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The association between disability and poverty has been noted intuitively, although there is little systematic evidence to support this claim, mainly due to a lack of quality data on disability. This paper attempts to fill a knowledge gap on disability and poverty in developing countries by using a unique data set, the World Health Survey, which has comparable measures of disability and economic indicators for working age population in 15 developing countries. Disability is significantly associated with higher multidimensional poverty in most of the developing countries under study. At the individual level, in most of the countries included in the study, persons with disabilities have lower educational attainment and experience lower employment rates than persons without disabilities. At the household level, in most countries households with disabilities are not worse off when their well-being is measured by mean non-health PCE. However, in most countries, households with disabilities have a significantly lower mean asset index and report spending a higher proportion of their expenditure on health care.

Integrating equity components into the monitoring of disability trends would help ensure that interventions reach and benefit populations with greatest need.

IntroductionWomen represent a growing proportion of older people and experience increasing disability in their longer lives. Using a universally agreed definition of disability based on the International Classification of Functioning, Disability and Health, this paper examines how, apart from age, social and economic factors contribute to disability differences between older men and women.MethodsWorld Health Survey data were analyzed from 57 countries drawn from all income groups defined by the World Bank. The final sample comprises 63638 respondents aged 50 and older (28568 males and 35070 females). Item Response Theory was applied to derive a measure of disability which ensured cross country comparability. Individuals with scores at or above a threshold score were those who experienced significant difficulty in their everyday lives, irrespective of the underlying etiology. The population was then divided into “disabled” vs. “not disabled”. We firstly computed disability prevalence for males and females by socio-demographic factors, secondly used multiple logistic regression to estimate the adjusted effects of each social determinant on disability for males and females, and thirdly used a variant of the Blinder-Oaxaca decomposition technique to partition the measured inequality in disability between males and females into the “explained” part that arises because of differences between males and females in terms of age and social and economic characteristics, and an “unexplained” part attributed to the differential effects of these characteristics.ResultsPrevalence of disability among women compared with men aged 50+ years was 40.1% vs. 23.8%. Lower levels of education and economic status are associated with disability in women and men. Approximately 45% of the sex inequality in disability can be attributed to differences in the distribution of socio-demographic factors. Approximately 55% of the inequality results from differences in the effects of the determinants.ConclusionsThere is an urgent need for data and methodologies that can identify how social, biological and other factors separately contribute to the health decrements facing men and women as they age. This study highlights the need for action to address social structures and institutional practices that impact unfairly on the health of older men and women.