title: The effect of smoking on the duration of life with and without disability, Belgium 1997-2011.
abstract: BACKGROUND
  Smoking is the single most important health threat yet there is no consistency as to whether non-smokers experience a compression of years lived with disability compared to (ex-)smokers. The objectives of the manuscript are (1) to assess the effect of smoking on the average years lived without disability (Disability Free Life Expectancy (DFLE)) and with disability (Disability Life Expectancy (DLE)) and (2) to estimate the extent to which these effects are due to better survival or reduced disability in never smokers.
  
  
  METHODS
  Data on disability and mortality were provided by the Belgian Health Interview Survey 1997 and 2001 and a 10 years mortality follow-up of the survey participants. Disability was defined as difficulties in activities of daily living (ADL), in mobility, in continence or in sensory (vision, hearing) functions. Poisson and multinomial logistic regression models were fitted to estimate the probabilities of death and the prevalence of disability by age, gender and smoking status adjusted for socioeconomic position. The Sullivan method was used to estimate DFLE and DLE at age 30. The contribution of mortality and of disability to smoking related differences in DFLE and DLE was assessed using decomposition methods.
  
  
  RESULTS
  Compared to never smokers, ex-smokers have a shorter life expectancy (LE) and DFLE but the number of years lived with disability is somewhat larger. For both sexes, the higher disability prevalence is the main contributing factor to the difference in DFLE and DLE. Smokers have a shorter LE, DFLE and DLE compared to never smokers. Both higher mortality and higher disability prevalence contribute to the difference in DFLE, but mortality is more important among males. Although both male and female smokers experience higher disability prevalence, their higher mortality outweighs their disability disadvantage resulting in a shorter DLE.
  
  
  CONCLUSIONS
  Smoking kills and shortens both life without and life with disability. Smoking related disability can however not be ignored, given its contribution to the excess years with disability especially in younger age groups.
authors.affiliation: Unit of Survey, Life Styles and Chronic Diseases, Directorate Public Health and Surveillance, Scientific Institute of Public Health, Brussels, Belgium. hvanoyen@wiv-isp.be.
authors.forename: Herman
authors.initials: H
authors.lastname: Van Oyen
authors.forename: Nicolas
authors.initials: N
authors.lastname: Berger
authors.forename: Wilma
authors.initials: W
authors.lastname: Nusselder
authors.forename: Rana
authors.initials: R
authors.lastname: Charafeddine
authors.forename: Carol
authors.initials: C
authors.lastname: Jagger
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Cambois
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Robine
authors.forename: Stefaan
authors.initials: S
authors.lastname: Demarest
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys / Q000379:methods* / Q000706:statistics & numerical data*; D006801:Humans; D008017:Life Expectancy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology*