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Modelling the association of disability according to the WHO International Classification of Functioning, Disability and Health (ICF) with mortality in the British Women's Heart and Health Study
  1. Caroline Dale1,
  2. David Prieto-Merino2,
  3. Hannah Kuper3,
  4. Joy Adamson4,
  5. Ann Bowling5,
  6. Shah Ebrahim1,6,
  7. Juan P Casas1,7
  1. 1Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
  2. 2Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK
  3. 3Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, UK
  4. 4Department of Health Sciences, University of York, UK
  5. 5Faculty of Health and Social Care Sciences, Kingston University and St George's, University of London, UK
  6. 6South Asia Network for Chronic Disease, Public Health Foundation of India, New Delhi, India
  7. 7Department of Epidemiology and Public Health, University College London, UK
  1. Correspondence to Caroline Dale, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK; caroline.dale{at}lshtm.ac.uk

Abstract

Background The WHO International Classification of Functioning, Disability and Health (ICF) is now the dominant model for exploring the social consequences of a health condition. This paper investigates the association of the different ICF disability domains with mortality.

Methods Data are from the British Women Heart and Health Study, a large (n=4157) prospectively studied cohort of women randomly selected from 23 towns aged 64–83 years in 2003. Scores were calculated to describe the cumulative load of impairments, limitations and restrictions within each ICF domain. Cox proportional hazards regression was used to calculate mortality HRs per unit score increase within each ICF domain. Adjustments were made for age, town, living status, socioeconomic status, lifestyle behaviours and health conditions.

Results Each ICF domain was associated with mortality after controlling for lifestyle factors and health conditions. However, only complex activities (HR=1.09, 95% CI 1.01 to 1.18) and participation (HR=1.10, 95% CI 1.04 to 1.16) were independent predictors of mortality following adjustment for all other disability domains and potential confounders.

Conclusions Results suggest that difficulties with complex activities or social participation could be used to identify and target women at high risk of dying. Interventions to facilitate complex activities or improve social participation may help to delay mortality in elderly women.

  • Disability
  • mortality
  • elderly
  • social participation
  • WHO-ICF
  • epidemiology
  • addictive behaviour/addiction
  • ageing
  • alcohol
  • heart disease
  • genetic epidemiology
  • developing country
  • coronary heart disease
  • stroke
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Footnotes

  • Caroline Dale, David Prieto-Merino contributed equally to this work.

  • Funding The British Women Heart and Health Study is supported by grants from the British Heart Foundation (EPNCCD08) and the Department of Health (009/0049). The funders had no role in the study design; in the collection, analysis and interpretation of the data; in the writing of the report or in the decision to submit the paper for publication.

  • Competing interests None.

  • Ethics approval This study was approved by London School of Hygiene & Tropical Medicine Ethics Committee and 23 Local Research Ethics Committees.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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