Determinants of Functional Disability in India: The Interplay of Health Conditions, Environmental and Personal Factors

Understanding the relationship between health conditions, particularly non-communicable diseases (NCDs), environmental and personal factors, and functional disability is crucial to achieve the SDG aim - "leaving no one behind." However, these risk-outcome pathways remain understudied. This study assesses the relationship between NCDs, environmental factors (social capital), and personal factors with functional disability (ADL: Activities of Daily Living, IADL: Instrumental Activities of Daily Living) in the middle and elderly population (45+ years). It adopts the International Classification of Functioning, Disability, and Health (ICIDH-2) framework, used Longitudinal Ageing Study in India (LASI,2017-18), and performed Multinomial Logistic Regression and Multiple Indicators Multiple Causes Model for middle-and-old population (45+ years). The findings suggest that hypertension (27.3%) was the most prevalent condition, and stroke increased the likelihood of disability. However, hypertension is a precursor to stroke, highlighting the need to target hypertension. NCDs are a significant predictor of disability, with social capital having a protective effect of reducing the likelihood of disability, and personal factors mediate to contribute to the disability burden. Disability is prevalent among vulnerable groups-older adults, women, and individuals with low wealth, limited education, and rural residence. However, these relationships are bidirectional, as disability may also limit social participation, further exacerbating low social capital and high NCDs. It highlights the need to effectively implement WHO Best Buys to address NCD, specifically hypertension, and adopt bottom-up strategies to strengthen social capital through community empowerment, trust-building, and participatory engagement. Lastly, expanding health, education, and social security programs would ensure adequate support for vulnerable populations.