Association of disability with mortality in the Spanish adult non-institutionalized population

Abstract

Background. There is limited information about the association between disability and all-cause and cause-specific mortality among community-dwelling adults. Methods. We used baseline data from 162,381 adults who participated in a countrywide disability survey in 2008. A nationally representative sample was selected and interviewed in their homes. We present data on people aged 18 or over. Disability was considered as any substantial limitation found on a list of 44 life activities that have lasted or are expected to last more than 1 year and originate from an impairment. Cause-specific mortality data were obtained from the Spanish Statistical Office. Subjects contributed follow-up time from their baseline interview until death or the censoring date of 31stDecember 2017. We computed standardized rate ratios, with age, sex, living with a partner, and education level distribution of the total group as the standard population. Results. Adults with disability (11%) had an adjusted mortality rate more than twice as high as adults without disability [standardized rate ratio (SRR) (95% confidence interval): 2.37 (2.24-2.50)]. A clear higher mortality risk remained over 10-year follow-up. Mortality due to diseases of the nervous system [SRR 4.86 (3.93-6.01)], diseases of the musculoskeletal system [SRR 3.45 (2.18-5.47)], infectious diseases [SRR 3.38 (2.27-5.01)] and diabetes mellitus [SRR 3.56 (2.71-4.68)] was particularly high in those with disability. Conclusions. All-cause mortality rates are markedly higher among adults with disability. Preventive measures and health promotion initiatives are needed to reduce mortality risk in this population. Special attention should be paid to disabled people with certain specific diseases.