disabilities in 2017. Logistic regression analyses explored differences in the association between age and NCD risk factors according to the disability types, after adjusting for sociodemographic characteristics. We observed significant differences in the association between age and NCD risk factors across disability types; a significant association was observed between older age and higher odds of hypertension (p < 0.001) among subjects with a physical disability. However, the prevalence of hypertension did not significantly differ by age in subjects with multiple disabilities. Interventions for elderly patients whose disabilities are more strongly affected by environmental factors should focus more on reduction of subjects’ barriers to activities through improvements in living and environmental adaptability for physical activities.
Collapse
Affiliation(s)
- Xichen Wang
- Department of Health Law and Health Inspection, School of Public Health, Fudan University, Shanghai 200032, China;
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
| | - Mei Sun
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
| | - Xiaohong Li
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
| | - Jun Lu
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
- Correspondence: (J.L.); (G.C.)
| | - Gang Chen
- Department of Health Law and Health Inspection, School of Public Health, Fudan University, Shanghai 200032, China;
- China Research Center on Disability Issues at Fudan University, Shanghai 200032, China; (M.S.); (X.L.)
- Correspondence: (J.L.); (G.C.)
| |
Collapse
|
9
|
Ge T, Zhang Q, Lu J, Chen G, Sun M, Li X. Association between education and health outcomes among adults with disabilities: evidence from Shanghai, China. PeerJ 2019; 7:e6382. [PMID: 30809431 PMCID: PMC6385680 DOI: 10.7717/peerj.6382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/01/2019] [Indexed: 01/15/2023] Open
Abstract
Background Adults with disabilities often have worse health outcomes than do their peers without disabilities. While education is a key determinant of health, there is little research available on the health disparities across education levels among adults with disabilities in developing countries. We therefore examined the association between health outcomes and education among adults with disabilities in Shanghai, China. Methods We used the health examination records of 42,715 adults with disabilities in Shanghai in 2014. Five health outcomes, including two diseases (fatty liver and hemorrhoids) and three risk factors (overweight [body mass index ≥ 24]), high blood glucose, and high blood lipid), were evaluated. Descriptive statistics and Pearson’s chi-square test were used to assess differences in participants’ demographic and disability characteristics. Pearson’s chi-square test and Fisher’s exact test were conducted to compare the prevalence of each health outcome among the different education levels. Finally, logistic regression analyses were conducted to explore the association between education and health outcomes after adjusting for sociodemographic characteristics. Results People with an elementary school or lower degree had the highest prevalence of overweight (52.1%) and high blood glucose (20.8%), but the lowest prevalence of hemorrhoids (18.6%) and fatty liver (38.9%). We observed significant differences in the association between education and health outcomes across disability types. For example, in physically disabled adults, higher education was related to higher odds of hemorrhoids (p < 0.001); however, there were no significant disparities in hemorrhoids across the education levels among adults with intellectual disabilities. Discussion Compared with people without disabilities, adults with disabilities in Shanghai have relatively poor health. The association between education and health outcomes differed according to the health condition and disability type. To reduce the prevalence rate of overweight and high blood glucose among people with disabilities, tailored health promotion initiatives must be developed for people with lower education levels. In contrast, specific attention should be paid to the prevention of hemorrhoids and fatty liver among more-educated people with disabilities. Our study provides important evidence for targeting educational groups with specific disability types for health promotion and intervention.
Collapse
Affiliation(s)
- Tong Ge
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, United States of America
| | - Jun Lu
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Gang Chen
- China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China.,Department of Health Law and Health Inspection/ School of Public Health, Fudan University, Shanghai, China
| | - Mei Sun
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| | - Xiaohong Li
- Department of Health Policy and Management/ School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Fudan University, Shanghai, China.,Key Laboratory of Health Technology Assessment, National Health and Family Planning Committee (Fudan University), Fudan University, Shanghai, China
| |
Collapse
|
10
|
Zhang Y, Chen G, Zhang Q, Lu J, Yu H. Gender disparities in the association between socio-demographics and non-communicable disease risk factors among adults with disabilities in Shanghai, China. PeerJ 2018; 6:e4505. [PMID: 29576973 PMCID: PMC5855884 DOI: 10.7717/peerj.4505] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 02/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background Non-communicable disease (NCD) risk factors can co-exist with disability and cause a greater burden on the health status of adults with disabilities. A lack of egalitarian social policies in China may result in gender disparities in the NCD risk factors of adults with disabilities. However, little is known about the gender disparities in the association between socio-demographics and NCD risk factors among adults with disabilities in China; consequently, we examined this association among adults with disabilities in Shanghai, China. Methods We used the health examination data of 44,896 adults with disabilities in Shanghai in 2014. Descriptive analyses and logistic regression models were conducted to estimate gender disparities in the association between socio-demographics, disability characteristics, and four selected NCD risk factors among adults with disabilities—including high blood pressure, high blood glucose, high blood lipids, and being overweight. We estimated marginal effects (MEs) on NCD risk factors between gender and other confounders. Results Women with disabilities were about 11.6 percentage points more likely to suffer from high blood lipids and less likely to develop the other three risk factors than men were. The association of age group, residence permit, education level, marital status, and disability type with health outcomes varied by gender among adults with disabilities. The difference in age effects between men and women was more pronounced in older age groups. Urban residence was associated with less risk of high blood pressure risk among women (ΔME = − 0.035, p < 0.01), but no significant difference in other NCD risk factors. Education remained a major protective factor against high blood pressure, high blood glucose and being overweight among women with disabilities (MEs < 0, p < 0.05); however, this did not hold for men. The difference in marriage effects between men and women was observed in high blood lipids (ΔME = − 0.048 for the married group and −0.054 for the divorced or widowed group) and overweight individuals (ΔME = − 0.091 for the married group and −0.114 for the divorced or widowed group). Women with intellectual disabilities or mental disabilities reported worse health conditions than men did. Discussion Preventive strategies and interventions on NCD risk factors for adults with disabilities should take into account gender disparities in these socio-demographic effects. Rural women or poorly educated women with disabilities can be a vulnerable population that requires more health education and promotion strategies. Health education for caregivers of women with intellectual or mental disabilities may also play a vital role in preventing their NCD risk factors.
Collapse
Affiliation(s)
- Youran Zhang
- Department of Health Law and Health Inspection, School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Shanghai, China
| | - Gang Chen
- Department of Health Law and Health Inspection, School of Public Health, Fudan University, Shanghai, China.,China Research Center on Disability Issues at Fudan University, Shanghai, China
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, United States of America
| | - Jun Lu
- China Research Center on Disability Issues at Fudan University, Shanghai, China
| | - Huijiong Yu
- Department of Rehabilitation, Shanghai Disabled Persons' Federation, Shanghai, China
| |
Collapse
|