From rationality to identity: the impact of using community health services for the aged on the well-being of older adults in China.

Objectives: To better understand the outcome benefits of community health services for the aged (CHSA) and provide bottom-up identity for development, this study examined the impact of using CHSA on well-being of older adults from both objective and subjective dimensions. Methods: Data from 1,411 people aged 60+ in Shaanxi, China was used in this study. The OLS estimate was used to analyze the impact of using CHSA on well-being of older adults. Then, the instrumental variable estimate was further hired to examine associations among variables to address the potential endogeneity concerns. The heterogeneity among disabled and non-disabled group was also estimated. Results: For objective well-being, the mental health (ß = 0.44) and financial well-being (ß = 0.59) of older people using CHSA were significantly higher than those not using any service. The impact on objective well-being were more significant in non-disabled group. For subjective well-being, life meaning (ß = 0.54) and security (ß = 0.72) were positively associated with CHSA utilization, while independence index (ß = -0.33) was negatively related with CHSA utilization. The subjective well-being of disabled group using services increased more than non-disabled group. Conclusion: Findings underscore the positive, albeit group-selective, role of CHSA in improving well-being of older people in China and imply the necessity of high-quality development of CHSA and the targeted differentiation strategy.

Lung cancer and smoking: years lived with disability in Tuscany (Italy). An analysis from the ACAB study.

BACKGROUND: Lung cancer (LC) is among the most common neoplasms, mostly caused by smoking. This study, carried out within the ACAB project, aims to provide local, updated and systematic estimates of years lived with disability (YLD) from LC due to smoking in the Tuscany region, Italy. METHODS: We estimated YLD for the year 2022 for the whole region and at subregional level by local health unit (LHU) using data from the Tuscany Cancer Registry and local surveys. YLD were calculated by applying the severity-specific LC prevalence, estimated with an incidence-based disease model, to the corresponding disability weight. The burden from smoking was computed by: modelling the prevalence of smokers with a Bayesian Dirichlet-Multinomial regression model; estimating the distribution of smokers by pack-years simulating individual smoking histories; collecting relative risks from the literature. RESULTS: In 2022 in Tuscany, LC caused 7.79 (95% uncertainty interval [UI] = 2.26, 17.27) and 25.50 (95% UI = 7.30, 52.68) YLDs per 100,000 females and males, respectively, with slight variations by LHU, and 53% and 66% of the YLDs were caused by smoking. CONCLUSION: The updated estimates of the burden of LC attributable to smoking for the Tuscany region as a whole and for each LHU provide indications to inform strategic prevention plans and set public health priorities. The impact of smoking on YLDs from LC is not negligible and heterogeneous by LHU, thus requiring local interventions.

Disability, poverty and health-service accessibility in the context of the COVID-19 pandemic: a population-based repeated cross-sectional study in Colombia.

OBJECTIVES: In Colombia, 4.3% of the population 5 years or older lives with a disability. They face higher levels of poverty and social exclusion compared with persons without disabilities. This article aims to understand the factors associated with access to preventative and curative health services for people with disabilities in Colombia. Additionally, it explores whether access to health services for people with disabilities changed during the COVID-19 pandemic. DESIGN: This is a population-based repeated cross-sectional study. SETTING: This study took place in Colombia, from 2018 to 2021. DATA SOURCES AND PARTICIPANTS: National Quality of Life Survey datasets in Colombia from 2018 to 2021, including people 5 years or older, were reviewed. People were classified into three groups: person with any disability, person with multiple disabilities and person without disabilities. PRIMARY AND SECONDARY OUTCOME MEASURES: A multinomial regression model was used to calculate the probability of access to preventative services during the previous year in four categories: general practitioner (GP) and dentist, GP only, dentist only and no consultation. A logistic model for curative consultations with and without hospitalisation in people who reported having a health problem. RESULTS: People with disabilities demanded more preventative health services, except for dental services, compared with people without disabilities. Similarly, they experienced more health problems and demanded more curative services than people without disabilities, except during the year 2020, when no significant differences were found between people with and without disabilities. For people with disabilities, poverty was not associated with a lower likelihood of consultation, except for preventative dental consultations, which were significantly lower for poor people with disabilities. In addition, the subsidised insurance regimen was identified as an important variable in the utilisation of healthcare in Colombia. CONCLUSION: People with disabilities in Colombia demand more health services compared with people without disabilities. Despite being in a worse condition according to various socioeconomic indicators, few factors affect their demand for healthcare services. The COVID-19 pandemic was associated with a significant reduction in the probability of access to outpatient treatment services during 2020 for people with disabilities. Longitudinal studies and comparison with other Latin American countries are recommended.

The prevalence of functional disability and associated factors among older adults living in Bahir Dar City, Northwest, Ethiopia: a community-based cross-sectional study.

Background: The limitation of carry out everyday activities independently is a common experience for older adults with functional disabilities, which can hurt their overall well-being. Unfortunately, there is still a dearth of evidence about how common it is among older adults, especially in low-and middle-income countries like Ethiopia. Therefore, the study aimed to assess the prevalence and associated factors of functional disability among older adults living in Bahir Dar city, Northwest, Ethiopia, 2023. Method: A community-based cross-sectional study was conducted among older adults (≥60 years) living in Bahir Dar city, Northwest, Ethiopia. A total of 598 study participants were included using a multistage sampling technique. Data were collected through interviewer-administered questionnaires. Barthel Index (BI) was used to assess the functional capacity of older adults which comprises 10 items. The total score ranges from 0 to 100. Variables significant in bivariable analysis were entered into multivariable logistic regression analysis. A p < 0.05 was considered statistically significant in the final logistic regression model. Results: Among the 598 participants studied, the overall prevalence of functional disability was 29.6 (95% CI: 26.0-33.4). Older age (≥70 years) {adjusted odds ratio(AOR: 2.24; 95% CI: 1.03-4.88)}, comorbidity (AOR: 2.96; 95% CI: 1.47-5.94), physically inactive (AOR: 2.42; 95% CI: 1.18-4.96), one and more drug users (AOR: 3.61; 95% CI: 2.12-6.15), cognitive impairment (AOR: 3.66; 95% CI: 2.26-4.93) and depression (AOR: 1.70; 95% CI: 1.08-2.68) were found significant associated factors of functional disabilities among older adults. Conclusion: This study found that nearly one-third of older adults had functional disabilities. Functional disability was significantly associated with factors such as increasing age, presence of comorbidities, being physically inactive, one and more drug users, who developed cognitive impairment, and having depression symptoms. Proactive measures need to be initiated to ensure proper care and support of functionally disabled individuals, especially targeting vulnerable groups identified in this study.

Pregnancy Intendedness Among Racial and Ethnically Minoritized Women with Disabilities.

Background: A limited number of studies have examined the prevalence of unintended pregnancy among disabled women. However, no studies to date have examined the association between pregnancy intention and disability, in combination with race and ethnicity. Methods: We analyzed data from the National Survey of Family Growth from the period 2011-2019 to estimate the prevalence of pregnancy intendedness among women with disabilities 15-45 years of age. We compared pregnancy intendedness among respondents with and without disabilities. Modified Poisson regressions were conducted to estimate the unadjusted and adjusted prevalence ratios (with 95% confidence intervals) of unintended pregnancy across disability type and by race and ethnicity category. Non-Hispanic White women without disabilities served as the referent group. Results: Unadjusted results found that women with disabilities in all racial or ethnic groups were significantly more likely to report unintended pregnancies compared with non-Hispanic White women with no disabilities. Non-Hispanic Black women were more than three and a half times (PR = 3.72, 95% CI: 2.91-4.75) more likely than their non-Hispanic White counterparts to report an unintended pregnancy. After adjusting for demographic characteristics, results were slightly attenuated in all categories, with the exception of nondisabled Hispanic women, indicating high prevalence of unintended pregnancies. Conclusions: Racial and ethnic minority women with disabilities may experience heightened risk for unintended pregnancy. Targeted efforts are needed to address barriers to comprehensive sexual and reproductive health care and improve reproductive health outcomes among women who experience multiple forms of marginalization.

Prevalence of multiple long-term chronic conditions and associated disabilities among community-dwelling adults in Riyadh.

Background/objectives: Saudi Arabia is experiencing a rapid increase in chronic diseases and disabilities. However, there is a dearth of research on these topics in the Arab world. This study aimed to examine the prevalence of multiple long-term chronic conditions (MLTCs) and disabilities and their relationship. Methods: The survey was conducted in Riyadh, Saudi Arabia, in 2023. Convenient sampling was used to select 324 participants aged 50 years and older, using data on disabilities status. The survey collected information on age, sex, body mass index (BMI), MLTCs or multi-morbidity, and activities of daily living (ADL). Disabilities was measured using Arabic versions of basic ADL and the Barthel index. Results: The prevalence of MLTCs among participants was 49.4%. The prevalence of disabilities measured using the ADL and Barthel index was 33.6 and 49.7%, respectively, and these rates increased by 42.5 and 58.1% among participants with MLTCs (n = 160). MLTCs were associated with an increased risk of disabilities using ADL [odds ratio (OR) 1.99, p = 0.037] and the Barthel index (OR 2.27, p = 0.007). Conclusion: Approximately half of the participants with disabilities data had MLTCs, and approximately a third to half had a disabilities. MLTCs were significantly associated with various types of disabilities among community-dwelling Saudi adults. Hence, strategies to reduce chronic diseases may result in a reduction in disabilities, and vice versa.

Disability trends among elderly Ukrainians in war conditions: a 10-year retrospective study.

AIM: Non-communicable diseases (NCDs) in elderly are a significant problem in Ukraine. It is expected that the ongoing war will augment this problem. The study aimed to analyze the trends of disability due to NCDs s in newly-diagnosed elderly patients between 2013 and 2023. METHODS: This retrospective study included data obtained from the official document "Report on the Causes of Disability and Indications for Medical, Professional, and Social Rehabilitation" commissioned by the Ministry of Health of Ukraine. The data on disability due to NCDs s were obtained from for 2013-2023. RESULTS: During the 2013-2021 the average number of disabled elderly patients due to NCDs per 10,000 elderly persons was significantly lower in compare with working-age. During the first year of full-scaled war the average number of disabled elderly patients due to NCDS s per 10,000 elderly persons dramatically increased by 2-fold, and in 2023 - by 2.8-fold against 2013 value (p < 0.05), while in working-age the disability rate increased significantly only in 2023 by 1.4-fold compared to the pre-war level. In 2013-2021 the main causes of disability among those related to NCDs in elderly were cardiovascular diseases, followed by cancer. In 2022 compared to the pre-war level, the indicators of disability of the elderly due to CVD increased by 1.5 times, due to cerebrovascular diseases - by 2.2 times, due to cancer - by 1.7 times, due to musculoskeletal diseases - by 2 times (p < 0.05). The most significant increase in the number of elderly people with disabilities during the full-scale war occurred due to coronary artery disease - by 55.1%, and osteoarthritis - by 83.4% from baseline in 2013. It estemated the differences in indicators of disability of elderly between regions of Ukraine, significantly higher indicators of disability of the elderly due to cardiovascular diseases, cancer, cerebrovascular diseases, musculoskeletal diseases were noted in the frontline regions. CONCLUSIONS: Data on primary disability among elderly Ukrainians indicates a significant increase in NCDs-related disability during the war in compare with working population, especially in frontline regions and regions with a high concentration of displaced persons. In this structure of NCDs-related increasing disability, CVD, oncology and musculoskeletal diseases system prevailed.

Dynapenic abdominal obesity and activities of daily living disability among older adults residing in low- and middle-income countries.

BACKGROUND: Dynapenic abdominal obesity (DAO) may be associated with an increased risk of disability. However, to date, this has not been investigated in low- and middle-income countries (LMICs), while the mediators are largely unknown. AIMS: Therefore, we aimed to investigate the association between DAO and activities of daily living (ADL) disability, and to identify potential mediators among older adults from six LMICs. METHODS: Cross-sectional, nationally representative data from the WHO Study on global AGEing and adult health were analyzed. Data on 20,198 adults aged ≥ 60 years were analyzed [mean (SD) age 69.3 (13.1) years; 54.1% females]. Dynapenia was defined as handgrip strength of < 26 kg for men and < 16 kg for women. Abdominal obesity was defined as waist circumference of > 88 cm for women and > 102 cm for men. DAO was defined as having both dynapenia and abdominal obesity. Disability was defined as severe or extreme difficulty in conducting at least one of six types of ADL. Multivariable logistic regression and mediation analysis were conducted. RESULTS: Compared to no dynapenia and no abdominal obesity, DAO was significantly associated with 2.08 (95%CI = 1.37-3.17) times higher odds for ADL disability Mediation analysis showed that diabetes (mediated percentage 4.7%), hypertension (7.2%), and angina (7.7%) were significant mediators in the association between DAO and ADL disability. CONCLUSIONS: DAO was associated with increased odds for ADL disability among older adults from LMICs. Future longitudinal studies are warranted to assess temporal associations, and whether addressing or preventing DAO can impact on future occurrence of disability.

Epidemiology and Prevalence of Musculoskeletal Disabilities Following Motor Vehicle Accidents in Aljouf Region, Saudi Arabia.

Background and Objectives: Motor vehicle accidents (MVAs) are the leading cause of disability, particularly among young adults in Saudi Arabia. Persistent disabilities account for around 7% of all injuries attributed to MVAs in Saudi Arabia in the last twenty years. Limited studies on musculoskeletal disabilities following MVAs have been carried out in Saudi Arabia. This study aims to explore the epidemiology and prevalence of musculoskeletal disabilities in motor vehicle accident (MVA) patients in the Aljouf region, Saudi Arabia. Materials and Methods: This retrospective cross-sectional study evaluated all MVA victims treated in the Aljouf region, Saudi Arabia, from January 2020 to December 2022. A total of 3252 medical records were collected, with 731, 1197, and 1324 musculoskeletal injury cases per year, of which 88, 168, and 153 records from 2020, 2021, and 2022 were analysed, respectively. Results: The study found that patients aged 25-34 and 35-44 years were the most likely to experience disability following MVAs. The difference between age groups during a single year was statistically significant (p < 0.001). Most patients were male (89.8%, 82.7%, and 79.7%) during 2020, 2021, and 2022, respectively. The majority of injuries involved the upper extremities (38.6%, 36.9%, and 40.5%), followed by lower extremities (36.4%, 35.7%, and 34.6%), head and neck (21.6%, 26.2%, and 34.6%), thoracic region (20.5%, 24.4%, and 17%), and finally lumbosacral spine (6.8%, 5.4%, and 6.5%) during 2020, 2021, and 2022, respectively, with a significant difference for each year (p < 0.001). The study found a link between the likelihood of developing high disability grades and injury severity scores. The patients with very severe ISS ≥ 25 (OR: ∞ CI 95%: 39.81-∞; p < 0.001), severe ISS = 16-24 (OR: ∞ CI 95%: 20.90-∞; p < 0.001), and moderate ISS = 9-15 (OR: ∞ CI 95%: 1.2-∞; p = 0.02) were at greater risk of developing high grades of disability. Conclusions: This study highlighted the musculoskeletal disabilities in the Aljouf region following MVAs. Severe musculoskeletal disabilities were rare, but fractures were the most common following MVAs. More efforts should be directed towards education on early transportation and transfer to the nearest medical centres, seeking assistance immediately after MVAs for patient safety, and disability prevention.

Analysis of the Association between Telomere Length and Neurological Disability in Stroke Types.

Background and Objectives: The association between neurological disability, prognosis, and telomere length (TL) in patients with stroke has been investigated in various ways. However, analysis of the type of stroke and ischemic stroke subgroups is limited. In this study, we aimed to determine the association between TL and neurological disability according to stroke type. Materials and Methods: This prospective study included patients with stroke who visited a single-center emergency department (ED) between January 2022 and December 2023. The association between TL and neurological disabilities, using the Modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS), was evaluated according to the patient's stroke type and subgroup of ischemic stroke. Multivariate analysis was performed to determine the association between neurological disabilities in patients with ischemic stroke and the subgroups. Results: A total of 271 patients with stroke were enrolled. The NIHSS score was found to be higher at the time of ED visit (adjusted odds ratio [OR], 5.23; 95% confidence interval [CI], 1.59-17.2, p < 0.01) and 1 day later (adjusted OR, 7.78; 95% CI, 1.97-30.70, p < 0.01) in the ischemic stroke group with a short TL. In the other determined etiology (OD) or undetermined etiology (UD) group, the NIHSS was higher in the short TL group at the ED visit (adjusted OR, 7.89; 95% CI, 1.32-47.25, p = 0.02) and 1 day after (adjusted OR, 7.02; 95% CI, 1.14-43.47, p = 0.04). Conclusions: TL is associated with neurological disability in early ischemic stroke and is prominent in the UD and OD subgroups.

Effectiveness of targeted financial aid on disability welfare for the ageing population in China: A quasi-experiment study.

Background: Addressing the problem of disabilities and disability deterioration is a key task for healthy ageing. Financial aid has been an effective measure for vulnerable groups, especially ageing people with disabilities. However, the effects of targeted financial aid on preventing disability deterioration remain unknown. The Chinese government launched a targeted financial aid programme aimed at people with disabilities. In this study, we investigated the causal effects of such targeted financial aid on disability deterioration prevention for elderly people with disabilities in China. Methods: The data set used in this study included 36 640 elderly individuals with disabilities in China between 2016-19. We constructed a quasi-experiment approach and used a difference-in-differences (DID) method to examine the counterfactual differences between the treatment group in four cities that implemented such targeted financial aid in 2018 and the control group in three cities that did not adopt the policy over the study period. We employed propensity score matching (PSM) jointly with DID to mitigate selective bias. For sensitivity analysis, we conducted supplementary analyses on alternative samples, focusing on each of the treated cities respectively. Besides the main outcome, we also used fixed effect models to test the impact of such financial aid on rehabilitation access. Results: The targeted financial aid significantly reduced the possibility of disability deterioration for elderly people with severe disabilities (0.26%; P < 0.001). Using PSM-DID models, the impact remained significant (0.33%; P < 0.001). Moreover, financial aid was significantly related to their access to rehabilitation services (12.71%; P < 0.001). Further analysis showed the heterogenous effects of targeted financial aid across individual demographic and socioeconomic factors, as well as communities with and without rehabilitation facilities. Conclusions: Targeted financial aid had a positive impact on preventing disability deterioration among elderly individuals aged ≥65 years with severe disabilities. Moreover, rehabilitation care had a potential mediating role in the relationship between targeted financial aid and disability deterioration prevention. This study highlights the effectiveness of targeted financial aid in preventing disability deterioration and improving rehabilitation care for people with disabilities.

Social Determinants of Health Affect Psychological Distress among People with Disabilities.

People with disabilities experience inequitable exposure to social determinants of health (SDOH) that contribute to disparate health outcomes, including psychological distress. There is little research examining which SDOH have the strongest effect on psychological distress among people with disabilities. This leaves healthcare providers and policy makers with insufficient information to make well-informed treatment decisions or allocate resources effectively. We explored the association between SDOH and disability and which factors may moderate the association between disability and psychological distress. Using data from the US Census Bureau's Household Pulse Survey (Phase 3.5), we examined SDOH among people with and without disability (n = 26,354). Among people with disability, the odds of severe psychological distress were highest among those who had low incomes (OR = 4.41, 95% CI: 3.51-5.60), were food insecure (OR = 3.75, 95% CI: 3.43-4.10), housing insecure (OR = 3.17, 95% CI: 2.82-3.58), or were unable to work (OR = 1.98, 95% CI: 1.80-2.18). Only difficulty paying for household expenses moderated the association between disability and severe psychological distress (OR = 9.81, 95% CI: 7.11-13.64). These findings suggest that supporting employment and economic opportunities and improving access to safe and affordable housing and food may improve psychological well-being among people with disabilities.

Disability and its impact on life expectancy: heterogeneity across Mexican states.

BACKGROUND: The percentage of the world's population with disabilities is estimated to be 16%, although its distribution and intensity varies within nations. We aim to disentangle the degree and types of disabilities, estimate the years spent with more severe disabilities, and analyze their distribution across states and between sexes in Mexico. METHODS: The Mexican Census of 2020 includes information on disabilities, which allows the study of its national distribution. We used life tables and the Sullivan method to calculate the number of years spent with disability (NYSD) and its percentage with respect to life expectancy for each state and each sex. RESULTS: In Mexico, the population with disabilities is estimated to be 16.5%. Of this total, 69% have milder disabilities, while the remaining 31% have more severe disabilities. At age eighteen, there is a higher NYSD from more severe disabilities for females with 5.67 years (95% CI 5.66 to 5.69) as opposed to males with 3.66 years (95% CI 3.65 to 3.67). Across states, a more homogeneous distribution with lower NYSD is observed for men (between 2.44 and 5.69 years) than for women (4.14 and 8.08 years). A north-south division can also be observed, with particularly notorious disadvantages among coastal states, which is more distinctive among women. CONCLUSIONS: This study shows that comparing the number of years spent with disability and the total life expectancy between subpopulations is essential for monitoring the well-being of aging populations, guiding policy decisions, and promoting a society that values and supports all individuals, regardless of their abilities.

Patterns of intrinsic capacity trajectory and onset of activities of daily living disability among community-dwelling older adults.

Background: Global population ageing has brought about new challenges for elderly care. Exploring intrinsic capacity (IC) over time, which is designed as a composite measure of an individual's physical and mental capabilities, is essential for promoting healthy ageing and preventing dependency, such as that emerging from disability in activities of daily living (ADL). We aimed to identify and examine the differences between classes of IC trajectory and onset of ADL disability. Methods: We conducted an observational study using data from three waves (2011-15) of the China Health and Retirement Longitudinal Study, comprising 2609 participants with 6034 observations. IC was measured by five domains, including locomotion, cognition, psychological, sensory capacities, and vitality. We used joint latent class modelling to identify distinct classes with similar patterns of IC trajectory and onset of ADL disability, as well as to explore the variation in IC trajectory and predict five-year risks of ADL disability considering the heterogeneity in the elderly population. Results: The average baseline IC score was 7.15 (range: 0-15). We observed that IC scores slowly decreased with age, with 17.25% of participants developing ADL disability. We identified three classes of IC, which could be described as moderate health (class 1: n = 1634, 62.63%), at-risk (class 2: n = 716, 27.44%; had the highest risk of ADL disability), and optimal health (class 3: n = 259, 9.93%; had the lowest baseline risk of ADL disability). The probability of being in the moderate health class was decreased the most by emotional problems (odds ratio (OR) = 0.219; P < 0.001). Having a self-rated poor standard of living substantially reduced the chances of moderate (OR = 0.308; P = 0.001) and optimal health (OR = 0.110; P < 0.001). Conclusions: Observing IC trajectories and the onset of ADL disability can stratify the elderly into heterogeneous groups, as well as provide data for implementing person-centred care plans to reverse the trend and delay the adverse outcomes in clinical practice.

Burden of leprosy and associated risk factors for disabilities in Tanzania from 2017 to 2020.

BACKGROUND: Leprosy is caused by Mycobacterium leprae which affects skin, nerves, eyes, and nasal mucosa. Despite global elimination efforts, Tanzania remains among 13 countries reporting more than 1000 leprosy cases annually. In 2021, Tanzania identified 1,511 new cases, with 10% having grade II disability. Moreover, 14 councils recorded leprosy rates exceeding 10 cases per 100,000 population. This study aimed to assess the burden of leprosy and associated risk factors for disabilities in Tanzania from 2017 to 2020. METHODOLOGY: A retrospective cross-sectional study was conducted to investigate all registered treated leprosy patients from January 2017 to December 2020. The Leprosy Burden Score (LBS) was used to assess the disease burden, while binary logistic regression was employed to evaluate the risk factors for disability. RESULT: A total of 6,963 leprosy cases were identified from 2017 to 2020. During this period, the point prevalence of leprosy declined from 0.32 to 0.25 per 10,000 people, and the new case detection rate decreased from 3.1 to 2.4 per 100,000 people; however, these changes were not statistically significant (p > 0.05). Independent risk factors for leprosy-related disabilities included male sex (Adjusted Odds Ratio (AOR) = 1.38, 95% Confidence Interval (CI) 1.22-1.57), age 15 years and above (AOR = 2.42, 95% CI 1.60-3.67), previous treatment history (AOR = 2.18, 95% CI 1.69-2.82), and positive Human Immunodeficiency Virus (HIV) status (AOR = 1.60, 95% CI 1.11-2.30). CONCLUSION: This study identified male sex, older age, positive HIV status, and prior treatment history as independent risk factors for leprosy-related disabilities. Additionally, despite the observed decline in point prevalence and new case detection rates, these changes were not statistically significant. To address leprosy-related disabilities, it is crucial to implement specific prevention strategies that focus on high-risk groups. This can be accomplished by enhancing screening and contact tracing efforts for early patient identification to prevent delays in intervention. Further research is warranted to analyze the burden of leprosy over a more extended period and to explore additional risk factors not covered in this study.

Trends in Medical Encounters Involving Cannabis-Related Disorders Among US Medicare Beneficiaries, 2017-2022.

Objectives. To characterize cannabis-related disorder medical encounter trends in the US Medicare population during 2017 to 2022. Methods. We conducted a descriptive study, which included 56 624 432 beneficiaries aged 65 years or older and 10 247 953 aged 18 to 64 years with disability. All were continuously enrolled in Medicare (Fee-for-Service or Advantage) for 183 or more days before the first day of the calendar year. We identified cannabis-related disorder encounters using International Classification of Diseases, 10th Revision, Clinical Modification diagnosis codes and computed annual encounter rates per 10 000 beneficiaries. We used the Mann-Kendall test to analyze trends over time. Results. Annual cannabis-related disorder encounter trends among beneficiaries aged 65 years or older ranged from 15.9 (95% confidence interval [CI] = 15.8, 16.0) to 39.3 (95% CI = 39.1, 39.5) per 10 000. Rates among beneficiaries aged 18 to 64 years with disability ranged from 274.8 (95% CI = 273.6, 276.0) to 373.7 (95% CI = 372.3, 375.2) per 10 000. Rates increased over time across both groups, with average annual increases of 4.3 (95% CI = 3.3, 5.3; P = .01) and 17.1 (95% CI = 11.0, 23.2; P = .02) per 10 000, respectively. Conclusions. Further work is needed to explore the impact of coexisting medical conditions on outcomes that result from cannabis-related disorders. (Am J Public Health. 2024;114(S8):S694-S697. https://doi.org/10.2105/AJPH.2024.307729).

The Impact of Severe Heart Disease on Causes of Death and Survival after Disability Retirement. / O Impacto da Cardiopatia Grave nas Causas de Óbito e Sobrevida após Aposentadoria por Invalidez.

BACKGROUND: Noncommunicable diseases contribute to premature deaths and limitations. Disability retirement is linked to chronic conditions, particularly cardiovascular diseases. The II Brazilian Guideline for Severe Heart Disease established criteria for cardiovascular disease classification. However, there is a lack of research in this topic within federal institutions. OBJECTIVES: Evaluate the survival and causes of death among disabled retirees at UFRJ, focusing on the impact of severe heart disease. METHODS: A retrospective cohort study based on retirement and death records over 15 years. Retirements were categorized into three groups: full retirement due to severe heart disease, full retirement due to other diseases and proportional. Causes of death were obtained from death certificates. Mortality rates, survival and the presence of matching diagnoses between retirement and death were evaluated. Chi-square, log-rank, Cox models, Kaplan-Meier curves were utilized. Statistical significance with a 95% confidence interval, considering p<0.05. RESULTS: There were 630 retirements, 368 (51.4%) in females, with an average age of 52.9 (SD=7.8) years, and 169 (26.8%) deaths. Mortality was higher in professors (37.0%; p=0.113), in the age group between 65 and 70 years (48.4%; p=0.004), in males (34.0%; p=0.001), and in full retirements due to severe heart disease (41.5%; p<0.001). Matching diagnoses between retirement and death were more frequent in professors (74.1%; p=0.026) and in full retirements due to severe heart disease (72.7%; p<0.001). CONCLUSIONS: Severe heart disease diagnosis is associated with higher mortality and shorter survival in disabled retirees. Its frequent occurrence in retirement and death diagnoses underscores its significance in this context.

FUNDAMENTO: As doenças não comunicáveis são responsáveis por mortes prematuras e limitações. A aposentadoria por invalidez está associada a condições crônicas, especialmente a doenças cardiovasculares. A II Diretriz Brasileira de Cardiopatia Grave definiu critérios para enquadramento das doenças cardiovasculares. Poucos estudos abordam esse tema em instituições federais. OBJETIVOS: Avaliar sobrevida e causas de óbito de servidores aposentados por invalidez na UFRJ, com ênfase no impacto da cardiopatia grave. MÉTODOS: Estudo de coorte retrospectivo baseado nos registros de aposentadorias e óbitos ao longo de 15 anos. As aposentadorias foram divididas em três grupos: integral por cardiopatia grave, integral por outras doenças e proporcional. As causas de óbito foram obtidas a partir das certidões de óbito. Foram avaliadas taxa de mortalidade, sobrevida e a presença de diagnósticos concordantes entre a aposentadoria e o óbito. Foram utilizados testes qui-quadrado, log-rank, modelos de Cox e curvas de Kaplan-Meier. Significância estatística com intervalo de confiança de 95%, considerando p < 0,05. RESULTADOS: Foram 630 aposentadorias, 368 (51,4%) no sexo feminino, com idade média de idade de 52,9 (DP=7,8) anos, e 169 (26,8%) óbitos. A mortalidade foi maior nos professores (37,0%; p=0,113), na faixa etária entre 65 e 70 anos (48,4%; p=0,004), no sexo masculino (34,0%; p=0,001), e nas aposentadorias integrais por cardiopatia grave (41,5%; p < 0,001). Diagnósticos concordantes entre aposentadoria e óbito foram mais frequentes em professores (74,1%; p=0,026) e nas aposentadorias integrais por cardiopatia grave (72,7%; p < 0,001). CONCLUSÕES: O diagnóstico de cardiopatia grave confere maior taxa de mortalidade e menor sobrevida aos aposentados por invalidez, e sua presença em maior frequência nos diagnósticos de aposentadoria e óbito ressalta sua importância neste contexto.

Economic burden of sarcopenia-related disability in the elderly population: a study in Iran.

OBJECTIVE: Sarcopenia is linked to escalating health costs, heightened risk of physical disability, diminished quality of life and an increased demand for care services. This study aimed to assess the economic impact of sarcopenia-related disability in Iran. A prevalence-based economic burden study was conducted utilizing the Population Attributable Risk (PAR) method, based on 2022 price index. Prevalence data for sarcopenia, categorized by gender and disease severity, were extracted from recent comprehensive studies. The relative risk of sarcopenia disability was determined from the most robust available evidence. Subsequently, direct medical costs, direct non-medical costs, and indirect costs for each individual with sarcopenia were computed and adjusted to 2022 values to estimate disability costs. RESULTS: Taking into account the prevalence of sarcopenia and the Iranian population across various age groups, 2,192,168 adults aged ≥ 60 years with sarcopenia in Iran were included. The total PAR of sarcopenia for men and women was estimated at 49% and 28%, respectively. The cumulative direct medical costs, direct non-medical costs, and indirect costs amounted to $215.1 million, $7.76 million, and $34.1 million, respectively. Additionally, the average total economic burden of sarcopenia-related disability in Iranian population aged ≥ 60 years was estimated at $257.1 million.

Weight-adjusted waist index and disability: a cohort study from CHARLS.

BACKGROUND: The association between weight-adjusted waist index (WWI) and disability is unclear. This study aimed to assess the relationship between WWI and disability in middle-aged and elderly Chinese individuals and provide more predictive indicators for disability prevention. METHODS: In this study, 13,015 middle-aged and older adults aged 45 years and above who were surveyed in 2011 by the China Health and Aging Tracking Survey (CHARLS) database were selected, and 8344 respondents with complete data were included for cohort analysis after seven years of follow-up. Information on clinical demographic characteristics, anthropometric indices, assessment of disability, and related covariates were collected, and the presence or absence of disability was assessed by the disability scale. WWI was calculated by dividing the waist circumference (cm) by the square root of the body weight (kg). Cox proportional hazards model was used to analyze the association between WWI and disability after follow-up. RESULTS: Our study found that 2912 of 8344 participants had disability after seven years of follow-up, and disability incidence was approximately 34.9%. Age, sex, place of residence, chronic disease, depression, waist circumference, and WWI were significantly associated with disability in univariate analysis. Among them, there was a positive association between WWI as a continuous variable and incidence of disability (hazard ratio (HR) = 1.26, 95% CI: 1.22-1.31, p < 0.001). WWI was transformed into categorical variables using quartiles as cutoffs for disability regression analysis. After adjusting covariates, HR values in the 2nd, 3rd and 4th quantile showed an increasing trend compared with the 1st quantile, and the risk of disability among WWI subjects in the 4th quantile increased by 43% (95% CI: 1.24-1.64). P values for the trend test in the model were all < 0.001. In subgroup analyses, the positive association between WWI and risk of disability remained robust for sex, age, alcohol consumption, smoking status, education level, marital status, and place of residence after adjusting for all covariates considered in this study. CONCLUSIONS: WWI is a new and reliable obesity-related indicator that can be used for disability prevention. WWI can be detected and controlled for reducing the risk of disability.

Prevalence of, and Disability Due to, Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder in Japan by the Fifth Nationwide Survey.

BACKGROUND AND OBJECTIVES: All 4 previous nationwide surveys of multiple sclerosis (MS) in Japan were conducted before the discovery of anti-aquaporin-4 (AQP4) antibodies; thus, neuromyelitis optica spectrum disorder (NMOSD) was included in MS, as optic-spinal MS. We aimed to clarify the epidemiologic features and trends of MS and NMOSD in Japan separately using a fifth nationwide survey. METHODS: The primary survey, in which a questionnaire was sent to 3,799 selected departments (including neurology/internal medicine, pediatrics, and ophthalmology), explored the estimated number and prevalence of patients with MS or NMOSD in 2017, and the secondary survey collected detailed characteristics of the patients using a second questionnaire. RESULTS: The response rates for the primary and secondary surveys were 60.1% and 53.9%, respectively. The estimated total number of patients with MS or NMOSD was 24,800, 2.5-fold higher than that in the fourth survey in 2003. The crude prevalence was 19.6 per 100,000 patients (14.2 for MS and 5.4 for NMOSD), compared with 7.7 per 100,000 patients in the fourth survey. Patients with MS showed milder disability (median Expanded Disability Status Scale [EDSS] score: 2.0 [interquartile range 1.0-4.5] vs 2.5 [1.0-6.0]), decreased secondary progression (8.5% vs 15.2%), and increased usage of disease-modifying drugs (63.7% vs 37.2%) compared with those with conventional MS in the fourth survey. The proportions of oligoclonal bands and Barkhof criteria fulfillment on MRI, which are features of classical MS, increased with advancing year of birth. Patients with NMOSD also showed less disability and shorter disease duration than patients with optic-spinal MS in the fourth survey (EDSS score: 3.5 [2.0-5.5] vs 3.8 [2.0-6.0]; disease duration: 8.0 [3.9-14.8] vs 10.0 [5.0-16.0]). Among patients with NMOSD, disability was exacerbated by a history of longitudinally extensive spinal cord lesions and anti-AQP4 antibody positivity, which both decreased with advancing year of birth. DISCUSSION: The prevalences of MS (particularly with classical features) and NMOSD have been increasing in Japan, suggesting the contribution of environmental factors. However, disabilities in patients with MS and NMOSD have been mitigated. Extensive usage of various disease-modifying drugs could be a factor contributing to this disability mitigation in MS.