title: Disability and all-cause mortality in the older population: evidence from the English Longitudinal Study of Ageing.
abstract: Despite the vast body of literature studying disability and mortality, evidence to support their association is scarce. This work investigates the role of disability in explaining all-cause mortality among individuals aged 50+ who participated in the English Longitudinal Study of Aging. The aim is to explain the gender paradox in health and mortality by analysing whether the association of disability with mortality differs between women and men. Disability was conceived following the International Classification of Functioning, Disability and Health (ICF), proposed by the WHO, that conceptualizes disability as a combination of three components: impairment, activity limitation and participation restriction. Latent variable models were used to identify domain-specific factors and general disability. The association of the latter with mortality up to 10 years after enrolment was estimated using discrete-time survival analysis. Our work confirms the validity of the ICF framework and finds that disability is strongly associated with mortality, with a time-varying effect among men, and a smaller constant effect for women. Adjusting for demographic, socioeconomic and behavioural factors attenuated the association for both sexes, but overall the effects remained high and significant. These findings confirm the existence of gender paradox by showing that, when affected by disability, women survive longer than men, although if men survive the first years they appear to become more resilient to disability. Sensitivity analyses suggested that the gender paradox cannot be solely explained by gender-specific health conditions: there must be other mechanisms acting within the pathway between disability and mortality that need to be explored.
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK. benedetta.pongiglione@lshtm.ac.uk.
authors.forename: Benedetta
authors.initials: B
authors.lastname: Pongiglione
authors.affiliation: Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
authors.forename: Bianca L
authors.initials: BL
authors.lastname: De Stavola
authors.affiliation: International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kuper
authors.affiliation: Centre for Longitudinal Studies, Department of Social Science, UCL Institute of Education, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK.
authors.forename: George B
authors.initials: GB
authors.lastname: Ploubidis
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000375:Aging; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods* / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012737:Sex Factors
keywords: Ageing; Disability; Gender; Mortality