Is stroke the most common cause of disability?
BACKGROUND
It is widely stated that stroke is the most common cause of severe disability. We aimed to examine whether this claim is supported by any evidence.


METHODS
We conducted secondary analysis of the Office of National Statistics 1996 Survey of Disability, United Kingdom. This was a multistage stratified random sample of 8683 noninstitutionalized individuals aged between 16 and 101 years, mean 62 years, response rate 83% (n = 8816). The outcome used was the Office of Population Censuses and Surveys severity scale for disability. Odds ratios and population-attributable fractions were calculated to examine the associations between diagnoses and disability.


RESULTS
Logistic regression modelling suggests that, after adjustment for comorbidity and age, those with stroke had the highest odds of reporting severe overall disability (odds ratio 4.88, 95% confidence interval [CI] 3.37-6.10). Stroke was also associated with more individual domains of disability than any of the other conditions considered. Adjusted population-attributable fractions were also calculated and indicated that musculoskeletal disorders had the highest population-attributable fraction (30.3%, 95% CI 26.2-34.1) followed by mental disorders (8.2%, 95% CI 6.9-9.5) and stroke (4.5%, 95% CI 3.6-5.3).


CONCLUSIONS
Stroke is not the most common cause of disability among the noninstitutionalized United Kingdom population. However, stroke is associated with the highest odds of reporting severe disability. Importantly, stroke is associated with more individual domains of disability compared with other conditions and might be considered to be the most common cause of complex disability.
Adamson
Joy
J
Department of Health Sciences, University of York, Heslington, United Kingdom UK.
Beswick
Andy
A
Ebrahim
Shah
S