Disparities in mortality by disability: an 11-year follow-up study of 1 million individuals

Abstract

Objectives: This longitudinal study examines to what extent the risk of mortality—all-cause, natural death, suicide, and unintentional injury mortality—differs by types and severity of disabilities as well as disability status. Methods: Data were the National Sample Cohort of 1,025,340 individuals in South Korea followed from 2002 to 2013. Cox regression with time-variant variables was used to estimate the hazard ratio of mortality by disability. Results: Individuals with disabilities had a higher risk of mortality compared to those without (HR 1.84, 95% CI 1.80–1.88 for natural death; HR 1.83, 95% CI 1.64–2.03 for suicide; HR 1.54, 95% CI 1.38–1.71 for unintentional injury). All types of disability were associated with an increased risk of natural death. Individuals with mental disability were the highest risk group for suicide (HR 7.14, 95% CI 5.31–9.60). People defined as having severe disability had an elevated risk for all categories of mortality. Conclusions: Disabilities are important markers of high risk of mortality. Findings call for actions to reduce mortality risk of people with disabilities, including preventing suicidal behaviors of those with mental disability. © 2017 Swiss School of Public Health (SSPH+)