%0 Journal Article %J European Journal of Public Health %D 2019 %T Contribution of chronic conditions to disability in men and women in France %A Nusselder, Wilma J %A Dagmar Wapperom %A Looman, Caspar W N %A Renata T C Yokota %A Herman Van Oyen %A Jagger, Carol %A Jean Marie Robine %A Emanuelle M Cambois %K chronic diseases %K disabilty %K GALI %K Global activity limitation Indicator %X

Background: Women report more disability than men perhaps due to gender differences in the prevalence of diseases and/or in their disabling impact. We compare the contribution of chronic diseases to disability in men and women in France, using a disability survey conducted in both private households and institutions, and we also examine the effect of excluding the institutionalized population.

Methods: Data comprised 17 549 individuals age 50+, who participated in the 2008–09 French Disability Health Survey including people living in institutions. Disability was defined by limitations in activities people usually do due to health problems (global activity limitation indicator). Additive regression models were fitted separately by gender to estimate the contribution of conditions to disability taking into account multi-morbidity.

Results: Musculoskeletal diseases caused most disability for both men (10.1%, CI: 8.1–12.0) and women (16.0%, CI 13.6–18.2). The second contributor for men was heart diseases (5.7%, CI: 4.5–6.9%), and for women anxiety-depression (4.0, CI 3.1–5.0%) closely followed by heart diseases (3.8%, CI 2.9–4.7%). Women’s higher contribution of musculoskeletal diseases reflected their higher prevalence and disabling impact; women’s higher contribution of anxiety-depression and lower contributions of heart diseases reflected gender differences in prevalence. Excluding the institutionalized population did not change the overall conclusions.

Conclusions: The largest contributors to the higher disability of women than men are moderately disabling conditions with a high prevalence. Whereas traditional disabling conditions such as musculoskeletal diseases are more prevalent and disabling in women, fatal diseases such as cardiovascular disease are also important contributors in women and men.

%B European Journal of Public Health %V 29 %8 02/2019 %G eng %N 1 %& 99 %R 10.1093/eurpub/cky138 %0 Journal Article %J European Journal of Public Health %D 2019 %T Contribution of chronic conditions to gender disparities in health expectancies in Belgium, 2001, 2004 and 2008 %A Renata T C Yokota %A Nusselder, Willma J %A Robine, Jean-Marie %A Jean Tafforeau %A Françoise Renard %A Deboosere, Patrick %A Herman Van Oyen %K chronic diseases %K DISABILITY %K Gender %K HEALTH EXPECTANCY %K inequality %K trend %X

Background: We aimed to investigate the contribution of chronic conditions to gender differences in disability- free life expectancy (DFLE) and life expectancy with disability (LED) in Belgium in 2001, 2004 and 2008.

Methods: Data on disability and chronic conditions from participants of the 2001, 2004 and 2008 Health Interview Surveys in Belgium were used to estimate disability prevalence by cause using the attribution method. Disability prevalence was applied to life tables to estimate DFLE and LED using the Sullivan method. Decomposition techniques were used to assess the contribution of mortality and disability and further of causes of death and disability to gender disparities in DFLE and LED.

Results: Higher LE, DFLE and LED were observed for women compared with men in all years studied. A decrease in the gender gap in LE (2001: 5.9; 2004: 5.6; 2008: 5.3) was observed in our cross- sectional approach followed by a decrease in gender differences in DFLE (2001: 1.9; 2004: 1.3; 2008: 0.5) and increase in LED (2001: 4.0; 2004: 4.4; 2008: 4.8). The higher LED in women was attributed to their lower mortality due to lung/larynx/trachea cancer, ischaemic heart diseases, and external causes (2001 and 2004) and higher disability prevalence due to musculoskeletal conditions (2008). Higher DFLE was observed in women owing to their lower mortality from lung/larynx/trachea cancer, ischaemic heart diseases, digestive cancer and chronic re- spiratory diseases.

Conclusion: To promote healthy ageing of populations, priority should be given to reduce the LED disadvantage in women by targeting non-fatal diseases, such as musculoskeletal conditions.

%B European Journal of Public Health %V 29 %8 2/2019 %G eng %N 1 %& 82 %R 10.1093/eurpub/cky105 %0 Journal Article %J Archives of Public Health %D 2019 %T Contribution of chronic diseases to educational disparity in disability in France: results from the cross-sectional “disability-health” survey %A Clémence Palazzo %A Renata T C Yokota %A Jean Tafforeau %A François Ravaud %A Cambois, Emmanuelle %A Serge Poiraudeau %A Herman Van Oyen %A Wilma J. Nusselder %K attribution method %K chronic diseases %K DISABILITY %K educational attainment %K GALI %K Global activity limitation Indicator %K Socioeconomic status %X

Background

This study aimed 1) to assess whether the contribution of chronic conditions to disability varies according to the educational attainment, 2) to disentangle the contributions of the prevalence and of the disabling impact of chronic conditions to educational disparities.

Methods

Data of the 2008–09 Disability Health Survey were examined (N = 23,348). The disability indicator was the Global Activity Limitation Indicator (GALI). The attribution method based on an additive hazard model was used to estimate educational differences in disabling impacts and in the contributions of diseases to disability. Counterfactual analyses were used to disentangle the contribution of differences in disease prevalence vs. disabling impact.

Results

In men, the main contributors to educational difference in disability prevalence were arthritis (contribution to disability prevalence: 5.7% (95% CI 5.4–6.0) for low-educated vs. 3.3% (3.0–3.9) for high-educated men), spine disorders (back/neck pain, deformity) (3.8% (3.6–4.0) vs. 1.9% (1.8–2.1)), chronic obstructive pulmonary diseases (2.4% (2.3–2.6) vs. 0.6% (0.5–0.7)) and ischemic heart /peripheral artery diseases (4.1% (3.9–4.3) vs. 2.4% (2.2–3.0)). In women, arthritis (9.5% (9.1–9.9) vs. 4.5%, (4.1–5.2)), spine disorders (4.5% (4.3–4.7) vs. 2.1% 1.9–2.3) and psychiatric diseases (3.1% (3.0–3.3) vs. 1.1% (1.0–1.3)) contributed most to education gap in disability. The educational differences were equally explained by differences in the disease prevalence and in their disabling impact.

Conclusions

Public health policies aiming to reduce existing socioeconomic disparities in disability should focus on musculoskeletal, pulmonary, psychiatric and ischemic heart diseases, reducing their prevalence as well as their disabling impact in lower socioeconomic groups.

%B Archives of Public Health %V 77 %8 Jan-12-2019 %G eng %& 2 %R 10.1186/s13690-018-0326-9 %0 Journal Article %J European Journal of Public Health %D 2019 %T Women’s excess unhealthy life years: disentangling the unhealthy life years gapAbstractBackgroundMethodsResultsConclusion %A Nusselder, Wilma J %A Emmanuelle M Cambois %A Dagmar Wapperom %A France Meslé %A Looman, Caspar W N %A Renata T C Yokota %A Herman Van Oyen %A Carrol Jagger %A Jean Marie Robine %K composite health measures %K GALI %K gender inequality %K Healthy Life Years %K HLY %X

Background: Compared to men, women live longer but have more years with disability. We assessed the contribution of gender differences in mortality and disability, total and by cause, to women’s excess unhealthy life years (ULYs).

Methods: We used mortality data for France 2008 from Eurostat, causes of death from the CépiDc-INSERM database; and disability and chronic conditions data from the French Disability Health Survey 2008–09. ULYs were calculated by the Sullivan method. The contributions of mortality and disability differences to gender differences in ULY were based on decomposition analyses.

Results: Life expectancy of French women aged 50 was 36.3 years of which 19.0 were ULYs; life expectancy of men was 30.4 years of which 14.2 were ULYs. Of the 4.8 excess ULYs in women, 4.0 years were due to lower mortality. Of these 4.0 ULYs, 1.8 ULY originated from women’s lower mortality from cancer, 0.8 ULY from heart disease and 0.3 ULY from accidents. The remaining 0.8 excess ULY in women were from higher disability prevalence, including higher disability from musculoskeletal diseases (+1.8 ULY) and anxiety-depression (+0.6 ULY) partly offset by lower disability from heart diseases (_0.8 ULY) and accidents (_0.3 ULY). Conclusion: Lower mortality and higher disability prevalence contributed to women’s longer life expectancy with disability. Women’s higher disability prevalence due to non-fatal disabling conditions was partly offset by lower disability from heart disease and accidents. Conditions differentially impact gender differences in ULY, depending on whether they are mainly life-threatening or disabling.

The conclusions confirm the health-survival paradox.

%B European Journal of Public Health %8 May-07-2019 %G eng %R 10.1093/eurpub/ckz114 %0 Journal Article %J R Journal %D 2018 %T addhaz: Contribution of Chronic Diseases to the Disability Burden Using R. %A Renata T C Yokota %A Looman, Caspar W N %A Nusselder, Wilma J %A Herman Van Oyen %A Molenberghs, Geert %K addhaz %K attribution method %K Chronic disease %K DISABILITY %K morbidity %K mortality %K R package %X

The increase in life expectancy followed by the burden of chronic diseases contributes to disability at older ages. The estimation of how much chronic conditions contribute to disability can be useful to develop public health strategies to reduce the burden. This paper introduces the R package addhaz, which is based on the attribution method (Nusselder and Looman, 2004) to partition disability into the additive contributions of diseases using cross-sectional data. The R package includes tools to fit the additive hazard model, the core of the attribution method, to binary and multinomial outcomes. The models are fitted by maximizing the binomial and multinomial log-likelihood functions using constrained optimization. Wald and bootstrap confidence intervals can be obtained for the parameter estimates. Also, the contribution of diseases to the disability prevalence and their bootstrap confidence intervals can be estimated. An additional feature is the possibility to use parallel computing to obtain the bootstrap confidence intervals. In this manuscript, we illustrate the use of addhaz with several examples for the binomial and multinomial models, using the data from the Brazilian National Health Survey, 2013

%B R Journal %V 10/2 %8 12/2018 %@ 2073-4859 %G eng %N 55 %& 1 %0 Journal Article %J European Journal of Public Health %D 2018 %T Contribution of chronic conditions to disability in men and women in France %A Nusselder, Wilma J %A Dagmar Wapperom %A Looman, Caspar W N %A Renata T C Yokota %A Herman Van Oyen %A Jagger, Carol %A Jean Marie Robine %A Emanuelle M Cambois %B European Journal of Public Health %8 Sep-08-2018 %G eng %R 10.1093/eurpub/cky138 %0 Journal Article %J European Journal of Public Health %D 2018 %T Contribution of chronic conditions to gender disparities in health expectancies in Belgium, 2001, 2004 and 2008 %A Renata T C Yokota %A Nusselder, Willma J %A Robine, Jean-Marie %A Jean Tafforeau %A Françoise Renard %A Deboosere, Patrick %A Herman Van Oyen %K causes of death %K causes of morbidity %K DISABILITY %K Gender %K HEALTH EXPECTANCY %K inequity %K Life expectancy %X

Background

We aimed to investigate the contribution of chronic conditions to gender differences in disability-free life expectancy (DFLE) and life expectancy with disability (LED) in Belgium in 2001, 2004 and 2008.

Methods

Data on disability and chronic conditions from participants of the 2001, 2004 and 2008 Health Interview Surveys in Belgium were used to estimate disability prevalence by cause using the attribution method. Disability prevalence was applied to life tables to estimate DFLE and LED using the Sullivan method. Decomposition techniques were used to assess the contribution of mortality and disability and further of causes of death and disability to gender disparities in DFLE and LED.

Results

Higher LE, DFLE and LED were observed for women compared with men in all years studied. A decrease in the gender gap in LE (2001: 5.9; 2004: 5.6; 2008: 5.3) was observed in our cross-sectional approach followed by a decrease in gender differences in DFLE (2001: 1.9; 2004: 1.3; 2008: 0.5) and increase in LED (2001: 4.0; 2004: 4.4; 2008: 4.8). The higher LED in women was attributed to their lower mortality due to lung/larynx/trachea cancer, ischaemic heart diseases, and external causes (2001 and 2004) and higher disability prevalence due to musculoskeletal conditions (2008). Higher DFLE was observed in women owing to their lower mortality from lung/larynx/trachea cancer, ischaemic heart diseases, digestive cancer and chronic respiratory diseases.

Conclusion

To promote healthy ageing of populations, priority should be given to reduce the LED disadvantage in women by targeting non-fatal diseases, such as musculoskeletal conditions.

%B European Journal of Public Health %8 Mar-06-2019 %G eng %R 10.1093/eurpub/cky105 %0 Journal Article %J European Journal of Public Health %D 2018 %T Contribution of chronic conditions to smoking differences in life expectancy with and without disability in Belgium %A Renata T C Yokota %A Nusselder, Willma J %A Robine, Jean-Marie %A Jean Tafforeau %A Rana Charafeddine %A Lydia Gisle %A Deboosere, Patrick %A Herman Van Oyen %K Chronic disease %K disabilities %K Disability-free life expectancy %K HEALTH EXPECTANCY %K Life expectancy %K mortality %K SMOKING %X

Background

Smoking is the leading cause of premature mortality and morbidity. This study aimed at assessing the impact of smoking on life expectancy (LE) and LE with (LED) and without disability (DFLE). We further estimated the contribution of disability and mortality and their causes to differences in LED and DFLE by smoking.

Methods

Data on disability, chronic conditions, and smoking from 17 148 participants of the 1997, 2001, 2004 Belgian Health Interview Surveys were used to estimate causes of disability using the attribution method. A 10-year mortality follow-up of survey participants was used. The Sullivan method was applied to estimate LED and DFLE. The contribution of disability and mortality and of causes of disability and death to smoking differences in LED and DFLE was assessed using decomposition methods.

Results

Never smokers live longer than daily smokers. DFLE advantage at age 15 of +8.5/+4.3 years (y) in men/women never compared with daily smokers was the result of lower mortality (+6.2y/+3y) and lower disability (2.3y/1.3y). The extra 0.3y/1.6y LED in never smokers was due to lower mortality (+2.6y/+2.9y) and lower disability (−2.3y/−1.3y). Lower mortality from lung/larynx/trachea cancer, chronic respiratory, and ischaemic heart diseases was the main contributor to higher LED and DFLE in never smokers. Lower disability from musculoskeletal conditions in men and chronic respiratory diseases in women increased LED and DFLE in never smokers.

Conclusions

Mortality and disability advantage among never smokers contributed to longer DFLE, while mortality advantage contributed to their longer LED.

%B European Journal of Public Health %V 28 %8 Dec-06-2018 %G eng %N 5 %R 10.1093/eurpub/cky101 %0 Journal Article %J Arch Public Health %D 2018 %T Measuring disability: a systematic review of the validity and reliability of the Global Activity Limitations Indicator (GALI). %A Herman Van Oyen %A Petronille Bogaert %A Renata T C Yokota %A Nicolas Berger %X

Background: GALI or Global Activity Limitation Indicator is a global survey instrument measuring participation restriction. GALI is the measure underlying the European indicator Healthy Life Years (HLY). Gali has a substantial policy use within the EU and its Member States. The objective of current paper is to bring together what is known from published manuscripts on the validity and the reliability of GALI.

Methods: Following the PRISMA guidelines, two search strategies (PUBMED, Google Scholar) were combined to identify manuscripts published in English with publication date 2000 or beyond. Articles were classified as reliability studies, concurrent or predictive validity studies, in national or international populations.

Results: Four cross-sectional studies (of which 2 international) studied how GALI relates to other health measures (concurrent validity). A dose-response effect by GALI severity level on the association with the other health status measures was observed in the national studies. The 2 international studies (SHARE, EHIS) concluded that the odds of reporting participation restriction was higher in subjects with self-reported or observed functional limitations. In SHARE, the size of the Odds Ratio's (ORs) in the different countries was homogeneous, while in EHIS the size of the ORs varied more strongly. For the predictive validity, subjects were followed over time (4 studies of which one international). GALI proved, both in national and international data, to be a consistent predictor of future health outcomes both in terms of mortality and health care expenditure. As predictors of mortality, the two distinct health concepts, self-rated health and GALI, acted independently and complementary of each other. The one reliability study identified reported a sufficient reliability of GALI.

Conclusion: GALI as inclusive one question instrument fits all conceptual characteristics specified for a global measure on participation restriction. In none of the studies, included in the review, there was evidence of a failing validity. The review shows that GALI has a good and sufficient concurrent and predictive validity, and reliability.

%B Arch Public Health %V 76 %8 2018 %G eng %R 10.1186/s13690-018-0270-8 %0 Journal Article %J International Journal of Epidemiology %D 2018 %T Methods to assess the contribution of diseases to disability using cross-sectional studies: comparison of different versions of the attributable fraction and the attribution method %A C. Palazzo %A Renata T C Yokota %A J. Ferguson %A Jean Tafforeau %A J.F. Ravaud %A Herman Van Oyen %A W.J. Nusselder %K attributable fraction %K attribution %K contribution %K DISABILITY %K Diseases %B International Journal of Epidemiology %8 Jan-01-2018 %G eng %R 10.1093/ije/dyy222 %0 Journal Article %J Biom J %D 2017 %T Multinomial additive hazard model to assess the disability burden using cross-sectional data. %A Renata T C Yokota %A Herman Van Oyen %A Looman, Caspar W N %A Nusselder, Wilma J %A Otava, Martin %A Kifle, Yimer Wasihun %A Molenberghs, Geert %K Chronic disease %K cross-sectional studies %K Disabled Persons %K Humans %K Proportional Hazards Models %K Quality of Life %K Risk Factors %X

Population aging is accompanied by the burden of chronic diseases and disability. Chronic diseases are among the main causes of disability, which is associated with poor quality of life and high health care costs in the elderly. The identification of which chronic diseases contribute most to the disability prevalence is important to reduce the burden. Although longitudinal studies can be considered the gold standard to assess the causes of disability, they are costly and often with restricted sample size. Thus, the use of cross-sectional data under certain assumptions has become a popular alternative. Among the existing methods based on cross-sectional data, the attribution method, which was originally developed for binary disability outcomes, is an attractive option, as it enables the partition of disability into the additive contribution of chronic diseases, taking into account multimorbidity and that disability can be present even in the absence of disease. In this paper, we propose an extension of the attribution method to multinomial responses, since disability is often measured as a multicategory variable in most surveys, representing different severity levels. The R function constrOptim is used to maximize the multinomial log-likelihood function subject to a linear inequality constraint. Our simulation study indicates overall good performance of the model, without convergence problems. However, the model must be used with care for populations with low marginal disability probabilities and with high sum of conditional probabilities, especially with small sample size. For illustration, we apply the model to the data of the Belgian Health Interview Surveys.

%B Biom J %V 59 %P 901-917 %8 2017 Sep %G eng %N 5 %1 https://www.ncbi.nlm.nih.gov/pubmed/28332222?dopt=Abstract %& 901 %R 10.1002/bimj.201600157 %0 Journal Article %J Int J Public Health %D 2016 %T Contribution of chronic conditions to gender disparities in disability in the older population in Brazil, 2013. %A Renata T C Yokota %A de Moura, Lenildo %A Silvânia Suely Caribé de Araújo Andrade %A Naíza Nayla Bandeira de Sá %A Nusselder, Wilma Johanna %A Herman Van Oyen %K Activities of daily living %K Aged %K Aged, 80 and over %K ARTHRITIS %K Back Pain %K Brazil %K Cardiovascular Diseases %K Chronic disease %K Diabetes Mellitus %K Disabled Persons %K Female %K Health Status Disparities %K health surveys %K Humans %K Male %K middle aged %K prevalence %K Sex Distribution %K Socioeconomic Factors %X

OBJECTIVES: To assess the contribution of chronic conditions to the disability burden in the older men and women in Brazil.

METHODS: Data from 10,290 participants of the Brazilian National Health Survey in 2013 aged 60 years or older were used. Disability was defined based on limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL). Binomial additive hazards models were fitted to assess the contribution of chronic conditions to the disability prevalence.

RESULTS: Back pain was the most common condition, followed by diabetes and heart diseases in men and arthritis and diabetes in women. Stroke and mental disorders were by far the most disabling conditions in men and women. A higher disability prevalence was observed in women (34.4 %, CI 32.4; 36.2 %) compared to men (28.4 %; CI 25.9; 30.8 %). The most important contributors to the disability prevalence were stroke, back pain, and arthritis among men, and diabetes, heart diseases, and arthritis in women.

CONCLUSIONS: Interventions to reduce disability in the older population in Brazil should take into account the gender gap in the occurrence of chronic conditions, focusing on the main contributors to the disability burden.

%B Int J Public Health %V 61 %P 1003-1012 %8 2016 Dec %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/27339159?dopt=Abstract %R 10.1007/s00038-016-0843-7 %0 Journal Article %J PLoS One %D 2016 %T Contribution of Chronic Conditions to the Disability Burden across Smoking Categories in Middle-Aged Adults, Belgium. %A Renata T C Yokota %A Nusselder, Wilma Johanna %A Robine, Jean-Marie %A Jean Tafforeau %A Deboosere, Patrick %A Herman Van Oyen %K Adult %K Belgium %K Chronic disease %K Disabled Persons %K Female %K Humans %K Male %K middle aged %K SMOKING %X

INTRODUCTION: Smoking is considered the single most important preventable cause of morbidity and mortality worldwide, contributing to increased incidence and severity of disabling conditions. The aim of this study was to assess the contribution of chronic conditions to the disability burden across smoking categories in middle-aged adults in Belgium.

METHODS: Data from 10,224 individuals aged 40 to 60 years who participated in the 1997, 2001, 2004, or 2008 Health Interview Surveys in Belgium were used. Smoking status was defined as never, former (cessation ≥2 years), former (cessation <2 years), occasional light (<20 cigarettes/day), daily light, and daily heavy (≥20 cigarettes/day). To attribute disability to chronic conditions, binomial additive hazards models were fitted separately for each smoking category adjusted for gender, except for former (cessation <2 years) and occasional light smokers due to the small sample size.

RESULTS: An increasing trend in the disability prevalence was observed across smoking categories in men (never = 4.8%, former (cessation ≥2 years) = 5.8%, daily light = 7.8%, daily heavy = 10.7%) and women (never = 7.6%, former (cessation ≥2 years) = 8.0%, daily light = 10.2%, daily heavy = 12.0%). Musculoskeletal conditions showed a substantial contribution to the disability burden in men and women across all smoking categories. Other important contributors were depression and cardiovascular diseases in never smokers; depression, chronic respiratory diseases, and diabetes in former smokers (cessation ≥2 years); chronic respiratory diseases, cancer, and cardiovascular diseases in daily light smokers; cardiovascular diseases and chronic respiratory diseases in men and depression and diabetes in women daily heavy smokers.

CONCLUSIONS: Beyond the well-known effect of smoking on mortality, our findings showed an increasing trend of the disability prevalence and different contributors to the disability burden across smoking categories. This information can be useful from a public health perspective to define strategies to reduce disability in Belgium.

%B PLoS One %V 11 %P e0153726 %8 2016 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/27105185?dopt=Abstract %R 10.1371/journal.pone.0153726 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2016 %T Impact of Chronic Conditions and Multimorbidity on the Disability Burden in the Older Population in Belgium. %A Renata T C Yokota %A Johan Van der Heyden %A Nusselder, Wilma Johanna %A Robine, Jean-Marie %A Jean Tafforeau %A Deboosere, Patrick %A Herman Van Oyen %K Activities of daily living %K Aged %K Aging %K Belgium %K Cardiovascular Diseases %K Chronic disease %K comorbidity %K Cost of Illness %K Disability Evaluation %K Female %K health surveys %K Humans %K Male %K middle aged %K Musculoskeletal Diseases %K prevalence %K Respiratory Tract Diseases %X

BACKGROUND: The increase in longevity along with a high prevalence of chronic conditions contribute to increased disability burden. Despite the high occurrence of multimorbidity observed in advanced ages, most studies are restricted to the investigation of individual diseases. In this study, we assessed the impact of chronic conditions and multimorbidity on the disability burden in the older population in Belgium.

METHODS: Data from 9,482 participants in the 2001, 2004, or 2008 Belgian Health Interview Surveys aged 55 years or older were analyzed. Disability was defined based on the Global Activity Limitation Indicator (GALI). To attribute disability to single chronic conditions and disease pairs, a multiple additive hazard model was fitted.

RESULTS: Musculoskeletal conditions (45.3%), chronic respiratory diseases (11.2%), and cardiovascular diseases (10.2%) diseases were the most frequent conditions. Cardiovascular diseases, the co-occurrence of chronic respiratory diseases and depression, neurological diseases, cancer, and the combination of diabetes and cardiovascular diseases were the top five disabling conditions. The disability prevalence in the older population in Belgium was 35.6% (confidence interval =35.0; 36.2%). The most important contributors to the disability burden were musculoskeletal, cardiovascular, and chronic respiratory diseases.

CONCLUSIONS: The present findings provide a deeper understanding of the role of chronic conditions and multimorbidity on the disability burden in the older population in Belgium. Although the disease pairs showed a low contribution to the disability burden, their occurrence presented a high impact on disability. Prevention strategies to tackle disability should target the main contributors to the disability burden and the most disabling conditions/disease pairs, especially in the clinical practice.

%B J Gerontol A Biol Sci Med Sci %V 71 %P 903-9 %8 2016 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/26774118?dopt=Abstract %R 10.1093/gerona/glv234 %0 Generic %D 2015 %T Contribution of chronic diseases to mild and severe disability burden in Belgium %A Renata T C Yokota %A Stefaan Demarest %A Johan Van der Heyden %A Jean Tafforeau %A W.J. Nusselder %A Deboosere,P. %A Herman Van Oyen %K Belgium %K burden %K chronic %K chronic condition %K Chronic disease %K chronic diseases %K Congresses %K contribution %K disabilities %K DISABILITY %K disease %K Diseases %K epidemiology %K European %K functional limitation %K Mild %K mobility %B European Congress of Epidemiology %C Maastricht %8 0/0/2015 %G eng %N / %1 38016 %2 / %R http://dx.doi.org/10.1186/s13690-015-0083-y %0 Journal Article %J BMC Public Health %D 2015 %T Contribution of chronic diseases to the disability burden in a population 15 years and older, Belgium, 1997-2008. %A Renata T C Yokota %A Nicolas Berger %A Nusselder, Wilma J %A Robine, Jean-Marie %A Jean Tafforeau %A Deboosere, Patrick %A Herman Van Oyen %K Activities of daily living %K ADOLESCENT %K Adult %K Aged %K Aged, 80 and over %K ARTHRITIS %K Belgium %K Chronic disease %K Cost of Illness %K cross-sectional studies %K Disabled Persons %K Female %K health surveys %K Humans %K Male %K middle aged %K Mobility Limitation %K Musculoskeletal Diseases %K prevalence %K Quality of Life %K Young adult %X

BACKGROUND: Age-associated disability reduces quality of life in older populations and leads to wide-range implications for social and health policy. The identification of diseases that contribute to the disability burden is crucial to the development of prevention and intervention strategies to reduce disability. In this study, we assessed the contribution of chronic diseases to the prevalence of disability in Belgium.

METHODS: Data from 35,837 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were used. Disability was defined as difficulties in doing at least one of six activities of daily living (transfer in and out of bed, transfer in and out of chair, dressing, washing hands and face, feeding, and going to the toilet) and/or mobility limitations (ability to walk without stopping less than 200 m). Multiple additive regression models were fitted separately for men and women to estimate the age-specific background disability rate (experienced by everyone, independent of the presence of specific diseases) and disease-specific disability rates (disability rate in subjects who reported selected chronic diseases).

RESULTS: Musculoskeletal, cardiovascular, and respiratory diseases were the main contributors to the disability burden in Belgium. Musculoskeletal diseases were the most prevalent diseases in men and women in all age groups. Neurological diseases and stroke were the most disabling diseases, i.e. caused the highest level of disability among the diseased individuals, in all age groups for men and women, respectively. Back pain was the main cause of disability in men aged 15 to 64 years, while heart attack was the major contributor to the disability prevalence in men aged 65 or older. Likewise, arthritis was the main cause of disability among women across all age groups. Depression was also an important contributor in young subjects (15-54 years). Cancer was not an important contributor to the disability prevalence in Belgium.

CONCLUSIONS: To reduce the burden of disability in Belgium, interventions should target musculoskeletal, cardiovascular and respiratory diseases especially among elderly. Furthermore, attention should also be given to depression in young individuals.

%B BMC Public Health %V 15 %P 229 %8 2015 Mar 07 %G eng %1 http://www.ncbi.nlm.nih.gov/pubmed/25879222?dopt=Abstract %R 10.1186/s12889-015-1574-z %0 Journal Article %J Arch Public Health %D 2015 %T Contribution of chronic diseases to the mild and severe disability burden in Belgium. %A Renata T C Yokota %A Johan Van der Heyden %A Stefaan Demarest %A Jean Tafforeau %A Nusselder, Willma J %A Deboosere, Patrick %A Herman Van Oyen %X

BACKGROUND: Population aging accompanied by an increased longevity with disability has raised international concern, especially due to its costs to the health care systems. Chronic diseases are the main causes of physical disability and their simultaneous occurrence in the population can impact the disablement process, resulting in different severity levels. In this study, the contribution of chronic diseases to both mild and severe disability burden in Belgium was investigated.

METHODS: Data on 21 chronic diseases and disability from 35,799 individuals aged 15 years or older who participated in the 1997, 2001, 2004, or 2008 Belgian Health Interview Surveys were analysed. Mild and severe disability were defined based on questions related to six activities of daily living and/or mobility limitations. To attribute disability by severity level to selected chronic diseases, multiple additive hazard models were fitted to each disability outcome, separately for men and women.

RESULTS: A stable prevalence of mild (5 %) and severe (2-3 %) disability was observed for the Belgian population aged 15 years or older between 1997 and 2008. Arthritis was the most important contributor in women with mild and severe disability. In men, low back pain and chronic respiratory diseases contributed most to the mild and severe disability burden, respectively. The contribution also differed by age: for mild disability, depression and chronic respiratory diseases were important contributors among young individuals, while heart attack had a large contribution for older individuals. For severe disability, neurological diseases and stroke presented a large contribution in young and elderly individuals, respectively.

CONCLUSIONS: Our results indicate that the assessment of the contribution of chronic diseases on disability is more informative if different levels of disability are taken into consideration. The identification of diseases which are related to different levels of disability - mild and severe - can assist policymakers in the definition and prioritisation of strategies to tackle disability, involving prevention, rehabilitation programs, support services, and training for disabled individuals.

%B Arch Public Health %V 73 %P 37 %8 2015 %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/26240753?dopt=Abstract %R 10.1186/s13690-015-0083-y %0 Generic %D 2015 %T Impact of smoking on the contribution of chronic diseases to the disability burden in Belgium, 1997-2008 %A Renata T C Yokota %A Johan Van der Heyden %A Jean Tafforeau %A W.J. Nusselder %A Robine,J.M. %A Herman Van Oyen %K 2001 %K 2004 %K 2008 %K a %K Activities of daily living %K Activity %K ADL %K age %K AGE GROUP %K AGE GROUPS %K Age-group %K Aged %K an %K ARTHRITIS %K AS %K Attack %K Back %K Back Pain %K Belgian %K Belgium %K burden %K cause %K chronic %K Chronic disease %K chronic diseases %K CI %K conditions %K conference %K contribution %K data %K dépression %K disabilities %K DISABILITY %K disease %K Diseases %K European %K function %K Gender %K Group %K hazard %K health %K health interview survey %K health interview surveys %K Heart %K heart attack %K Heart-attack %K HIS %K Impact %K incidence %K Increase %K Individuals %K Interview %K Interview survey %K IS %K limitation %K Limitations %K living %K Low Back Pain %K MEN %K method %K methods %K mobility %K Mobility Limitation %K MODEL %K models %K morbidity %K mortality %K Multiple %K older %K ON %K pain %K prevalence %K public %K public health %K Public-health %K relative %K Respiratory %K Respiratory disease %K respiratory diseases %K result %K results %K severity %K smokers %K SMOKING %K specific %K status %K Strategies %K Strategy %K study %K survey %K surveys %K top %K WHO %K WOMEN %K young %X Smoking is considered the single most important preventable cause of morbidity and mortality worldwide. Moreover, smoking can increase the incidence and severity of disabling conditions. In this study, the aim was to assess the impact of smoking on the contribution of chronic diseases to the disability burden in Belgium. %B European Public Health Conference %C Milan %8 0/10/2015 %G eng %N ? %1 38014 %2 18/06/2015 %0 Generic %D 2015 %T Major contributors to moderate and severe disability in Belgium %A Renata T C Yokota %K Belgium %K chronic condition %K conference %K Demography %K disabilities %K DISABILITY %K Functional status %B Demography Day Conference %C Antwerpen %8 0/0/2015 %G eng %N ? %1 38017 %2 ?