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PubMed1997

Classification, prevalence, prevention and rehabilitation of intellectual disability: an overview of research in the People's Republic of China.

The People's Republic of China is a developing country with all the problems and challenges that face such countries all over the world. Progress has been hampered by scarcity of resources, and a lack of relevant information and appropriate skills, as well as by the stigma traditionally attached to people with intellectual disability. The present rapid economic development has made possible further improvement and expansion of educational opportunities, and health and rehabilitation services. According to a recent census and sample surveys conducted in the People's Republic of China, the overall prevalence rate of people with disabilities was estimated to 4.9%. Thus, China has more individuals with disabilities than any other country in the world. According to these figures, the prevalence of intellectual disability in the population is approximately 1%. For children younger than 14 years of age, the prevalence is around 2%, which accounts for 66% of all handicapped children, making it the most frequent childhood disability. Today, the existing medical facilities, and educational and social welfare organizations cannot meet the tremendous need of care and services. The problems of the large number of disabled children and adults are a major challenge for contemporary Chinese society. This paper is devoted to research pertinent to intellectual disability in China. With a few exceptions, only publications in the English language were included in this review, which makes the overview selective rather than comprehensive. Publications on classification systems and diagnostic criteria, screening methods and assessment instruments, prevalence rates, aetiology and risk factors, prevention and intervention efforts, special education, and families with children with intellectual disability are presented.

Adaptation, Psychological↗

PubMed1997

Schizophrenia in people with intellectual disability: the role of pregnancy and birth complications.

The literature suggests that mental illness is more common in people with intellectual disability than in the general population. Having reviewed the literature, Turner (1989) [Psychological Medicine 19, 301-14] suggested that about 3% of people with intellectual disability also have schizophrenia. As pregnancy and birth complications (PBCs) occur more commonly in people with intellectual disability than in the general population and are also implicated in the aetiology of schizophrenia, it is possible that these conditions share a common aetiology. This study reports on the occurrence of PBCs in those people with intellectual disability who develop schizophrenia. Fifty people with intellectual disability and schizophrenia were matched for age, sex, degree of intellectual disability and presence of epilepsy with a control group who did not suffer from schizophrenia or a schizophreniform psychosis. The obstetric history was obtained and events rated on a scale specifically designed for this study. This PBCs scale consists of six sub-scales covering areas of general maternal health, pregnancy, delivery, medication in labour, total medication score and neonatal score, as well as an overall total score. The study found that people with intellectual disability who develop schizophrenia have significantly higher rates of PBCs than controls. All of the sub-scales on the PBCs scale were significantly higher in people with schizophrenia, with the exception of the medication scales. Only five out of the 50 people with schizophrenia had not had a major obstetric complication, compared to 13 subjects from the control group. A number of abnormalities were specifically higher in people who later developed schizophrenia. These included: abnormally long or short labour; maternal episiotomy; maternal preeclamptic toxaemia; induction of labour; dysmaturity; maternal smoking in pregnancy; and a delay in neonatal crying. The results suggest that PBCs are important in the aetiology of schizophrenia in people with intellectual disability.

Adult↗

PubMed2006

Determinants of disability in everyday activities differ in primary and cervicogenic headaches and in low back pain.

The aim of this study was to test whether the association between disability and depressive symptoms in patients with cervicogenic headache is similar to that found in primary headaches or to the pattern found in low back pain. During a 2-year period, 716 consecutive patients with the clinical diagnosis of cervicogenic headache (n=182), low back pain (n=116), migraine (n=231), tension-type headache (n=176), and cluster headache (n=11) filled in the Beck Depression Inventory (BDI). Disability was scored by the migraine disability score questionnaire reflecting the number of days with lost or decreased work, household and social activities. Non-parametric tests and multiple general regression were used for statistical analysis. In multivariate testing, significant independent determinants of disability were pain frequency, pain intensity and the severity of depressive symptoms in migraine and tension-type headache; pain frequency and the BDI score in cervicogenic headache, and pain frequency alone in low back pain. Disability is related to pain frequency in all pain syndromes evaluated in the present study. The level of disability is associated with the severity of pain only in primary headaches, but not in pain syndromes of vertebral origin (cervicogenic headache and low back pain). Disability is associated with the severity of depressive symptoms in all headache types but not in low back pain. Both the location and the etiology of pain have importance in determining the interrelationship between pain characteristics, depression and disability.

Activities of Daily Living↗

PubMed1985

Storage-retrieval processes of normal and learning-disabled children: a stages-of-learning analysis of picture-word effects.

Previous research comparing acquisition performance of learning-disabled and normally achieving children has led to the suggestion that the locus of memory differences lies in either the storage or retrieval components of recall. In this paper we report a free-recall experiment in which a new stages-of-learning model was used to examine the effects of a picture-word manipulation on storage and retrieval differences between nondisabled and disabled grade 2 and 6 children. Although the results of this experiment were consistent with the idea that disabled students are poorer at memory tasks than nondisabled students, the stages-of-learning analysis provided information regarding the precise locus of the deficiencies. Specifically, although disabled and nondisabled children benefited from the presentation of information in pictorial format, normally achieving children were consistently better than their learning-disabled counterparts at storing and learning to retrieve both pictures and words. From a developmental standpoint, the most important finding was that while differences between learning-disabled and normally achieving students at storage remained age invariant, differences in learning to retrieve increased with age. As it turned out, however, differences between disabled and nondisabled children were absent when it came to retaining traces once they had been stored in memory and in retrieval performance between the time a trace was stored and retrieval learning was complete. These results are consistent with previous research in which it has been shown that the ability to learn how to reliably retrieve information that has been stored in memory develops more slowly for disabled than nondisabled children.

Age Factors↗

PubMed2006

Middle-aged and mobility-limited: prevalence of disability and symptom attributions in a national survey.

BACKGROUND: Lower limb mobility disabilities are well understood in older people, but the causes in middle age have attracted little attention. OBJECTIVES: To estimate the prevalence of mobility disabilities among noninstitutionalized adults in England and to compare the disabling symptoms reported by middle-aged and older people. DESIGN: Cross-sectional data from the 2002 English Longitudinal Study of Ageing (ELSA). Mobility disability was identified by level of reported difficulty walking a quarter mile. PARTICIPANTS: Eleven thousand two hundred sixteen respondents aged 50 years and older living in private households in 2002. RESULTS: The prevalence of difficulty walking a quarter mile increases sharply with age, but even in the middle-aged (50 to 64 years age-group) 18% (95% confidence interval [CI]: 16% to 19%) of men and 19% (95% CI: 17% to 20%) of women reported some degree of difficulty. Of the 16 main symptoms reported as causing mobility disability in middle age, 2 dominated: pain in the leg or the foot (43%; 95% CI: 40% to 46%) and shortness of breath/dyspnea (21%; 95% CI: 18% to 23%). Fatigue or tiredness, and stability problems were cited by only 5% and 6%, respectively. These proportions were slightly different from those in the 65 to 79-year age group: 40%, 23%, 6%, and 8%, respectively. CONCLUSIONS: Mobility (walking) disabilities in the middle-aged are relatively common. The symptoms reported as causes in this age group differ little from those reported by older groups, and are dominated by lower limb pain and shortness of breath. More clinical attention paid to disabling symptoms may lead to disability reductions in later life.

Activities of Daily Living↗

PubMed2005

Disability pattern in chronic migraine with medication overuse: a comparison with migraine without aura.

OBJECTIVES: To assess headache-related disability in chronic migraine with medication overuse (CMO), as defined by Silberstein and Lipton (1996, 2001) in comparison to that caused by migraine without aura, investigating similarities and differences in disability patterns in these two conditions. BACKGROUND: It is well known that migraine has a marked impact on daily activities. Less information is available on the functional consequences of chronic migraine. METHODS: This was a prospective study on 247 patients with CMO and 264 with migraine without aura. All completed the validated Italian version of the Migraine Disability Assessment questionnaire (MIDAS). The MIDAS total score and scores of each question (investigating total or partial inability to perform different daily activities) were evaluated, and compared in the two groups using the Mann-Whitney rank sum test. We also evaluated the number of missed days (question 1) and days with significantly reduced effectiveness at work (question 2) and in nonwork activities (questions 3, 4, and 5), using descriptive statistics. RESULTS: MIDAS total score in the CMO group was rather high (mean 84.1, median 70) and significantly higher than in the migraine group (mean 23.4, median 19). CMO patients also reported higher scores than migraine patients in MIDAS questions investigating disability in different domains, the differences being highly significant for questions 3, 4, and 5. In both CMO and migraine the number of days with total or significant disability in nonwork activities was higher than the number of days with total or significant disability in work activities, and days spent at work with significantly reduced effectiveness were more than work days missed. CONCLUSIONS: Our findings show that CMO has a profound effect on patients' daily functioning. They suggest that differences between CMO and migraine are mainly quantitative, while the two groups are similar in terms of disability pattern. These results are consistent with the fact that CMO may be an evolution of episodic migraine, characterized by increase in headache frequency and more evident disability in performing different daily duties.

Activities of Daily Living↗

PubMed2005

Depressive symptoms and insecure attachment as predictors of disability in a clinical population of patients with episodic and chronic migraine.

OBJECTIVES: To define predictors of migraine-related disability in patients with episodic and chronic migraine referred to a specialty migraine clinic, focusing on depressive symptoms and insecure attachment style that, because of their association with responses to pain and physical illness, might be predictive of greater migraine-related disability. BACKGROUND: The Migraine Disability Assessment questionnaire (MIDAS) has proved to be a reliable and easy-to-use instrument to assess migraine-related disability. As clinicians are increasingly using MIDAS in their diagnostic and treatment decisions for patient care, an understanding of the factors influencing migraine-related disability is essential for a rationale use of such an instrument. METHODS: Two-hundred patients suffering from episodic migraine without aura (EM), and chronic migraine (CM) with and without medication overuse, and referred to a specialty headache clinic were evaluated using the MIDAS, the Beck Depression Inventory (BDI), and the Attachment Style Questionnaire (ASQ). Diagnosis of episodic and chronic migraine was operationally defined according to the International Headache Society (IHS) and Silberstein-Lipton criteria. RESULTS: Multiple regression analysis showed that, in the total sample, disability was higher in those patients with CM, more severe depressive symptoms, an insecure style of attachment (as reflected by a lower score on the ASQ confidence scale), and experiencing more severe headache pain intensity. In the subgroup of patients with episodic migraine, an insecure style of attachment emerged as the most significant predictor of disability (other significant predictors were female sex and number of headache days per month). In contrast, in the subgroup of patients with CM, the only significant predictor of the total MIDAS score was a greater severity of depressive symptoms. CONCLUSIONS: Our findings demonstrate the relevance of attachment style, an enduring psychological trait not evaluated in previous studies, in influencing the disability level in patients with migraine and confirm the role of comorbid depressive symptoms in modulating the impact of migraine on every day functioning.

Adolescent↗

PubMed1996

Depression and disability in older people with impaired vision: a follow-up study.

OBJECTIVE: To determine the prevalence of depressive symptoms and their relationship to disability in older low vision patients. DESIGN: Panel study with 2-year follow-up. PARTICIPANTS: Community-residing older people (N = 31). MEASUREMENTS: Geriatric Depression Scale, Community Disability Scale, and Snellen visual acuity. RESULTS: Twelve of 31 patients (38.7%) had GDS scores > or = 11 at baseline. Two years later, 10 of these 12 patients remained depressed, and three of the 19 (15.8%) previously nondepressed patients had become depressed. Depressed patients tended to be more disabled functionally than nondepressed patients at follow-up. The correlation of disability with depression and with vision were examined for the entire sample and revealed a strong correlation between disability and depression (r = .40; P = .013) compared with that of disability and vision (r = .34; P = .032) at baseline and at follow-up: depression (r = .68; P = .001), vision (r = .45; P = .006). There was no significant correlation between depression and vision at baseline (r = .06; P = .383), but there was a trend toward correlation at follow-up (r = .28; P = .067). CONCLUSION: Depressive symptoms are prevalent and persistent among low vision patients and appear more highly related to disability than is vision. The frequent occurrence of depression and the availability of effective treatment argue for its recognition and treatment as possible ways to reduce disability in older persons with low vision.

Activities of Daily Living↗

PubMed1997

Disability in older adults: evidence regarding significance, etiology, and risk.

OBJECTIVES: This article synthesizes and assesses current evidence about the importance of physical disability to older adults. It then considers the applications of research findings to clinical geriatrics practice. RESULTS: Physical disability is a major adverse health outcome associated with aging. Certain subgroups of older adults, including individuals with mobility difficulty, with preclinical functional changes, and persons who are hospitalized, are at particularly high risk of becoming disabled or experiencing disability progression. The major underlying causes of physical disability are chronic diseases, including both acute events, such as hip fracture and stroke and slowly progressive diseases such as arthritis and heart disease. These diseases appear to have task-specific effects; understanding this may assist in setting treatment and prevention goals. Comorbidity, particularly certain combinations of chronic diseases, is a strong risk factor for disability in itself. Recent trials indicate that clinical interventions may be able to prevent onset or progression of disability. CONCLUSIONS: Available evidence now suggests clinical approaches to both treatment and prevention of disability and directions for defining optimal clinical care for the future.

Aged↗

PubMed1998

Emotional vitality among disabled older women: the Women's Health and Aging Study.

OBJECTIVE: To examine correlates of high overall level of emotional functioning (emotional vitality) in disabled older women. DESIGN: A community-based study: The Women's Health and Aging Study. POPULATION: A total of 1002 moderately to severely disabled women aged 65 and older living in the community. MEASUREMENTS: Emotional vitality was defined as having a high sense of personal mastery, being happy, and having low depressive symptomatology and anxiety. Correlations with demographics, health status, and social context were examined. RESULTS: Despite their physical disabilities, 35% of the 1002 disabled older women were emotionally vital. The percent of emotionally vital women declined with increasing severity of disability. After adjustment for disability status, a significantly increased likelihood for being emotionally vital was found for black race (OR=1.69) and for having higher income (OR=1.77), better cognition (OR=2.36), no vision problems (OR=1.61), adequate emotional support (OR=2.54), and many face-to-face contacts (OR=1.64). Having more than one negative life event reduced the likelihood of emotional vitality (OR=0.57). CONCLUSION: A substantial proportion of even the most disabled older women can be described as emotionally vital. Findings also suggest that emotional vitality is not solely a function of stable, enduring individual characteristics but that health status, disability, and sociodemographic context also have an influence on emotional vitality.

Aged↗

PubMed2006

Influence of sarcopenia on the development of physical disability: the Cardiovascular Health Study.

OBJECTIVES: To examine the temporal relationship between sarcopenia and disability in elderly men and women. DESIGN: Cardiovascular Health Study, a longitudinal study of cardiovascular disease and its risk factors in older people. SETTING: Four U.S. communities. PARTICIPANTS: Five thousand thirty-six men and women aged 65 and older. MEASUREMENTS: Whole-body skeletal muscle mass was measured at baseline, and subjects were classified as having normal muscle mass, moderate sarcopenia, or severe sarcopenia based on previously established thresholds. Disability was measured via questionnaire at baseline in up to eight annual follow-up examinations. The cross-sectional relationship between sarcopenia and prevalent disability at baseline was examined using logistic regression models. The longitudinal relation between sarcopenia and incident disability over 8 years of follow-up was examined using Cox proportional hazards models. RESULTS: At baseline, the likelihood of disability was 79% greater in those with severe sarcopenia (P<.001) but was not significantly greater in those with moderate sarcopenia (P=.38) than in those with normal muscle mass. During the 8-year follow-up, the risk of developing disability was 27% greater in those with severe sarcopenia (P=.006) but was not statistically greater in those with moderate sarcopenia (P=.23) than in those with normal muscle mass. CONCLUSION: Severe sarcopenia was a modest independent risk factor for the development of physical disability. The effect of sarcopenia on disability was considerably smaller in the longitudinal analysis than in the cross-sectional analysis.

Activities of Daily Living↗

PubMed2006

Benzodiazepine use and physical disability in community-dwelling older adults.

OBJECTIVES: To determine whether benzodiazepine use is associated with incident disability in mobility and activities of daily living (ADLs) in older individuals. DESIGN: A prospective cohort study. SETTING: Four sites of the Established Populations for Epidemiologic Studies of the Elderly. PARTICIPANTS: This study included 9,093 subjects (aged > or =65) who were not disabled in mobility or ADLs at baseline. MEASUREMENTS: Mobility disability was defined as inability to walk half a mile or climb one flight of stairs. ADL disability was defined as inability to perform one or more basic ADLs (bathing, eating, dressing, transferring from a bed to a chair, using the toilet, or walking across a small room). Trained interviewers assessed outcomes annually. RESULTS: At baseline, 5.5% of subjects reported benzodiazepine use. In multivariable models, benzodiazepine users were 1.23 times as likely as nonusers (95% confidence interval (CI) = 1.09-1.39) to develop mobility disability and 1.28 times as likely (95% CI = 1.09-1.52) to develop ADL disability. Risk for incident mobility was increased with short- (hazard ratio (HR) = 1.27, 95% CI = 1.08-1.50) and long-acting benzodiazepines (HR = 1.20, 95% CI = 1.03-1.39) and no use. Risk for ADL disability was greater with short- (HR = 1.58, 95% CI = 1.25-2.01) but not long-acting (HR = 1.11, 95% CI = 0.89-1.39) agents than for no use. CONCLUSION: Older adults taking benzodiazepines have a greater risk for incident mobility and ADL disability. Use of short-acting agents does not appear to confer any safety benefits over long-acting agents.

Activities of Daily Living↗

PubMed2005

Mild cognitive impairment and 10-year trajectories of disability in the Iowa Established Populations for Epidemiologic Studies of the Elderly cohort.

OBJECTIVES: To apply diagnostic criteria for mild cognitive impairment (MCI) to a geographically representative sample, to estimate the prevalence of MCI, and to estimate 10-year trajectories of incident disability for cognitively intact participants and subgroups with MCI. DESIGN: Prospective cohort; 10 years of follow-up. SETTING: Community-based survey of noninstitutionalized population aged 65 and or older in two rural Iowa counties (Washington and Iowa). PARTICIPANTS: Iowa Established Populations for Epidemiologic Studies of the Elderly (aged > or = 65; N = 3,673; 61.3% female; 99.9% white). MEASUREMENTS: Age, sex, education, Short Portable Mental Status Questionnaire (SPMSQ), 20-item word recall, activities of daily living (ADLs), instrumental activities of daily living (IADLs), chronic medical conditions. RESULTS: MCI was prevalent in 24.7% of participants at baseline. Most participants in the overall cohort remained stable or changed slowly (< or = 1 new limitations) over 10 years (63.1% for SPMSQ, 89.3% for word recall, and 61.7% for ADL disability). For MCI/no prevalent IADL disability (Stage 1 MCI), disability progression was similar to that in the cognitively intact subgroup (median = 0.08 vs 0.05 disabilities per year). For MCI plus prevalent IADL disability (Stage 2 MCI), the median rate of change was equivalent to that of the severely impaired (0.23 disabilities per year; interquartile range = 0.12-0.36). CONCLUSION: Unlike participants with MCI who reported no IADL limitations, those with such limitations were more likely to develop ADL disability--a prerequisite for a diagnosis of dementia.

Activities of Daily Living↗

PubMed2004

Dental students, social policy students and learning disability: do differing attitudes exist?

OBJECTIVES: To examine the attitudes of dental students and social policy students towards learning disabilities in order to identify whether attitudinal differences exist and to suggest recommendations in the dental undergraduate curriculum commensurate with Government legislation in the United Kingdom. DESIGN: A cross-sectional survey of all undergraduate dental students at Queen's University, Belfast and all undergraduate social policy students at University of Ulster. METHOD: A convenience sample of all undergraduate dental and social policy students was obtained. The students completed a questionnaire to assess attitude towards learning disability. The data were analysed using Cronbach's alpha, Student's t-test and analysis of variance (one-way fixed effect model). The level of statistical significance was set at 5%. RESULTS: The response rate was 83% for dental students and 97% for social policy students. Dental students had significantly lower mean scores and hence less favourable attitudes to learning disability compared with social policy students. Female dental students had significantly higher mean scores and hence more favourable attitudes to learning disability compared with male students. CONCLUSIONS: The findings show that dental undergraduates compared with social policy students had less favourable attitudes towards those with learning disability. Dental students should receive training in learning disability and undergraduate programmes should be conceptualised as a spiral curriculum. It is proposed that social policy theory should be introduced into undergraduate dental curricula, that early exposure to learning disability in a community setting should be incorporated into the first undergraduate years and in later undergraduate clinical years students should treat patients with learning disability in order to promote experiential learning and reflective practice.

Analysis of Variance↗

PubMed2005

Risk behaviors for varying categories of disability in NELS:88.

A large body of research shows that youth with disabilities, who comprise about 13% of the country's school-aged population, report comparable to higher incidence rates of alcohol, tobacco, and other drug (ATOD) use than their peers. Furthermore, youth with disabilities who reported ATOD use or who engaged in binge drinking had significantly more negative educational outcomes and engaged in sexual activity at a younger age than nonusers. This study describes risk factors for substance use, personal characteristics, aspects of the attitudinal environment, and educational, employment, and social outcomes among youth across 6 categories of disability. Data came from the National Center for Education Statistics' National Education Longitudinal Study of 1988-2000 (NELS:88). The findings indicate that (a) youth with varying types of disabilities are relatively homogenous with respect to risk behaviors, personal characteristics, and outcomes; (b) youth with emotional, learning, or multiple disabilities may be at heightened risk for binge drinking and marijuana use; and (c) youth with emotional and multiple disabilities may be less likely to graduate from high school or its equivalent 8 years beyond the 12th grade. Based on these results and limitations of the NELS sampling strategy, appropriate interventions are discussed as well as the need for more definitive operational definitions for disabilities, specifically the biopsychosocial approach used by the International Classification of Functioning, Disability, and Health.

Adolescent↗

PubMed1991

Generality vs. specificity of attitudes towards people with disabilities.

This study explored the generality vs. specificity of attitudes as measured by the Interaction with Disabled Persons Scale. This scale is a new measure devised to measure discomfort in social interaction posited to be experienced by people with low levels of prior contact with people with disabilities. Twelve parallel versions of the IDP Scale were administered to a sample of 481 respondents. Eleven versions specified a different disabling condition in the preamble to the scale, whilst one version was based on the general concept of disability. Analyses of variance indicated that type of disability did not significantly influence responding, whereas a significant main effect emerged for level of prior contact. These findings are interpreted as providing support for the rationale of the IDP Scale and for the operation of generalized attitudes towards people with disabilities. Further analysis using t tests revealed six significant differences between parallel forms for diabetes, AIDS, drug dependence and other disabilities. These results were interpreted as reflecting high public awareness of these conditions and the likelihood that they fall outside the public definition of disability.

Adolescent↗

PubMed2005

Prevalence and determinants of one month hand pain and hand related disability in the elderly (Rotterdam study).

OBJECTIVE: To study the prevalence of hand pain and hand disability in an open population, and the contribution of their potential determinants. METHODS: Baseline data were used from 7983 participants in the Rotterdam study (a population based study in people aged > or =55 years). A home interview was used to determine the presence of hand pain during the previous month, rheumatoid arthritis, osteoarthritis in any joint, diabetes, stroke, thyroid disease, neck/shoulder pain, gout, history of fracture in the past five years, and Parkinson's disease, as well as age, sex, and occupation. Hand disability was defined as the mean score of eight questions related to hand function. Body mass index was measured and hand x rays were taken. RESULTS: The one month period prevalence of hand pain was 16.9%. The prevalence of hand disability was 13.6%. In univariate analysis for hand pain, rheumatoid arthritis had the highest explained variance (R(2)) and odds ratio. For hand disability, aging showed the highest explained variance and Parkinson's disease had the highest odds ratio. All determinants together showed an explained variance of 19.8% for hand pain and 25.2% for hand disability. In multivariate analysis, positive radiographic hand osteoarthritis was a poor explanation for hand pain (R(2) = 0.5%) or hand disability (R(2) = 0). CONCLUSIONS: The contribution of available potential determinants in this study was about 20% for hand pain and 25% for hand disability in an unselected population of elderly people. Thus a greater part of hand pain/hand disability remains unexplained.

Aged↗

PubMed2006

Systemic lupus erythematosus in a multiethnic US cohort LUMINA (XLI): factors predictive of self-reported work disability.

OBJECTIVE: To examine the risk factors for self-reported work disability in patients from the LUpus in MInorities: NAture vs. Nurture cohort with systemic lupus erythematosus (SLE). METHODS: Patients with SLE of Hispanic (Texas and Puerto Rico), African American and Caucasian ethnicity were studied. Work disability was defined by patients' self-report. Only patients known to be employed at the baseline visit were included. The probabilities of self-reporting work disability over time were examined by the Kaplan-Meier method; differences between ethnic groups were examined by the log-rank test. The relationship of baseline socioeconomic-demographic, clinical, behavioural and psychological features with work disability was examined by standard statistical tests. Variables with p<or=0.10 in these analyses were examined by logistic regression. RESULTS: The rate of self-reported work disability among the 273 patients studied was 19% at 5 years; it was numerically higher for the African Americans (25%) than for the Hispanics from Texas (19%) and the Caucasians (18%). The rate for the Hispanics from Puerto Rico was 7% at 2 years; 5-year rates could not be estimated for this ethnic subgroup (shorter follow-up in the cohort). In the regression analysis, age, male sex, poverty, total disease duration, disease activity and damage accrual were predictors of work disability. CONCLUSIONS: The rate of work disability was 19% at 5 years. Patients with SLE with more severe disease and with lower socioeconomic status are at high risk of becoming disabled. The toll SLE imposes could possibly be reduced in patients at risk if, in addition to medical treatment, services needed to overcome their disadvantageous socioeconomic status are provided.

Adult↗