Variations in disability and quality of life with age and sex between eight Lower and Middle Income Countries: data from the INDEPTH WHO-SAGE collaboration

Francesc Xavier Gomez-Olive, Julia Schröders, Isabella Aboderin, Peter Byass, Somnath Chatterji, Kathleen Kahn, Paul Kowal, Rose Nathan, Nawi Ng, Abdur Razzaque, Osman Sankoh, Peter K Streatfield, Stephen Tollman, Siswanto A Wilopo, Miles D. Witham

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Disability and quality of life are key outcomes for older people. Little is known about how these measures vary with age and gender across lower and middle income countries; such information is necessary to tailor health and social care policy to promote healthy ageing and minimise disability.


We analysed data from participants aged 50 years and over from health and demographic surveillance system sites of the INDEPTH Network in Ghana, Kenya, Tanzania, South Africa, Vietnam, India, Indonesia and Bangladesh, using an abbreviated version of the WHO Study on global AGEing survey instrument. We used the eight-item WHOQoL tool to measure quality of life, and the WHODAS-II tool to measure disability. We collected selected health status measures via the survey instrument, and collected demographic and socioeconomic data from linked surveillance site information. We performed regression analyses to quantify differences between countries in the relationship between age, gender and both quality of life and disability, and we used anchoring vignettes to account for differences in interpretation of disability severity.


We included 43,935 individuals in the analysis. Mean age was 63.7 years (SD 9.7) and 24,434 (55.6%) were women. In unadjusted analyses across all countries, WHOQoL scores worsened 0.13 points (95%CI 0.12-0.14) per year increase in age; WHODAS scores worsened 0.60 points (95%CI 0.57-0.64). WHODAS-II and WHOQoL scores varied markedly between countries, as did the gradient of scores with increasing age. In regression analyses, differences were not fully explained by age, socioeconomic status, marital status, education or health factors. Differences in disability scores between countries were not explained by differences in anchoring vignette responses.


The relationship between age, sex and both disability and quality of life varies between countries. The findings may guide tailoring of interventions to individual country needs, although these associations require further study.
Original languageEnglish
Article numbere000508
Number of pages12
JournalBMJ Global Health
Issue number4
Publication statusPublished - 20 Dec 2017


  • Ageing
  • Quality of life
  • Global health
  • Disability
  • INDEPTH Network


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