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

• Published in: Journal of epidemiology and community health (1979) Vol. 55; no. 9; pp. 631 - 638
• Main Authors: Mackenbach, J P, Borsboom, G J J M, Nusselder, W J, Looman, C W N, Schrijvers, C T M
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 01.09.2001; BMJ Publishing Group; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: Activities of Daily Living; Adolescent; Adult; Aged; Analysis. Health state; Angina pectoris; Asthma; Asthma - epidemiology; Asthma - physiopathology; Back pain; Backache; Biological and medical sciences; Cardiovascular disease; Cardiovascular diseases; Case studies; Chronic Disease; Chronic diseases; chronic illness; Chronic illnesses; Chronic obstructive pulmonary disease; Chronically ill; Determinants; Diabetes; Diabetes mellitus; Diabetes Mellitus - epidemiology; Diabetes Mellitus - physiopathology; Disabilities; Disability; Disability Evaluation; Disabled persons; Disease models; Emigration; Epidemiology; Error rates; Exercise; Female; General aspects; Heart diseases; Heart Diseases - epidemiology; Heart Diseases - physiopathology; Heart failure; Household income; Humans; Living conditions; Longitudinal Studies; Low back pain; Low Back Pain - epidemiology; Low Back Pain - physiopathology; Lung diseases, Obstructive; Lung Diseases, Obstructive - epidemiology; Lung Diseases, Obstructive - physiopathology; Male; Marital status; Market positioning; Medical sciences; Middle Aged; Missing data; Morbidity; Mortality; Physical Fitness; physical functioning; Prevalence; Psychological aspects; Public health. Hygiene; Public health. Hygiene-occupational medicine; Questionnaires; Radiation; Research Report; Research Reports; Response rates; Risk Factors; Social support; Sociodemographics; Socioeconomic Factors; Surveys and Questionnaires; Urbanization; Variables; Working conditions; United States; Human; Evaluation; Chronicity; Socioeconomic status; Patient; Epidemiology; Morbidity; Physical handicap; Disability; Risk factor; Behavior; Public health; Life style
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.55.9.631

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.