Functional disability of adults in Brazil: prevalence and associated factors

Andrade, Keitty Regina Cordeiro de; Silva, Marcus Tolentino; Galvão, Taís Freire; Pereira, Maurício Gomes

doi:10.1590/S0034-8910.2015049005945

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Sumário

Original Articles • Rev. Saúde Pública 49 • 2015 • https://doi.org/10.1590/S0034-8910.2015049005945 copy

Functional disability of adults in Brazil: prevalence and associated factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To estimate the prevalence and factors associated with functional disability in adults in Brazil.

METHODS

We used information from the health supplement of the National Household Sample Survey in 2008. The dependent variable was the functional disability among adults of 18 to 65 years, measured by the difficulty of walking about 100 meters; independent variables were: health plan membership, region of residence, state of domicile, education level, household income, economic activity, self-perception of health, hospitalization, chronic diseases, age group, sex, and color. We calculated the gross odds ratios (OR), and their respective confidence intervals (95%), and adjusted them for variables of study by ordinal logistic regression, following hierarchical model. Sample weights were considered in all calculations.

RESULTS

We included 18,745 subjects, 74.0% of whom were women. More than a third of adults reported having functional disability. The disability was significantly higher among men (OR = 1.17; 95%CI 1.09;1.27), people from 35 to 49 years (OR = 1.30; 95%CI 1.17;1.45) and 50 to 65 years (OR = 1.38; 95%CI 1.24;1.54); economically inactive individuals (OR = 2.21; 95%CI 1.65;2.96); adults who reported heart disease (OR = 1.13; 95%CI 1.03;1.24), diabetes mellitus (OR = 1.16; 95%CI 1.05;1.29), arterial systemic hypertension (OR = 1.10; 95%CI 1.02;1.18), and arthritis/rheumatism (OR = 1.24; 95%CI 1.15;1.34); and participants who were admitted in the last 12 months (OR = 2.35; 95%CI 1.73;3.2).

CONCLUSIONS

Functional disability is common among Brazilian adults. Hospitalization is the most strongly associated factor, followed by economic activity, and chronic diseases. Sex, age, education, and income are also associated. Results indicate specific targets for actions that address the main factors associated with functional disabilities and contribute to the projection of interventions for the improvement of the well-being and promotion of adults' quality of life.

Adult; Mobility Limitation; Risk Factors; Statistics on Sequelae and Disability; Disabled Persons

Variables	Adults (%)	Functional disability (%)				Bivariate analysis

		With no difficulty	With little difficulty	With great difficulty	Not able to do it	OR	95%CI	p
Health insurance membership
Yes	20.2	67.2	24.9	6.6	1.3	0.81	0.75;0.89	< 0.001
Family arrangement
Living alone	7.3	60.8	32.0	6.4	0.7	1.08	0.98;1.21	0.203
Region of residence
North	8.3	64.6	28.9	6.0	0.6	1.00	–	–
Northeast	28.0	66.2	26.4	6.3	1.2	0.95	0.86;1.06	0.371
Southeast	40.0	61.7	29.1	7.8	1.4	1.16	1.05;1.29	0.005
South	16.7	61.4	30.0	7.6	1.0	1.16	1.04;1.30	0.010
Midwest	7.0	63.4	27.6	7.2	1.8	1.09	0.96;1.24	0.181
State of domicile
Urban	82.4	62.5	29.0	7.3	1.3	1.22	1.12;1.33	< 0.001
Education level (years)
≥ 12	21.0	70.0	24.2	4.6	1.2	1.00	–	–
8 to 11	16.6	66.4	25.3	6.9	1.4	1.21	1.08;1.35	0.001
4 to 7	33.9	61.7	29.9	7.4	1.0	1.45	1.32;1.59	< 0.001
0 to 3	28.4	58.4	31.4	8.8	1.5	1.68	1.53;1.85	< 0.001
Per capita household income^a
3^rd (> 507)	30.0	65.3	27.0	6.5	1.2	1.00	–	–
2^nd (277-507)	28.6	61.2	29.7	7.6	1.5	1.19	1.09;1.30	< 0.001
1^st (≤ 276)	41.4	63.2	28.4	7.3	1.1	1.09	1.01;1.18	0.027
Economic activity
Inactive	43.4	56.7	32.0	9.5	1.8	1.68	1.58;1.79	< 0.001
Self-perception of health
Good	31.0	73.0	22.2	3.8	1.1	1.00	–	–
Moderate	50.3	62.9	29.4	6.6	1.1	1.58	1.47;1.71	< 0.001
Bad	18.7	48.2	35.7	14.2	2.0	3.03	2.76;3.34	< 0.001
Hospitalization
In the last 12 months	16.0	53.1	32.8	11.6	2.5	1.73	1.59;1.88	< 0.001
Chronic diseases
Back problems	46.0	60.7	29.9	8.4	1.2	1.24	1.16;1.32	< 0.001
Arthritis or rheumatism	24.7	55.7	32.7	10.1	1.5	1.55	1.44;1.66	< 0.001
Cancer	1.8	54.8	30.1	13.3	1.8	1.52	1.19;1.94	0.001
Diabetes	12.4	53.5	33.4	11.1	2.0	1.62	1.48;1.79	< 0.001
Bronchitis or asthma	8.5	58.6	30.3	10.3	0.8	1.26	1.12;1.41	0.001
Arterial hypertension	43.2	58.0	31.6	9.0	1.4	1.51	1.41;1.61	< 0.001
Heart disease	15.2	53.2	34.3	10.8	1.6	1.65	1.51;1.80	< 0.001
Renal insufficiency	5.0	54.3	33.7	11.0	1.1	1.49	1.29;1.71	< 0.001
Depression	17.7	57.9	30.5	10.1	1.5	1.35	1.24;1.47	< 0.001
Tendonitis	10.0	59.2	30.4	9.4	1.0	1.22	1.10;1.36	< 0.001
Age group (years)
18 to 34	16.0	73.7	21.6	3.8	1.0	1.00	–	–
35 to 49	33.5	65.2	27.0	6.6	1.2	1.50	1.36;1.66	< 0.001
50 to 65	50.5	58.7	31.4	8.5	1.4	1.98	1.80;2.18	< 0.001
Sex
Male	25.8	61.6	29.2	7.5	1.7	1.11	1.03;1.19	0.005
Color/Race
White	45.5	64.0	27.5	7.4	1.1	0.95	0.89;1.02	0.149

Functional disability*	Prevalence %	95%CI
With no difficulty	63.3	62.5;64.0
With little difficulty	28.3	27.6;29.1
With great difficulty	7.1	6.7;7.5
Not able to do it	1.3	1.1;1.4

Variáveis	Scenario 1a			Scenario 2			Scenario 3

	OR	95%CI	p	OR	95%CI	p	OR	95%CI	p
Block 1^b

Health insurance membership
Yes	0.76	0.70;0.83	< 0.001	0.76	0.70;0.83	< 0.001	0.76	0.70;0.83	< 0.001
Family arrangement
Living alone	1.09	0.96;1.24	0.172	0.81	0.64;1.02	0.067	0.52	0.27;0.99	0.047
Region of residence
North	1	–	–	1	–	–	1	–	–
Northeast	0.94	0.85;1.05	0.262	1.05	0.89;1.23	0.562	1.63	1.08;2.46	0.020
Southeast	1.15	1.03;1.28	0.010	1.33	1.14;1.56	< 0.001	1.97	1.32;2.92	0.001
South	1.19	1.06;1.33	0.004	1.19	1.06;1.33	0.004	1.19	1.06;1.33	0.004
Midwest	1.06	0.93;1.21	0.356	1.28	1.05;1.57	0.014	2.53	1.59;4.02	< 0.001
State of domicile
Urban	1.23	1.12;1.34	0.000	1.23	1.12;1.34	< 0.001	1.23	1.12;1.34	< 0.001

Block 2

Education level (years)
≥ 12	1	–	–	1	–	–	1	–	–
8 to 11	1.07	0.95;1.20	0.261	1.31	1.10;1.56	0.002	1.50	1.03;2.18	0.035
4 to 7	1.23	1.11;1.36	< 0.001	1.23	1.11;1.36	< 0.001	1.23	1.11;1.36	< 0.001
0 to 3	1.37	1.23;1.53	< 0.001	1.37	1.23;1.53	< 0.001	1.37	1.23;1.53	< 0.001
Per capita household income
3^rd (> 507)	1	–	–	1	–	–	1	–	–
2^nd (277-507)	1.01	0.92;1.10	0.903	1.01	0.92;1.10	0.903	1.01	0.92;1.10	0.903
1^st (≤ 276)	0.88	0.81;0.97	0.006	0.88	0.81;0.97	0.006	0.88	0.81;0.97	0.006
Economic activity
Inactive	1.51	1.41;1.61	< 0.001	1.77	1.57;1.99	< 0.001	2.21	1.65;2.96	< 0.001
Self-perception of health
Good	1	–	–	1	–	–	1	–	–
Moderate	1.47	1.36;1.60	< 0.001	1.47	1.26;1.73	< 0.001	0.93	0.66;1.32	0.699
Bad	2.51	2.27;2.77	< 0.001	3.11	2.63;3.68	< 0.001	1.46	1.00;2.13	0.047
Hospitalization
In the last 12 months	1.51	1.38;1.65	< 0.001	1.83	1.60;2.10	< 0.001	2.35	1.73;3.20	< 0.001

Block 3

Chronic diseases
Back problems	1.02	0.95;1.09	0.598	1.02	0.95;1.09	0.598	1.02	0.95;1.09	0.598
Arthritis/Rheumatism	1.24	1.15;1.34	< 0.001	1.24	1.15;1.34	< 0.001	1.24	1.15;1.34	< 0.001
Cancer	1.19	0.93;1.52	0.159	1.19	0.93;1.52	0.159	1.19	0.93;1.52	0.159
Diabetes	1.16	1.05;1.29	0.004	1.16	1.05;1.29	0.004	1.16	1.05;1.29	0.004
Bronchitis/Asthma	1.11	0.95;1.25	0.097	1.17	0.97;1.41	0.098	0.50	0.27;0.94	0.033
Hypertension	1.10	1.02;1.18	0.010	1.10	1.02;1.18	0.010	1.10	1.02;1.18	0.010
Heart disease	1.13	1.03;1.24	0.009	1.13	1.03;1.24	0.009	1.13	1.03;1.24	0.009
Renal insufficiency	1.11	0.96;1.28	0.171	1.11	0.96;1.28	0.171	1.11	0.96;1.28	0.171
Depression	1.04	0.95;1.14	0.400	1.04	0.95;1.14	0.400	1.04	0.95;1.14	0.400
Tendonitis	1.05	0.94;1.18	0.388	1.05	0.94;1.18	0.388	1.05	0.94;1.18	0.388
Age group (years)
18 to 34	1	–	–	1	–	–	1	–	–
35 to 49	1.30	1.17;1.45	< 0.001	1.30	1.17;1.45	< 0.001	1.30	1.17;1.45	< 0.001
50 to 65	1.38	1.24;1.54	< 0.001	1.38	1.24;1.54	< 0.001	1.38	1.24;1.54	< 0.001
Sex
Male	1.17	1.09;1.27	< 0.001	1.17	1.09;1.27	< 0.001	1.17	1.09;1.27	< 0.001
Color/Race
White	0.96	0.89;1.03	0.241	1.07	0.95;1.20	0.276	0.84	0.63;1.12	0.222

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E-mail: revsp@usp.br

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[1] Correspondence
: Keitty Regina Cordeiro de Andrade Faculdade de Medicina – UnB Campus Universitário Darcy Ribeiro 70904-970 Brasília, DF, Brasil E-mail: keittyregina@hotmail.com