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Epidemiology
Original research
Self-reported disability in relation to mortality in rural Malawi: a longitudinal study of over 16 000 adults
  1. Josephine E Prynn1,2,
  2. Albert Dube2,
  3. Joseph Mkandawire2,
  4. Olivier Koole3,
  5. Steffen Geis2,3,
  6. Elenaus Mwaiyeghele2,
  7. Oddie Mwiba2,
  8. Alison J Price3,
  9. Lackson Kachiwanda2,
  10. Moffat Nyirenda3,4,
  11. Hannah Kuper5,
  12. Amelia C Crampin2,3
  1. 1Institute of Cardiovascular Science, University College London, London, UK
  2. 2Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
  3. 3Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
  4. 4NCD Phenotype Programme, MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Wakiso, Uganda
  5. 5Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Josephine E Prynn; josephineprynn{at}gmail.com

Abstract

Objectives We investigated whether self-reported disability was associated with mortality in adults in rural Malawi.

Setting Karonga Health and Demographic Surveillance Site (HDSS), Northern Malawi.

Participants All adults aged 18 and over residing in the HDSS were eligible to participate. During annual censuses in 2014 and 2015, participants were asked if they experienced difficulty in any of six functional domains and were classified as having disabilities if they reported ‘a lot of difficulty’ or ‘can’t do at all’ in any domain. Mortality data were collected until 31 December 2017. 16 748 participants (10 153 women and 6595 men) were followed up for a median of 29 months.

Primary and secondary outcome measures We used Poisson regression to examine the relationship between disability and all-cause mortality adjusting for confounders. We assessed whether this relationship altered in the context of obesity, hypertension, diabetes or HIV. We also evaluated whether mortality from non-communicable diseases (NCD) was higher among people who had reported disability, as determined by verbal autopsy.

Results At baseline, 7.6% reported a disability and the overall adult mortality rate was 9.1/1000 person-years. Adults reporting disability had an all-cause mortality rate 2.70 times higher than those without, and mortality rate from NCDs 2.33 times higher than those without.

Conclusions Self-reported disability predicts mortality at all adult ages in rural Malawi. Interventions to improve access to healthcare and other services are needed.

  • epidemiology
  • hypertension
  • general diabetes
  • HIV & AIDS
  • public health
https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjopen-2019-034802

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    Footnotes

    • Contributors Conceptualisation: OK, AP, HK, AC. Funding acquisition: MN, AC. Design: AD, SG, AP. Project administration: AD, JM, EM, OM. Supervision of data collection: AD, OK, SG, EM, AP, LK. Data curation: OM. Analysis: JEP, AC. Original draft preparation: JEP, HK, AC. Review and editing of manuscript: JEP, AD, JM, OK, SG, EM, OM, AP, LK, MN, HK, AC.

    • Funding This work was supported by the Wellcome Trust (grant number 098610).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval for the HDSS census rounds and NCD survey was granted by the National Health Sciences Research Committee (NHSRC) (protocol numbers 419 and 1072, respectively), and by the London School of Hygiene and Tropical Medicine (LSHTM) (protocol numbers 5081 and 6303, respectively).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Data from the NCD survey are available from LSHTM Data Compass: Malawi Epidemiology and Intervention Research Unit Non-Communicable Disease Survey data, 2013–2017, https://doi.org/10.17037/DATA.0000096136. Data are available under the terms of the Creative Commons Attribution 3.0 International License (CC-BY 3.0). Summary demographic data sets are publicly available through the INDEPTH iShare platform. Longitudinal data (demographic surveillance episodes and linked rounds of disability questionnaires) cannot be sufficiently deidentified for public availability. Application may be made for access through the MEIRU director (mia.crampin@lshtm.ac.uk) or data scientist Chifundo Kanjala (chifundo.kanjala@lshtm.ac.uk). Those wishing to access the data will need to provide a brief proposal for what the data will be used for as a condition of access.