title: Factors Associated with Disability in Rural Bangladesh: Bangladesh Population-Based Diabetes and Eye Study (BPDES).
abstract: BACKGROUND
  To assess factors associated with disability in a rural district of Bangladesh.
  
  
  METHODS
  Using a population-based systematic sampling technique, data were collected from 3104 adults aged ≥ 30 years from the Banshgram union of Narail district. Data collected included an interviewer administered questionnaire to report physical disabilities including impairment that prevents engagement with paid work, visual, hearing, and mobility as well as mental disabilities. Socio-demographic and anthropometric factors including educational attainment and body mass index, as well as clinical factors such as blood pressure, and fasting blood glucose were also collected. Binary and multinomial logistic regression techniques were used to explore the association of various socio-demographic and clinical factors with disability.
  
  
  RESULTS
  The mean (SD), minimum and maximum ages of the participants were 51 (12), 30 and 89 years. Of total participants, 65% were female. The prevalence of disability varied from 29.1% for visual impairment (highest) to 16.5% for hearing, 14.7% for movement difficulties and 1.6% (lowest) for any other disability that prevented engagement with paid work. Overall, the prevalence of a single disability was 28.6% and that of two or more disabilities was 14.7%. Older age, gender (female), lower socio-economic status (SES), and hypertension were associated with a higher prevalence of most of the disability components. The prevalence of hearing problems (24.5% vs. 13.3%, p<0.001) and movement difficulties (24.9% vs. 13.0%, p<0.001) was significantly higher among lower-income participants than their higher-income counterparts after controlling for age. Prevalence of visual impairment (54.6% vs. 9.2%, p<0.001), hearing (32.2% vs. 6.7%, p<0.001) and movement difficulties (29.2% vs. 5.5%, p<0.001) were significantly higher in people of aged 60 years or older than those aged 30-34 years. After multivariate adjustment, the prevalence of single disability (prevalence risk ratio [PRR] 1.25, 95% CI: 1.09-1.42, p<0.001), and multiple disabilities (PRR 1.41, 95% CI 1.14-1.73, p<0.001) was higher among females than males. The prevalence of single disability and multiple disabilities was respectively 21% (PRR 1.21, 95% CI: 1.02-1.42, p<0.001) and 88% (PRR 1.88, 95% CI: 1.38-2.54, p<0.001) higher among participants with low educational attainment (primary level or less) than those with at least a secondary level of education.
  
  
  CONCLUSIONS
  In rural Bangladesh, the prevalence of disability is high. Public health programs should target those of low SES, older age, and female participants and aim to provide necessary supports in order to bridge disability-related inequities.
authors.affiliation: Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn campus, Hawthorn, Victoria, Australia.|Organization for Rural Community Development, Dariapur, Narail, Bangladesh.
authors.forename: Fakir M Amirul
authors.initials: FM
authors.lastname: Islam
authors.affiliation: Department of Statistics, Data Science and Epidemiology, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn campus, Hawthorn, Victoria, Australia.
authors.forename: Jahar L
authors.initials: JL
authors.lastname: Bhowmik
authors.affiliation: Organization for Rural Community Development, Dariapur, Narail, Bangladesh.|School of Economics, Finance and Marketing, RMIT University, Melbourne, Victoria, Australia.
authors.forename: Silvia Z
authors.initials: SZ
authors.lastname: Islam
authors.affiliation: Humanitarian and Development Studies, School of Social Science and Psychology, Western Sydney University, Penrith, New South Wales, Australia.|Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
authors.forename: Andre M N
authors.initials: AM
authors.lastname: Renzaho
authors.affiliation: School of Health Science, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn campus, Hawthorn, Victoria, Australia.|School of Population Health, University of Adelaide, Adelaide, Australia.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Hiller
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh / Q000453:epidemiology; D001766:Blindness / Q000453:epidemiology* / Q000503:physiopathology; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003638:Deafness / Q000453:epidemiology* / Q000503:physiopathology; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005215:Fasting; D005260:Female; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology* / Q000503:physiopathology; D008607:Intellectual Disability / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D012423:Rural Health / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors
chemical_list: D001786:Blood Glucose