Educational disparities in the burden of disability: Contributions of disease prevalence and disabling impact

Objectives. We assessed the contributions of the prevalence and disabling impact of specific diseases to educational disparities in the prevalence of disability. Methods. We examined a large representative survey of the Dutch population, the Dutch Permanent Survey of Living Conditions (2001-2007; n = 24 883; ages 40-97 years). We attributed the prevalence of disability to chronic diseases by using their empirical associations and assuming independent competing causes of disability. We estimated contributions of prevalence and the disabling impact of diseases to disparities in disability using counterfactuals. Results. We found that the prevalence of disability in individuals with only an elementary education was 19 to 20 percentage points higher than that in individuals with tertiary education. Sixty-five percent of this difference could be attributed to specific chronic diseases, but more so to their disabling impact (49%-51%) than to their prevalence (20%-29%). Back pain, neck or arm conditions, and peripheral vascular disease contributed most to the disparity in men, and arthritis, back pain, and chronic nonspecific lung disease contributed most to the disparity in women. Conclusions. Educational disparities in the burden of disability were primarily caused by high disabling impacts of chronic diseases among low educated groups. Tackling disparities might require more effective treatment or rehabilitation of disability in lower socioeconomic groups.