Respective Contribution of Chronic Conditions to Disability in France: Results from the National Disability-Health Survey

Abstract

BackgroundRepresentative national data on disability are becoming increasingly important in helping policymakers decide on public health strategies. We assessed the respective contribution of chronic health conditions to disability for three age groups (18–40, 40–65, and >65 years old) using data from the 2008–2009 Disability-Health Survey in France.MethodsData on 12 chronic conditions and on disability for 24,682 adults living in households were extracted from the Disability-Health Survey results. A weighting factor was applied to obtain representative estimates for the French population. Disability was defined as at least one restriction in activities of daily living (ADL), severe disability as the inability to perform at least one ADL alone, and self-reported disability as a general feeling of being disabled. To account for co-morbidities, we assessed the contribution of each chronic disorder to disability by using the average attributable fraction (AAF).FindingsWe estimated that 38.8 million people in France (81.7% [95% CI 80.9;82.6]) had a chronic condition: 14.3% (14.0;14.6) considered themselves disabled, 4.6% (4.4;4.9) were restricted in ADL and 1.7% (1.5;1.8) were severely disabled. Musculoskeletal and sensorial impairments contributed the most to self-reported disability (AAF 15.4% and 12.3%). Neurological and musculoskeletal diseases had the largest impact on disability (AAF 17.4% and 16.4%, respectively). Neurological disorders contributed the most to severe disability (AAF 31.0%). Psychiatric diseases contributed the most to disability categories for patients 18–40 years old (AAFs 23.8%–40.3%). Cardiovascular conditions were also among the top four contributors to disability categories (AAFs 8.5%–11.1%).ConclusionsNeurological, musculoskeletal, and cardiovascular chronic disorders mainly contribute to disability in France. Psychiatric impairments have a heavy burden for people 18–40 years old. These findings should help policymakers define priorities for health-service delivery in France and perhaps other developed countries.

The population impact of rheumatic and musculoskeletal diseases in relation to other non-communicable disorders: comparing two estimation approaches

“…Our findings regarding disability are also in accordance with previous studies, both at the individual and population levels [2,3], reporting that participants with RMDs have a higher risk of long-term disability, as well as an increased risk of activity limitations [20]. Moreover, having a RMD in co-occurrence with other conditions seems to worsen daily functioning [21], which is sustained by our empirical approach.…”

“…Despite their well-known association with a wide scope of adverse health outcomes [2][3][4][5], the comparative burden of RMDs at the populationlevel in relation to other NCDs is insufficiently explored, probably because they have a low case-fatality.…”

“…Additionally, multimorbidity might lead to the overestimation of the burden of each individual NCD [11]. Despite this well-known problem, several studies attempt to isolate independent effects of each disease through standard multivariate adjustment, which may not provide a realistic depiction of the multimorbidity burden [2,3].…”

The burden of osteoarthritis: development and validation of a new assessment tool (BONe’S)

“…The burden of osteoarthritis: development and validation of a new assessment tool (BONe'S) Introduction Osteoarticular diseases, specifically osteoarthritis (OA), represent chronic conditions that have the highest impact on patient health-related quality of life (HRQoL) 1,2 . Indeed, data from the 2008-2009 Disability-Health Survey in France show that musculoskeletal impairments contributed the most to selfreported disability and musculoskeletal diseases had the second largest impact on disability 1 .…”

“…Indeed, data from the 2008-2009 Disability-Health Survey in France show that musculoskeletal impairments contributed the most to selfreported disability and musculoskeletal diseases had the second largest impact on disability 1 . From a societal perspective, OA is also associated with significant economic burden 3 .…”