title: Respective contribution of chronic conditions to disability in France: results from the national Disability-Health Survey.
abstract: BACKGROUND
  Representative national data on disability are becoming increasingly important in helping policymakers decide on public health strategies. We assessed the respective contribution of chronic health conditions to disability for three age groups (18-40, 40-65, and >65 years old) using data from the 2008-2009 Disability-Health Survey in France.
  
  
  METHODS
  Data on 12 chronic conditions and on disability for 24,682 adults living in households were extracted from the Disability-Health Survey results. A weighting factor was applied to obtain representative estimates for the French population. Disability was defined as at least one restriction in activities of daily living (ADL), severe disability as the inability to perform at least one ADL alone, and self-reported disability as a general feeling of being disabled. To account for co-morbidities, we assessed the contribution of each chronic disorder to disability by using the average attributable fraction (AAF).
  
  
  RESULTS
  We estimated that 38.8 million people in France (81.7% [95% CI 80.9;82.6]) had a chronic condition: 14.3% (14.0;14.6) considered themselves disabled, 4.6% (4.4;4.9) were restricted in ADL and 1.7% (1.5;1.8) were severely disabled. Musculoskeletal and sensorial impairments contributed the most to self-reported disability (AAF 15.4% and 12.3%). Neurological and musculoskeletal diseases had the largest impact on disability (AAF 17.4% and 16.4%, respectively). Neurological disorders contributed the most to severe disability (AAF 31.0%). Psychiatric diseases contributed the most to disability categories for patients 18-40 years old (AAFs 23.8%-40.3%). Cardiovascular conditions were also among the top four contributors to disability categories (AAFs 8.5%-11.1%).
  
  
  CONCLUSIONS
  Neurological, musculoskeletal, and cardiovascular chronic disorders mainly contribute to disability in France. Psychiatric impairments have a heavy burden for people 18-40 years old. These findings should help policymakers define priorities for health-service delivery in France and perhaps other developed countries.
authors.affiliation: U738, INSERM, Paris, France. clemence.palazzo@cch.aphp.fr
authors.forename: Clémence
authors.initials: C
authors.lastname: Palazzo
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Ravaud
authors.forename: Ludovic
authors.initials: L
authors.lastname: Trinquart
authors.forename: Marie
authors.initials: M
authors.lastname: Dalichampt
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.forename: Serge
authors.initials: S
authors.lastname: Poiraudeau
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D062486:Public Health Surveillance; D012189:Retrospective Studies