Many people worldwide live with a disability, i.e. limitations in functioning. The prevalence is expected to increase due to demographic change and the growing importance of non-communicable disease and injury. To date, many epidemiological studies have used simple dichotomous measures of disability, even though the WHO's International Classification of Functioning, Disability, and Health (ICF) provides a multi-dimensional framework of functioning. We aimed to examine associations of socio-economic status (SES) and social integration in 3 core domains of functioning (impairment, pain, limitations in activity and participation) and perceived health. We conducted a secondary analysis of representative cross-sectional data of the Swiss Health Survey 2007 including 10,336 female and 8,424 male Swiss residents aged 15 or more. Guided by a theoretical ICF-based model, 4 mixed effects Poisson regressions were fitted in order to explain functioning and perceived health by indicators of SES and social integration. Analyses were stratified by age groups (15–30, 31–54, ≥55 years). In all age groups, SES and social integration were significantly associated with functional and perceived health. Among the functional domains, impairment and pain were closely related, and both were associated with limitations in activity and participation. SES, social integration and functioning were related to perceived health. We found pronounced social inequalities in functioning and perceived health, supporting our theoretical model. Social factors play a significant role in the experience of health, even in a wealthy country such as Switzerland. These findings await confirmation in other, particularly lower resourced settings.
References
[1]
WHO (2011) World Report on Disability. Geneva: WHO Press.
[2]
Lafortune G, Balestat G (2007) Trends in severe disability among the elderly people: assessing the evidence in 12 OECD countries and the future implications. Accessed May 16 2009.
[3]
Dans A, Ng N, Varghese C, Tai ES, Firestone R, et al. (2011) The rise of chronic non-communicable diseases in southeast Asia: time for action. Lancet 377: 680–689.
[4]
Sharma BR (2008) Road traffic injuries: a major global public health crisis. Public Health 122: 1399–1406.
[5]
Reinhardt JD, Li J, Gosney J, Rathore FA, Haig AJ, et al. (2011) Disability and health-related rehabilitation in international disaster relief. Glob Health Action 4: 7191. Accessed May 5 2012.
[6]
Sandel ME (2010) What effects? Measuring functional outcomes in comparative effectiveness research. PM R 2: 881–883.
[7]
OECD/WHO (2011) OECD Reviews of Health Systems: Switzerland 2011: OECD Publishing.
[8]
Koukouli S, Vlachonikolis IG, Philalithis A (2002) Socio-demographic factors and self-reported functional status: the significance of social support. BMC Health Serv Res 2: 20.
[9]
Huisman M, Kunst AE, Mackenbach JP (2003) Socioeconomic inequalities in morbidity among the elderly; a European overview. Soc Sci Med 57: 861–873.
[10]
Rautio N, Heikkinen E, Ebrahim S (2005) Socio-economic position and its relationship to physical capacity among elderly people living in Jyvaskyla, Finland: five- and ten-year follow-up studies. Soc Sci Med 60: 2405–2416.
[11]
Schoeni RF, Martin LG, Andreski PM, Freedman VA (2005) Persistent and growing socioeconomic disparities in disability among the elderly: 1982–2002. Am J Public Health 95: 2065–2070.
[12]
Minkler M, Fuller-Thomson E, Guralnik JM (2006) Gradient of disability across the socioeconomic spectrum in the United States. N Engl J Med 355: 695–703.
[13]
Ramsay SE, Whincup PH, Morris RW, Lennon LT, Wannamethee SG (2008) Extent of social inequalities in disability in the elderly: results from a population-based study of British men. Ann Epidemiol 18: 896–903.
[14]
Altmets K, Puur A, Uuskula A, Saava A, Sakkeus L, et al. (2011) Self-reported activity limitations among the population aged 20–79 in Estonia: a cross-sectional study. Eur J Public Health 21: 49–55.
[15]
Black D, Townsend P, Davidson N (1982) Inequalities in health: the Black report. Harmondsworth: Penguin.
[16]
Nilsson CJ, Avlund K, Lund R (2010) Mobility disability in midlife: a longitudinal study of the role of anticipated instrumental support and social class. Arch Gerontol Geriatr 51: 152–158.
[17]
Brekke M, Hjortdahl P, Kvien TK (2002) Severity of musculoskeletal pain: relations to socioeconomic inequality. Soc Sci Med 54: 221–228.
[18]
Huwiler K, Bichsel M, Junker C, Minder CE, Calmonte R (2002) Schweizerische Gesundheitsbefragung: Soziale Ungleichheit und Gesundheit in der Schweiz. Accessed November 8 2011.
[19]
(2011) Gesundheit im Kanton Freiburg. Ergebnisse aus der Schweizerischen Gesundheitsbefragung 2007. Obsan Berichte.Available: http://www.bfs.admin.ch/bfs/portal/de/in？dex/themen/14/22/publ.Document.138751.pd？f Accessed November 8.
[20]
Bickenbach JE, Chatterji S, Badley EM, Ustun TB (1999) Models of disablement, universalism and the international classification of impairments, disabilities and handicaps. Soc Sci Med 48: 1173–1187.
[21]
Reinhardt JD, Fellinghauer BAG, Strobl R, Stucki G (2010) Dimension Reduction in Human Functioning and Disability Outcomes Research: Graphical Models vs. Principal Components Analysis. ID:478063.5 Disability & Rehabilitation 32: 1000–1010.
[22]
WHO (2001) ICF – International Classification of Functioning, Disability and Health. Geneva: WHO Press.
[23]
United Nations (2006) Convention on the rights of persons with disabilities. Accessed May 5 2012.
[24]
Dale C, Prieto-Merino D, Kuper H, Adamson J, Bowling A, et al. (2012) Modelling the association of disability according to the WHO International Classification of Functioning, Disability and Health (ICF) with mortality in the British Women's Heart and Health Study. J Epidemiol Community Health 66: 170–175.
[25]
Wilson IB, Cleary PD (1995) Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 273: 59–65.
[26]
Graf E (2010) Rapport de méthodes. Enquête suisse sur la santé 2007. Plan d'échantillonnage, pondérations et analyses pondérées des données. Accessed June 14 2011.
[27]
United Nations Statstics Division (2010) Washington Group on Disability Statistics. Accessed May 15 2010.
[28]
UNESCO (1997) International standard classification of education (ISCED); UNESCO, editor. Paris.
[29]
Hagenaars AJM, De Vos K, Zaidi MA (1994) Poverty statistics in the late 1980s: Research based on micro-data, study carried out for Eurostat; Community OfOPotE, editor. Luxembourg: Office for Official Publications of the European Community.
[30]
Bourdieu P (1984) Distinction: a social critique of the judgment of taste [first published in French 1979]. Boston: Harvard University Press.
[31]
Kolenikov S (2009) Confirmatory factor analysis using confa. The Stata Journal 9: 329–373.
[32]
Skrondal A, Rabe-Hesketh S (2004) Generalized latent variable milevel, longitudinal, and structural equation models. Boca Raton: Chapman & Hall/CRC.
[33]
Gould W (2001) Pseudo-R2 for probit. Accessed May 2 2011.
[34]
Rabe-Hesketh S, Skrondal A (2008) Multilevel and longitudinal modeling using Stata. College Station (Texas, USA): Stata Press.
[35]
(2011) StataCorp LP (2006–2011) Stata 12: help for margins. Accessed October 18. Available: http://www.stata.com/help.cgi?margins.
[36]
Stekhoven DJ, Bühlmann P (2011) MissForest - nonparametric missing value imputation for mixed-type data. Submitted to Oxford Journal's Bioinformatics.
[37]
Reinhardt JD, Mansmann U, Fellinghauer BA, Strobl R, Grill E, et al. (2011) Functioning and disability in people living with spinal cord injury in high- and low-resourced countries: a comparative analysis of 14 countries. Int J Public Health 56: 341–352.
[38]
Fellinghauer B, Bühlmann P, Ryffel M, von Rhein M, Reinhardt JD (2012) Stable Graphical Model Estimation with Random Forests for Discrete, Continuous, and Mixed Variables. Computational Statistics & Data Analysis in press.
[39]
Wang PP, Badley EM, Gignac M (2006) Exploring the role of contextual factors in disability models. Disabil Rehabil 28: 135–140.
