title: Educational disparities in the burden of disability: contributions of disease prevalence and disabling impact.
abstract: OBJECTIVE
  We assessed the contributions of the prevalence and disabling impact of specific diseases to educational disparities in the prevalence of disability.
  
  
  METHODS
  We examined a large representative survey of the Dutch population, the Dutch Permanent Survey of Living Conditions (2001-2007; n = 24 883; ages 40-97 years). We attributed the prevalence of disability to chronic diseases by using their empirical associations and assuming independent competing causes of disability. We estimated contributions of prevalence and the disabling impact of diseases to disparities in disability using counterfactuals.
  
  
  RESULTS
  We found that the prevalence of disability in individuals with only an elementary education was 19 to 20 percentage points higher than that in individuals with tertiary education. Sixty-five percent of this difference could be attributed to specific chronic diseases, but more so to their disabling impact (49%-51%) than to their prevalence (20%-29%). Back pain, neck or arm conditions, and peripheral vascular disease contributed most to the disparity in men, and arthritis, back pain, and chronic nonspecific lung disease contributed most to the disparity in women.
  
  
  CONCLUSIONS
  Educational disparities in the burden of disability were primarily caused by high disabling impacts of chronic diseases among low educated groups. Tackling disparities might require more effective treatment or rehabilitation of disability in lower socioeconomic groups.
authors.affiliation: At the time of the study, Bart Klijs, Wilma J. Nusselder, Caspar W. Looman, and Johan P. Mackenbach were with the Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. Bart Klijs was also with the Department of Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Klijs
authors.forename: Wilma J
authors.initials: WJ
authors.lastname: Nusselder
authors.forename: Caspar W
authors.initials: CW
authors.lastname: Looman
authors.forename: Johan P
authors.initials: JP
authors.lastname: Mackenbach
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000193:education / Q000523:psychology / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D012737:Sex Factors