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. 2001 Sep;55(9):631–638. doi: 10.1136/jech.55.9.631

Determinants of levels and changes of physical functioning in chronically ill persons: results from the GLOBE Study

J Mackenbach 1, G Borsboom 1, W Nusselder 1, C Looman 1, C Schrijvers 1
PMCID: PMC1731989  PMID: 11511641

Abstract

STUDY OBJECTIVE—Declines in physical functioning are a common result of chronic illness, but relatively little is known about factors not directly related to severity of disease that influence the occurrence of disability among chronically ill persons. The aim of this study was to assess the effect of a large number of potential determinants (sociodemographic factors, health related behaviour, structural living conditions, and psychosocial factors).
DESIGN—Longitudinal study of levels and changes of physical functioning among persons suffering from four chronic diseases (asthma/chronic obstructive pulmonary disease (COPD), heart disease, diabetes, chronic low back pain). In 1991, persons suffering from one or more of these diseases were identified in a general population survey. Self reported disabilities, using a subset of the OECD disability indicator, were measured six times between 1991 and 1997. These data were analysed using generalised estimating equations, relating determinants measured in 1991 to disability between 1991 and 1997, and controlling for a number of potential confounders (age, gender, year of measurement, and type and severity of chronic disease).
SETTING—Region of Eindhoven (south eastern Netherlands).
PARTICIPANTS—1784 persons with asthma/COPD, heart disease, diabetes mellitus and/or low back pain.
MAIN RESULTS—In a "repeated prevalence" model, statistically significant (p<0.05) and strong associations were found between most of the determinants and the prevalence of disabilities. In a "longitudinal change" model, statistically significant (p<0.05) predictors of unfavourable changes in physical functioning were low income and excessive alcohol consumption, while we also found indications for effects of marital status, degree of urbanisation, smoking, and external locus of control.
CONCLUSIONS—Other factors than characteristics of the underlying disease have an important influence on levels and changes of physical functioning among chronically ill persons. Reduction of the prevalence of disabilities in the population not only depends on medical interventions, but may also require social interventions, health education, and psychological interventions among chronically ill persons.


Keywords: physical functioning; chronic illness

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Selected References

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  1. Amaducci L., Maggi S., Langlois J., Minicuci N., Baldereschi M., Di Carlo A., Grigoletto F. Education and the risk of physical disability and mortality among men and women aged 65 to 84: the Italian Longitudinal Study on Aging. J Gerontol A Biol Sci Med Sci. 1998 Nov;53(6):M484–M490. doi: 10.1093/gerona/53a.6.m484. [DOI] [PubMed] [Google Scholar]
  2. Avlund K., Davidsen M., Schultz-Larsen K. Changes in functional ability from ages 70 to 75. A Danish longitudinal study. J Aging Health. 1995 May;7(2):254–282. doi: 10.1177/089826439500700205. [DOI] [PubMed] [Google Scholar]
  3. Bosma H., Schrijvers C., Mackenbach J. P. Socioeconomic inequalities in mortality and importance of perceived control: cohort study. BMJ. 1999 Dec 4;319(7223):1469–1470. doi: 10.1136/bmj.319.7223.1469. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Breslow L., Breslow N. Health practices and disability: some evidence from Alameda County. Prev Med. 1993 Jan;22(1):86–95. doi: 10.1006/pmed.1993.1006. [DOI] [PubMed] [Google Scholar]
  5. Fries J. F. Aging, natural death, and the compression of morbidity. N Engl J Med. 1980 Jul 17;303(3):130–135. doi: 10.1056/NEJM198007173030304. [DOI] [PubMed] [Google Scholar]
  6. Guralnik J. M., Fried L. P., Salive M. E. Disability as a public health outcome in the aging population. Annu Rev Public Health. 1996;17:25–46. doi: 10.1146/annurev.pu.17.050196.000325. [DOI] [PubMed] [Google Scholar]
  7. Guralnik J. M., LaCroix A. Z., Abbott R. D., Berkman L. F., Satterfield S., Evans D. A., Wallace R. B. Maintaining mobility in late life. I. Demographic characteristics and chronic conditions. Am J Epidemiol. 1993 Apr 15;137(8):845–857. doi: 10.1093/oxfordjournals.aje.a116746. [DOI] [PubMed] [Google Scholar]
  8. Hubert H. B., Bloch D. A., Fries J. F. Risk factors for physical disability in an aging cohort: the NHANES I Epidemiologic Followup Study. J Rheumatol. 1993 Mar;20(3):480–488. [PubMed] [Google Scholar]
  9. Hubert H. B., Fries J. F. Predictors of physical disability after age 50. Six-year longitudinal study in a runners club and a university population. Ann Epidemiol. 1994 Jul;4(4):285–294. doi: 10.1016/1047-2797(94)90084-1. [DOI] [PubMed] [Google Scholar]
  10. Kuorinka I., Jonsson B., Kilbom A., Vinterberg H., Biering-Sørensen F., Andersson G., Jørgensen K. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987 Sep;18(3):233–237. doi: 10.1016/0003-6870(87)90010-x. [DOI] [PubMed] [Google Scholar]
  11. LaCroix A. Z., Guralnik J. M., Berkman L. F., Wallace R. B., Satterfield S. Maintaining mobility in late life. II. Smoking, alcohol consumption, physical activity, and body mass index. Am J Epidemiol. 1993 Apr 15;137(8):858–869. doi: 10.1093/oxfordjournals.aje.a116747. [DOI] [PubMed] [Google Scholar]
  12. Lord F. M. A paradox in the interpretation of group comparisons. Psychol Bull. 1967 Nov;68(5):304–305. doi: 10.1037/h0025105. [DOI] [PubMed] [Google Scholar]
  13. Mackenbach J. P., van de Mheen H., Stronks K. A prospective cohort study investigating the explanation of socio-economic inequalities in health in The Netherlands. Soc Sci Med. 1994 Jan;38(2):299–308. doi: 10.1016/0277-9536(94)90399-9. [DOI] [PubMed] [Google Scholar]
  14. McWhinnie J. R. Disability assessment in population surveys: results of the O.E.C.D. Common Development Effort. Rev Epidemiol Sante Publique. 1981;29(4):413–419. [PubMed] [Google Scholar]
  15. Mendes de Leon C. F., Seeman T. E., Baker D. I., Richardson E. D., Tinetti M. E. Self-efficacy, physical decline, and change in functioning in community-living elders: a prospective study. J Gerontol B Psychol Sci Soc Sci. 1996 Jul;51(4):S183–S190. doi: 10.1093/geronb/51b.4.s183. [DOI] [PubMed] [Google Scholar]
  16. Rose G. A., Blackburn H. Cardiovascular survey methods. Monogr Ser World Health Organ. 1968;56:1–188. [PubMed] [Google Scholar]
  17. Schrijvers C. T., Stronks K., van de Mheen H. D., Mackenbach J. P. Explaining educational differences in mortality: the role of behavioral and material factors. Am J Public Health. 1999 Apr;89(4):535–540. doi: 10.2105/ajph.89.4.535. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Smith P. W., Roccaforte J. S., Daly P. B. Infection and immune response in the elderly. Ann Epidemiol. 1992 Nov;2(6):813–822. doi: 10.1016/1047-2797(92)90075-2. [DOI] [PubMed] [Google Scholar]
  19. Strawbridge W. J., Cohen R. D., Shema S. J., Kaplan G. A. Successful aging: predictors and associated activities. Am J Epidemiol. 1996 Jul 15;144(2):135–141. doi: 10.1093/oxfordjournals.aje.a008900. [DOI] [PubMed] [Google Scholar]
  20. Vita A. J., Terry R. B., Hubert H. B., Fries J. F. Aging, health risks, and cumulative disability. N Engl J Med. 1998 Apr 9;338(15):1035–1041. doi: 10.1056/NEJM199804093381506. [DOI] [PubMed] [Google Scholar]

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