Predictors of disability among midlife men and women: differences by severity of impairment.

This study examines the influences on disability among men and women controlling for the degree of functional incapacity imposed by chronic illness or impairment. The associations between demographic, attitude, social role characteristics and disability are separately examined for persons with mild and severe levels of limitation in order to determine whether different factors are associated with disability when impairment is mild as opposed to severe. Separate logit regressions are estimated for four sex/severity groups using data from the 1978 Survey of Disability and Work. It is hypothesized that among persons with severe impairments, only demographic variables will be significantly associated with disability because the severity of limitations would make other factors unimportant, while among persons who are mildly impaired attitudes and social roles will be important influences. Contrary to these expectations, the factors associated with disability are similar among the four sex/severity groups. In all four groups the presence of pain and fatigue strongly influence disability while gender roles are generally not associated with disability. Attitudes regarding the importance of work for self-esteem are also found to be associated with reports of disability. An unexpected outcome of this analysis is an indication of what predicts the absence of disability among severely impaired persons. In particular, persons who report that their sense of self-esteem is tied to work are least likely to report disability. These findings suggest which non-medical factors may contribute to the maintenance of usual work roles and life activities among persons with severe levels of impairment. They also identify variables which may link impairment and disability across all levels of severity.