Original articles
Is stroke the most common cause of disability?

https://doi.org/10.1016/j.jstrokecerebrovasdis.2004.06.003Get rights and content

Abstract

Background: It is widely stated that stroke is the most common cause of severe disability. We aimed to examine whether this claim is supported by any evidence. Methods: We conducted secondary analysis of the Office of National Statistics 1996 Survey of Disability, United Kingdom. This was a multistage stratified random sample of 8683 noninstitutionalized individuals aged between 16 and 101 years, mean 62 years, response rate 83% (n = 8816). The outcome used was the Office of Population Censuses and Surveys severity scale for disability. Odds ratios and population-attributable fractions were calculated to examine the associations between diagnoses and disability. Results: Logistic regression modelling suggests that, after adjustment for comorbidity and age, those with stroke had the highest odds of reporting severe overall disability (odds ratio 4.88, 95% confidence interval [CI] 3.37–6.10). Stroke was also associated with more individual domains of disability than any of the other conditions considered. Adjusted population-attributable fractions were also calculated and indicated that musculoskeletal disorders had the highest population-attributable fraction (30.3%, 95% CI 26.2–34.1) followed by mental disorders (8.2%, 95% CI 6.9–9.5) and stroke (4.5%, 95% CI 3.6–5.3). Conclusion: Stroke is not the most common cause of disability among the noninstitutionalized United Kingdom population. However, stroke is associated with the highest odds of reporting severe disability. Importantly, stroke is associated with more individual domains of disability compared with other conditions and might be considered to be the most common cause of complex disability.

Section snippets

Disability survey 1996

The Office of National Statistics (ONS) Disability Survey was on the basis of a follow-up survey of disabled respondents from the 1996/1997 Family Resources Survey. Those who matched at least one of a series of criteria on the basis of age, benefit receipt, or reported health problems were asked to take part in a further interview, which was concerned with more detailed questions on health symptoms and difficulties performing everyday activities. It consisted of all the questions needed to

Results

Of the 8863 participants, 7168 answered the questions relating to disability, a total of 5704 reporting some level of disability. Table 1 shows the age distribution of disability and diseases. Disability increases with age and is very common, affecting the majority of participants at all ages. Table 2 shows the mean disability severity score for a range of conditions and the results of a regression analysis describing the relationship between disability and each chronic condition adjusting

Discussion

It is clear that the way the association between disability and chronic illness is considered will alter the conclusions drawn. For example, when we consider the proportion of those with severe disability who report each of the chronic conditions and the PAF, musculoskeletal disorders appear to be the most important. Stroke, by contrast, although being strongly associated with severe disability, is relatively uncommon compared with musculoskeletal disorders, and consequently has one of the

Acknowledgements

This study was funded by the Stroke Association UK. The views presented here are those of the authors and not necessarily those of the Stroke Association UK.

References (22)

  • J. Martin et al.

    The prevalence of disability among adultsOPCS surveys of disability in Great Britain; report 1

    (1988)
  • Cited by (0)

    View full text