Determining public health priorities for an ageing population: the value of a disability survey

In order to determine which diseases and health problems were most strongly associated with long-term disability among the Thai elderly and to determine their public health priority, a national cross-sectional multistage random sampling survey was conducted in 1997. Four thousand and forty-eight Thai older persons aged 60 years and over were recruited and interviewed by trained interviewers. Overall, 769 (19%) people reported having a long-term disability. Participants with long-term disability (LD) reported having between one and 21 long-term diseases or health problems. Eighteen of these problems were independently associated with LD in logistic regression analysis. Nearly half of the cases with LD (46.4%) suffered from two or more health problems. The odds of LD increased with the number of problems suffered. The problems contributing most to the population burden of disease as assessed by population attributable risk fractions were hemiparesis, arthritis, accidents (unintentional injuries), blindness and other eye diseases, kyphosis, weakness of limbs, deafness, and hypertension. This ranking of public health priority differs from conventional approaches using mortality statistics and disability adjusted life years (DALYs). In conclusion, national disability surveys provide a valuable means of assessing the population burden of disability and determining the underlying causes of disability. These methods provide a direct assessment of disability prevalence and disease priorities for rapidly ageing transitional countries where death certification may be incomplete or inaccurate.