A new study of over 175,000 people in 25 countries revealed that individuals in low- and middle-income countries face greater challenges with daily activities and are less likely to use assistive devices compared to those in high-income countries. These findings raise concerns about the global burden of disability, particularly in low-income countries.
Despite decreases in death and cardiovascular disease rates and increases in life expectancy worldwide, people in low- and middle-income countries still experience significantly worse health outcomes than those in high-income countries. Less is known, however, about the global prevalence of disabilities and how they differ between countries. In the first prospective study of its kind in 25 countries, over 175,000 participants were surveyed about limitations in mobility, vision, and hearing. The study found that activity limitations are common worldwide, with the most frequent being difficulties in walking, bending, and seeing. A third of the participants reported at least one limitation, with these issues being particularly prevalent among older adults and women.
Activity limitations were more common in low and middle-income countries compared to high-income countries, including two-times higher walking impairment and five-times higher visual impairment.
"Current data on activity limitations and how they affect health around the world are limited," said Raed Joundi, first author of the study and a scientist at the Population Health Research Institute (PHRI), a joint research institute of McMaster University and Hamilton Health Sciences. "Our research aimed to fill this gap by looking at the prevalence of basic activity limitations, the use of assistive devices, and health outcomes in 25 countries."
The study is part of the ongoing Prospective Urban Rural Epidemiological (PURE) study, coordinated by PHRI and led by Salim Yusuf, senior scientist at PHRI. Published in The Lancet on July 25, 2024, the study collected data from participants aged 35 to 70 years old using standardized questionnaires and followed them for an average of 11 years and up to 20 years.
Activity limitations in daily life can be alleviated or rectified by using low-cost devices such as canes or glasses. However, the research showed that despite the much higher percentage of people with activity limitations in low and middle-income countries, the use of simple devices like canes or walkers, glasses, and hearing aids was less than half of that in high-income countries.
"Having access to assistive devices when needed, like glasses and walking aids, is essential for achieving a person's potential despite having disabilities and improving quality of life," stated Yusuf. "The limited access to assistive devices in low and middle-income countries represents an important opportunity for health policies and interventions."
Movement limitations were linked to serious health problems. For example, difficulties with walking were associated with higher risks of death and other health issues, including cardiovascular disease, pneumonia, and falls.
"The striking differences between high-income and low and middle-income countries in our study highlight the need for policies and programs to make sure people with disabilities have access to simple assistive devices and other resources needed to maintain their health" added Joundi.
"We also need to better understand the factors contributing to these activity limitations and develop public health strategies to prevent them from happening in the first place, so people can live longer, healthier, and happier."
The PURE study is supported by several Canadian health agencies including Canadian Institutes of Health Research, Heart and Stroke Foundation of Ontario and the Ontario Ministry of Health, along with unrestricted grants from several pharmaceutical companies, the PHRI and the Hamilton Health Sciences Research Institute, with additional contributions from various national or local organizations in participating countries.
