ArticleBMJ global health2026
Association of disability and 12-year all-cause and cause-specific mortality: analyses from the Wellbeing of Older People cohort study in Uganda.
Article in BMJ global health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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7 authors.
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Abstract
introductionDisability is linked to poor health outcomes and increased mortality, yet evidence on this relationship in sub-Saharan Africa is limited. This study investigated the association between disability and all-cause and cause-specific mortality among older adults in Uganda.
methodsThe analysis was based on longitudinal data from the Wellbeing of Older People Study, an open cohort of individuals aged at least 50 years and followed over five data collection waves from 2009 to 2022. Disability was assessed using the WHO Disability Assessment Schedule 2.0. Mortality data were collected, supplemented by verbal autopsies. Gompertz regression models examined the association between disability severity and mortality, adjusting for sociodemographic, socioeconomic, health access and health risk factors.
resultsAmong 938 participants followed up for a median of 8.0 years (interquartile range (IQR): 3.2-11.5), 153 deaths were recorded (mortality rate: 2.4 per 100 person-years). The age-sex-adjusted analyses showed that the hazard ratio (HR) was 3.88-fold higher (95% confidence interval (CI) 2.50 to 6.02; p value <0.001) among people with severe disability compared with none/mild disability. Adjusting for sociodemographic, economic, social support and health factors (health status, access and risk factors) somewhat attenuated the association (adjusted HR (aHR) 3.08, 95% CI 1.92 to 4.93; p value <0.001). This excess risk persisted across broadly categorised causes of death: HIV (aHR 8.96, 95% CI 2.52 to 31.83), communicable diseases excluding HIV (aHR 2.24, 95% CI 0.80 to 6.25), non-communicable diseases (aHR 2.29, 95% CI: 1.20 to 4.37) and indeterminate causes of death (aHR 6.89, 95% CI 1.63 to 29.1). Additionally, disability was associated with sociodemographic disadvantages, poor healthcare access and higher prevalence of health risk factors.
conclusionsSevere disability was strongly associated with elevated mortality risk among older Ugandans, underscoring the need for targeted interventions to improve health equity. Reducing mortality disparities might require addressing barriers to healthcare access, stronger social support and integrating disability-inclusive policies in achieving global health targets, including Universal Health Coverage.
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