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8th Washington group Assessing the consequences of chronic diseases on functional health

8th Washington group Assessing the consequences of chronic diseases on functional health. Emmanuelle Cambois INED Resarch Unit « Mortality, Health, epidemiology ». Disability. Functional Limitations. Potentially disabling diseases. Activity restrictions. Sensory & physical.

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8th Washington group Assessing the consequences of chronic diseases on functional health

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  1. 8th Washington groupAssessing the consequences of chronicdiseases on functionalhealth Emmanuelle Cambois INED Resarch Unit « Mortality, Health, epidemiology »

  2. Disability Functional Limitations Potentially disabling diseases Activity restrictions Sensory & physical difficulty to see, walk, grip, to see, to ear, to bend… Operationalization of the conceptual frameworkCambois E, Robine JM. Revue de littérature sur les instruments de mesure des limitations fonctionnelles : approches en population générale et auprès de patients. Rapport intermédiaire à la Direction Générale de la Santé. Déc 2005, 43p

  3. Disability Functional Limitations Potentially disabling diseases Activity restrictions Sensory & physical Difficulty with personal care activities, chore activities, work... difficulty to see, walk, grip, to see, to ear, to bend… Operationalization of the conceptual frameworkCambois E, Robine JM. Revue de littérature sur les instruments de mesure des limitations fonctionnelles : approches en population générale et auprès de patients. Rapport intermédiaire à la Direction Générale de la Santé. Déc 2005, 43p • Disability: various perceptions, variousexperiences, variousneeds • Functional limitations: sensory and physical • Self-reportedwork / domestic / personal care activities

  4. 40 Restrictions d'activité seulement Limitations et restrictions d'activité 35 Limitations fonctionnelles (résiduelles) seulement 100% 100% 30 90% 90% 25 80% 80% 20 70% 70% 60% 60% 15 50% 50% 10 40% 40% 5 30% 30% 20% 20% 0 Cérébro - Respi - Endocri - Appareil Cardia- Ostéo - Trauma- Divers tumeurs endocrin. tr. mentaux syst nerveux œil app. auditif cardiaques cérébrovasc. artères syst. resp. ostéoartic. trauma divers Men - Système Tumeurs Œil Artères vasculaires ratoires niennes auditif ques articulaires tismes 10% 10% tales nerveux 0% 0% Diseases and disabilityFunctional limitations (23%) et activity restrictions ADL, IADL, work (17,5%)

  5. Method • Logisticregression(controlled for age, sex and anyotherpotentiallydisabling condition) • Diseases and variousdisabilityexperiences : • Work/household/personal care activity restrictions • Personal care ?

  6. Social recognition Of disability Pains Treatments Psychological distress Model Model From diseases to activity restriction … and other factors

  7. Method • Logisticregression(controlled for age, sex and anyotherpotentiallydisabling condition) • Diseases and variousdisabilityexperiences : • Work/household/personal care activity restrictions • Personal care • Factors: diseases and Work/household/personal care activity restrictions • Functional limitations • FL + High numbvisit to hospital or physicians • FL + Bad SPH • FL + Admdisabilitystatus • FL + Pain • FL + High numbvivits + bad SPH + admstatus.

  8. The other factors of activity restriction

  9. 2. Factors: some examplesOdds ratios Activity restrictions Eyes and auditory system 12,00 11,00 10,00 9,00 8,00 7,00 6,00 5,00 4,00 3,00 2,00 1,00 0,00 LF LF LF LF+SP LF+SP LF+SP LF+reconn LF+reconn LF+reconn LF+douleur LF+douleur LF+douleur Modèle brut Modèle brut Modèle brut LF+traitement LF+traitement LF+traitement LF+SP+reconn+trait LF+SP+reconn+trait LF+SP+reconn+trait Disabling nerv. diseases Epilepsy Other nervous syst Strabism Blindness Deafness diseases Nervous system

  10. 2. Factors: some examples Respiratory system Mental conditions

  11. Diseases et disability experiences • No disability (missingfunctional limitations / non-disablingdiseases) • Functional limitations only (non-malignan cancer, auditaroryproblemsotherthandeafness…) • Activity restrictions explained by body functionalterations : overweight, deafness, traumas … and sidefactors : circulatory and respiratorydiseases (traitments, badperceivedhealth), mainlyamoung the youngerages (< 50 yearsold)

  12. ? ? Diseases et disability experiences • Activity restrictions that are not totallyexplained by our variables : degenerativediseases, diabetes, osteo-articualr, malformations… • Activity restrictions that are not explained by FL (mainlyamoung the youngest) : • Strabism, skin diseases to whichoursidefactorscontribute… • cancers, epilepsywhichremainlargellyunexplained • Diseases are some time evolutive and may go throughthesedifferent types of experiences

  13. Summary • Differentdisabilityexperiences • Someappear to be more self-perceived / other more visible (mental diseases, malformations, disablingnervousdiseases) • Different « causes » for theseexperiences • Explained by the associatedfunctional limitations (weightproblems, deafness, some traumas…) • Explained by functional limitations and co-factors (circulatory and respiratorydiseases) / onlyparltyexplained (disablnerv. systdiseases, diabetes, osteo, dysformations…) • Explained by co-factorsonly (strabism, skin diseases) / onlypartlyexplained (some cancers, epilepsy) Possibility to describeeachdisease, regarding the disabilityexperience and itsdeterminants

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