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Association of Chronic Diseases and Impairments With Disability in Older Adults: A Decade of Change?

Hung, William W. MD, MPH*,†,‡; Ross, Joseph S. MD, MHS§,∥; Boockvar, Kenneth S. MD, MS*,†,‡,¶; Siu, Albert L. MD, MSPH*,†,‡

doi: 10.1097/MLR.0b013e318245a0e0
Original Articles

Background: Little is known about how the relationship between chronic disease, impairment, and disability has changed over time among older adults.

Objective: To examine how the associations of chronic disease and impairment with specific disability have changed over time.

Research Design: Repeated cross-sectional analysis, followed by examining the collated sample using time interaction variables, of 3 recent waves of the Health and Retirement Study.

Subjects: The subjects included 10,390, 10,621 and 10,557 community-dwelling adults aged 65 years and above in 1998, 2004, and 2008.

Measurements: Survey-based history of chronic diseases including hypertension, heart disease, heart failure, stroke, diabetes, cancer, chronic lung disease, and arthritis; impairments, including cognition, vision, and hearing; and disability, including mobility, complex activities of daily living (ADL), and self-care ADL.

Results: Over time, the relationship of chronic diseases and impairments with disability was largely unchanged; however, the association between hypertension and complex ADL disability weakened from 1998 to 2004 and 2008 [odds ratio (OR)=1.24; 99% confidence interval (CI), 1.06–1.46; OR=1.07; 99% CI, 0.90–1.27; OR=1.00; 99% CI, 0.83–1.19, respectively], as it did for hypertension and self-care disability (OR=1.32; 99% CI, 1.13–1.54; OR=0.97; 99% CI, 0.82–1.14; OR=0.99; 99% CI, 0.83–1.17). The association between diabetes and self-care disability strengthened from 1998 to 2004 and 2008 (OR=1.21; 99% CI, 1.01–1.46; OR=1.37; 99% CI, 1.15–1.64; OR=1.52; 99% CI, 1.29–1.79), as it also did for lung disease and self-care disability (OR=1.64; 99% CI, 1.33–2.03; OR=1.63; 99% CI, 1.32–2.01; OR=2.11; 99% CI, 1.73–2.57).

Conclusions: Although relationships between diseases, impairments, and disability were largely unchanged, disability became less associated with hypertension and more with diabetes and lung disease.

*Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, NY

The James J Peters VA Health Services Research and Development Research Enhancement Award Program, Bronx, NY

Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY

§Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine

Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT

Jewish Home Lifecare, New York, NY

W.W.H. is a John A Hartford Foundation Center of Excellence Scholar and a New York Academy of Medicine Hoar Fellow. J.S.R. is currently supported by the National Institute on Aging (K08 AG032886) and by the American Federation of Aging Research through the Paul B. Beeson Career Development Award Program. K.S.B. is supported by the Greenwall Foundation. The Health and Retirement Study is sponsored by the National Institute on Aging (grant number U01AG009740) and conducted by the Institute for Social Research at the University of Michigan.

The authors declare no conflict of interest.

Reprints: William W. Hung, MD, MPH, Mount Sinai School of Medicine, One Gustave L Levy Place, Box 1070, New York, NY 10029. E-mail: william.hung@mssm.edu.

© 2012 Lippincott Williams & Wilkins, Inc.