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J Epidemiol Community Health. 2017 Apr;71(4):381-389. doi: 10.1136/jech-2016-207982. Epub 2016 Oct 17.

Functional disability and social participation restriction associated with chronic conditions in middle-aged and older adults.

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Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Research Center on Aging, CIUSSS de l'Estrie-CHUS, and Faculty of Medicine and Health Sciences Université de Sherbrooke, Sherbrooke, Quebec, Canada.
Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada.
Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands.
Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.



We examine the population impact on functional disability and social participation of physical and mental chronic conditions individually and in combination.


Cross-sectional, population-based data from community-dwelling people aged 45 years and over living in the 10 Canadian provinces in 2008-2009 were used to estimate the population attributable risk (PAR) for functional disability in basic (ADL) and instrumental (IADL) activities of daily living and social participation restrictions for individual and combinations of chronic conditions, stratified by age and gender, after adjusting for confounding variables.


Five chronic conditions (arthritis, depression, diabetes, heart disease and eye disease) made the largest contributions to ADL-related and IADL-related functional disability and social participation restrictions, with variation in magnitude and ranking by age and gender. While arthritis was consistently associated with higher PARs across gender and most age groups, depression, alone and in combination with the physical chronic conditions, was associated with ADL and IADL disability as well as social participation restrictions in the younger age groups, especially among women. Compared to women, the combinations of conditions associated with higher PARs in men more often included heart disease and diabetes.


Our findings suggest that in community-dwelling middle-aged and older adults, the impact of combinations of mental and physical chronic conditions on functional disability and social participation restriction is substantial and differed by gender and age. Recognising the differences in the drivers of PAR by gender and age group will ultimately increase the efficiency of clinical and public health interventions.


AGEING; CHRONIC DI; Functioning and disability; PUBLIC HEALTH; Social activities

[Indexed for MEDLINE]

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