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Functional disability and social participation restriction associated with chronic conditions in middle-aged and older adults
  1. Lauren E Griffith1,
  2. Parminder Raina1,
  3. Mélanie Levasseur2,
  4. Nazmul Sohel1,
  5. Hélène Payette3,
  6. Holly Tuokko4,
  7. Edwin van den Heuvel5,
  8. Andrew Wister6,
  9. Anne Gilsing1,
  10. Christopher Patterson7
  1. 1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
  2. 2School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
  3. 3Research Center on Aging, CIUSSS de l’Estrie-CHUS, and Faculty of Medicine and Health Sciences Université de Sherbrooke, Sherbrooke, Quebec, Canada
  4. 4Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
  5. 5Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands
  6. 6Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
  7. 7Department of Medicine, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Lauren E Griffith, Department of Clinical Epidemiology and Biostatistics, MIP 309A, McMaster University, 175 Longwood Rd. S., Hamilton, ON L8P 0A1, Canada; griffith{at}


Background We examine the population impact on functional disability and social participation of physical and mental chronic conditions individually and in combination.

Methods Cross-sectional, population-based data from community-dwelling people aged 45 years and over living in the 10 Canadian provinces in 2008–2009 were used to estimate the population attributable risk (PAR) for functional disability in basic (ADL) and instrumental (IADL) activities of daily living and social participation restrictions for individual and combinations of chronic conditions, stratified by age and gender, after adjusting for confounding variables.

Results Five chronic conditions (arthritis, depression, diabetes, heart disease and eye disease) made the largest contributions to ADL-related and IADL-related functional disability and social participation restrictions, with variation in magnitude and ranking by age and gender. While arthritis was consistently associated with higher PARs across gender and most age groups, depression, alone and in combination with the physical chronic conditions, was associated with ADL and IADL disability as well as social participation restrictions in the younger age groups, especially among women. Compared to women, the combinations of conditions associated with higher PARs in men more often included heart disease and diabetes.

Conclusions Our findings suggest that in community-dwelling middle-aged and older adults, the impact of combinations of mental and physical chronic conditions on functional disability and social participation restriction is substantial and differed by gender and age. Recognising the differences in the drivers of PAR by gender and age group will ultimately increase the efficiency of clinical and public health interventions.

  • Functioning and disability
  • Social activities

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  • Contributors LEG and PR participated in study concept and design. PR undertook acquisition of subjects and/or data. All the authors participated in analysis and interpretation of data and preparation of the manuscript.

  • Funding LEG is supported by a CIHR New Investigator Award, PR holds a Tier 1 Canada Research Chair in Geroscience and the Raymond and Margaret Labarge Chair in Research and Knowledge Application for Optimal Aging. ML is a Fonds de la recherche du Québec en santé (FRQS) Junior 1 Researche.

  • Competing interests none declared

  • Ethics approval Hamilton Integrated Research Ethics Board at McMaster University.

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

  • Data sharing statement The manuscript was based on already available data sources from third parties that have been analysed to answer our research question.