Variations in disability and quality of life with age and sex between eight lower income and middle-income countries: data from the INDEPTH WHO-SAGE collaboration

Research output: Contribution to journalArticle


  • Francesc Xavier Gomez-Olive
  • Julia Schröders
  • Isabella Aboderin
  • Peter Byass
  • Somnath Chatterji
  • Cornelius Debpuur
  • Siddhivinayak Hirve
  • Abraham Hodgson
  • Sanjay Juvekar
  • Kathleen Kahn
  • Paul Kowal
  • Rose Nathan
  • Nawi Ng
  • Abdur Razzaque
  • Osman Sankoh
  • Peter K Streatfield
  • Stephen M Tollman
  • Siswanto A Wilopo
  • Miles D Witham

Colleges, School and Institutes

External organisations

  • MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umea, Sweden.
  • OPTENTIA Research Focus, North West University, Vanderbijlpark, South Africa.
  • Department of Health Statistics and Informatics, World Health Organization, Geneva, Switzerland.
  • Navrongo Health Research Centre, Navrongo, Ghana.
  • Vadu Rural Health Program, KEM Hospital Research Centre, Pune, India.
  • INDEPTH Network, Accra, Ghana.
  • Ifakara Health Institute, Dar es Salaam, Tanzania.
  • Matlab HDSS, Matlab, Bangladesh.
  • Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
  • HDSS Purworejo and Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
  • University of Dundee


Background: 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 income and middle-income countries; such information is necessary to tailor health and social care policy to promote healthy ageing and minimise disability.

Methods: We analysed data from participants aged 50 years and over from health and demographic surveillance system sites of the International Network for the Demographic Evaluation of Populations and their Health 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 WHO Quality of Life (WHOQoL) tool to measure quality of life and theWHO Disability Assessment Schedule, version 2 (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.

Results: 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 by 0.13 points (95% CI 0.12 to 0.14) per year increase in age and WHODAS scores worsened by 0.60 points (95% CI 0.57 to 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.

Conclusions: 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
JournalBMJ Global Health
Issue number4
Publication statusPublished - 20 Dec 2017