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Variations in disability and quality of life with age and sex between eight lower income and middle-income countries: data from the INDEPTH WHO-SAGE collaboration
  1. Francesc Xavier Gomez-Olive1,
  2. Julia Schröders2,
  3. Isabella Aboderin3,4,5,
  4. Peter Byass1,2,
  5. Somnath Chatterji6,
  6. Justine I Davies1,7,
  7. Cornelius Debpuur8,
  8. Siddhivinayak Hirve6,9,
  9. Abraham Hodgson8,
  10. Sanjay Juvekar9,10,
  11. Kathleen Kahn1,2,10,
  12. Paul Kowal6,
  13. Rose Nathan11,
  14. Nawi Ng2,
  15. Abdur Razzaque12,
  16. Osman Sankoh10,13,14,
  17. Peter K Streatfield12,
  18. Stephen M Tollman1,2,10,
  19. Siswanto A Wilopo15,
  20. Miles D Witham1,16
  1. 1 MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  2. 2 Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, Umeå, Sweden
  3. 3 African Population and Health Research Center, Nairobi, Kenya
  4. 4 Centre for Research on Ageing, University of Southampton, Southampton, UK
  5. 5 OPTENTIA Research Focus, North West University, Vanderbijlpark, South Africa
  6. 6 Department of Health Statistics and Informatics, World Health Organization, Geneva, Switzerland
  7. 7 Institute for Global Health, King’s College London, London, UK
  8. 8 Navrongo Health Research Centre, Navrongo, Ghana
  9. 9 Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India
  10. 10 INDEPTH Network, Accra, Ghana
  11. 11 Ifakara Health Institute, Dar es Salaam, Tanzania
  12. 12 Matlab HDSS, Matlab, Bangladesh
  13. 13 Department of Mathematics and Statistics, Njala University, Njala, Sierra Leone
  14. 14 School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  15. 15 HDSS Purworejo and Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
  16. 16 Department of Ageing and Health, School of Medicine, University of Dundee, Dundee, UK
  1. Correspondence to Dr Miles D Witham; m.witham{at}dundee.ac.uk

Abstract

Background Disability and quality of life are key outcomes for older people. Little is known about how these measures vary with age and gender across lower income and middle-income countries; such information is necessary to tailor health and social care policy to promote healthy ageing and minimise disability.

Methods We analysed data from participants aged 50 years and over from health and demographic surveillance system sites of the International Network for the Demographic Evaluation of Populations and their Health Network in Ghana, Kenya, Tanzania, South Africa, Vietnam, India, Indonesia and Bangladesh, using an abbreviated version of the WHO Study on global AGEing survey instrument. We used the eight-item WHO Quality of Life (WHOQoL) tool to measure quality of life and theWHO Disability Assessment Schedule, version 2 (WHODAS-II) tool to measure disability. We collected selected health status measures via the survey instrument and collected demographic and socioeconomic data from linked surveillance site information. We performed regression analyses to quantify differences between countries in the relationship between age, gender and both quality of life and disability, and we used anchoring vignettes to account for differences in interpretation of disability severity.

Results We included 43 935 individuals in the analysis. Mean age was 63.7 years (SD 9.7) and 24 434 (55.6%) were women. In unadjusted analyses across all countries, WHOQoL scores worsened by 0.13 points (95% CI 0.12 to 0.14) per year increase in age and WHODAS scores worsened by 0.60 points (95% CI 0.57 to 0.64). WHODAS-II and WHOQoL scores varied markedly between countries, as did the gradient of scores with increasing age. In regression analyses, differences were not fully explained by age, socioeconomic status, marital status, education or health factors. Differences in disability scores between countries were not explained by differences in anchoring vignette responses.

Conclusions The relationship between age, sex and both disability and quality of life varies between countries. The findings may guide tailoring of interventions to individual country needs, although these associations require further study.

  • other infection, disease, disorder, or injury
  • cross-sectional survey
  • epidemiology

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

https://doi.org/10.1136/bmjgh-2017-000508

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors FXG-O, JS and MDW drafted the manuscript. MDW conducted the analyses with contributions from FXGO, JS, SC and SH. All other authors contributed to the original design and data collection in the INDEPTH WHO–SAGE and contributed to critical revision of the manuscript. All authors approved the final draft.

    • Funding The original fieldwork was supported by the National Institute on Aging through an agency grant to the World Health Organization.

    • Competing interests None declared.

    • Ethics approval Ethics committees at each site approved the study, and approval was also obtained from the ethics committee of the WHO in Geneva.

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

    • Data sharing statement The dataset is publicly available at: http://www.tandfonline.com/doi/suppl/10.3402/gha.v3i0.5302/suppl_file/zgha_a_11817729_sm0003.zip, with password obtainable on request from global.health@epiph.umu.se.