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.
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.
Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, UK. caroline.dale@lshtm.ac.uk
Caroline
C
Dale
David
D
Prieto-Merino
Hannah
H
Kuper
Joy
J
Adamson
Ann
A
Bowling
Shah
S
Ebrahim
Juan P
JP
Casas
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000145:classification*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D011446:Prospective Studies; D011634:Public Health; D006113:United Kingdom / Q000453:epidemiology; D014944:World Health Organization