Disability transitions among mature adults in Malawi: a cohort modelling analysis

Abstract Background Though population growth remains a major issue in sub-Saharan Africa (SSA), falling fertility and increasing life expectancy foreshadow a growing elderly population. By 2060, persons aged over 45 years will be 25% of SSA's population, up from 10% in 2010. Ageing in SSA is associated with unique challenges due to poverty and inadequate social support. However, despite its importance for understanding the consequences of population ageing, detailed evidence about disability and health trajectories among adults in SSA is very limited. Methods Participants came from the 2006, 2008, and 2010 waves of the Malawi Longitudinal Survey of Families and Households (MLSFH). Our analyses investigate how individual health limits physical activities in domains relevant to this subsistence–agriculture context. Indicators of physical limitation from the 12-item short form questionnaire are used to parameterise limitations on daily living activities. We model age patterns of disability transitions with a discrete time hazard model, and use these rates to estimate the first microdata-based health expectancies calculated in SSA. Findings The risks of experiencing an onset of functional limitations due to poor health are high compared with developed contexts, and onset of functional limitations happens earlier in life. Women aged 45 years spend 58% (95% CI 55–64) of their remaining 28 years (25·7–33·5) with limitations; the figures for men are 41% (35–46) of 25·4 years (23·3–28·8) at age 45 years. Limitations have a substantial negative effect on individuals' labour activities, a major concern in this agrarian context. Interpretation These results represent a substantial addition to knowledge about the ageing process in this least-developed setting. Functional limitations will be increasingly salient as the age composition shifts over the coming years, but the older population is largely left out of health-focused policies implemented in SSA. New strategies are needed to ensure that these ageing individuals are supported and to lessen high rates of physical limitation. Funding CFP is supported by the United States National Science Foundation Graduate Research Fellowship ( Grant No. DGE-0822 ). We also gratefully acknowledge the generous support through the National Institute of Child Health and Development ( grant numbers R03HD058976, R21HD050652, R01HD044228, R01HD053781 ), the National Institute on Aging ( grant number P30 AG12836 ), the Boettner Center fo