Cardiometabolic disease, depressive symptoms, and sleep disorders in middle-aged adults with functional disabilities: NHANES 2007-2014.
Daniel G Whitney, Edward A Hurvitz, Mark D Peterson
PMID 30653371WHAT IT FOUND
After accounting for other factors, adults with severe functional disability were more likely to have cardiovascular disease and diabetes than adults without disability.
Adults with moderate disability were not. Depressive symptoms and sleep disorders did not explain this.
Key findings
01After adjustment for covariates in model 1, adults with severe functional disability had higher odds of cardiovascular disease than adults without disability (OR: 1.47; 95% CI: 1.07, 2.00), while adults with moderate functional disability did not (OR: 1.21; 95% CI: 0.96, 1.53).
02After adjustment for covariates in model 1, adults with severe functional disability had higher odds of diabetes than adults without disability (OR: 1.76; 95% CI: 1.36, 2.29), while adults with moderate functional disability did not (OR: 1.22; 95% CI: 0.83, 1.79).
03After further adjustment for depressive symptoms and sleep disorders, the higher odds of cardiovascular disease and diabetes in adults with severe functional disability remained compared with adults without functional disability.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study was cross-sectional and observational, so it cannot show that functional disability caused cardiovascular disease or diabetes, or that depressive symptoms and sleep disorders did not play a causal role. Sleep disorders were defined broadly and combined different problems, such as sleep duration, insomnia, and obstructive sleep apnea, which may not have the same effect. Functional disability was defined broadly, and the study did not separate diagnosis, cause, or duration of disability. No measure of pain was available, even though pain can interact with disability, sleep, and depression. The paper says moderate disability did not have higher odds in the main adjusted analyses, but the sensitivity analysis that excluded blood pressure did show higher odds, so the cardiovascular finding depends partly on how disease was defined.
Declared interests
No potential conflict of interest was reported. Publication types indicate NIH extramural and non-U.S. government research support.
The easy way to misread this
Do not read the higher odds as proof that severe functional disability causes cardiovascular disease or diabetes. This was a cross-sectional survey, so it shows association only.