TYPE Brief Research Report

PUBLISHED 27 February 2023

DOI 10.3389/fpubh.2023.1036499

Prevalence, pattern and

OPEN ACCESS determinants of disabilities in
India: Insights from NFHS-5
EDITED BY
Anand Krishnan,
All India Institute of Medical Sciences, India

REVIEWED BY
Leeberk Raja Inbaraj,
(2019–21)
National Institute of Research in Tuberculosis
(ICMR), India
Shamanna B. R., Sweta Pattnaik † , Jogesh Murmu † , Ritik Agrawal †
,
University of Hyderabad, India
Tanveer Rehman † , Srikanta Kanungo * and
*CORRESPONDENCE
Sanghamitra Pati Sanghamitra Pati *
[email protected]
Srikanta Kanungo Department of Health Research, ICMR-Regional Medical Research Center, Bhubaneswar, Odisha, India
[email protected]

†
These authors have contributed equally to this
There is a need to provide an overview of the disability burden in India as there are
work
limited studies. The present study aimed to estimate the prevalence and assess the
SPECIALTY SECTION
This article was submitted to
pattern and determinants of disability in India. We analyzed National Family Health
Life-Course Epidemiology and Social Survey-5 data using the “svyset” command in STATA software. We assessed the
Inequalities in Health, correlates by multivariable regression and reported an adjusted prevalence ratio
a section of the journal
Frontiers in Public Health
(aPR) with a 95% confidence interval (CI). QGIS 3.2.1 software was used for spatial
analysis of distributions of different disabilities. The mean (SD) age of 28,43,917
RECEIVED 04 September 2022
ACCEPTED 08 February 2023 respondents was 30.82 (20.62) years, with 75.83% (n = 21,56,633) and 44.44% (n
PUBLISHED 27 February 2023 = 12,63,086) of them being from a rural area and were not educated, respectively.
CITATION The overall prevalence of disability was 4.52% [(95% CI: 4.48–4.55), n = 1,28,528].
Pattnaik S, Murmu J, Agrawal R, Rehman T, Locomotor disabilities accounted for 44.70% of all disabilities (n = 51,659),
Kanungo S and Pati S (2023) Prevalence,
pattern and determinants of disabilities in India:
followed by mental disabilities (20.28%, n = 23,436). Age 75 years and above (vs.
Insights from NFHS-5 (2019–21). 0–14 years) [aPR: 2.65 (2.50–2.81)], male (vs. female) [aPR: 1.02 (1.0–1.04)], no
Front. Public Health 11:1036499. education (vs. higher education) [aPR 1.62 (1.56–1.68)], unmarried (vs married)
doi: 10.3389/fpubh.2023.1036499
[aPR: 1.76 (1.70–1.82)], seeking the care of non-governmental organization (NGO)
COPYRIGHT (vs. other) [aPR: 1.32 (1.13–1.55)] were significant independent determinants. The
© 2023 Pattnaik, Murmu, Agrawal, Rehman,
Kanungo and Pati. This is an open-access highest overall prevalence of locomotor was in Lakshadweep/UTs (8.88%) and
article distributed under the terms of the Delhi (57.03%), respectively. Out of every hundred individuals in India, four have a
Creative Commons Attribution License (CC BY). disability. More intervention strategies should be planned, considering factors like
The use, distribution or reproduction in other
forums is permitted, provided the original education, residence, health promotion and caste so that the services provided by
author(s) and the copyright owner(s) are the government can be available and accessible to everyone in need.
credited and that the original publication in this
journal is cited, in accordance with accepted
academic practice. No use, distribution or KEYWORDS

reproduction is permitted which does not disability, prevalence, NFHS-5, India, secondary data analysis
comply with these terms.

Background
World Health Organization (WHO) defines disability as impairment, limitation, or
restriction in activity caused mainly by health issues and environmental factors (1).
Worldwide, about one billion (15%) individuals face some form of disability, and 20% have
severe functional limitations (2). Since 80% of those with disabilities live in developing
nations, it is essential to ensure their inclusion in all aspects of development (3).
Census 2011 and recently held 76th round of the National Sample Survey (NSS) estimates
the prevalence of disability was 2.2% in India (4, 5). Over 10 years, India’s differently-abled
population increased somewhat, growing from 21.9 to 26.8 million from 2001 to 2011,
respectively (4). The prevalence of disabilities continues to rise gradually with age and is
highest in individuals above 60 (6, 7). In India, by 2050, 323 million (19.1% of the total

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Pattnaik et al. 10.3389/fpubh.2023.1036499

population) will be 60 years and above (8, 9). India will face there are limited studies that go into depth about the disability.
significant structural and budgetary hurdles due to the increase in For the first time, the fifth National Family Health Survey (NFHS)
the aging population and people with disabilities. (2019–21) included five disability statuses to depict the burden of
Functional and physical disability is positively associated with disability and its associated predictors. This study aimed to estimate
co-existing chronic illnesses (7, 10). The interaction between the prevalence of disability in India, determine the associated
chronic illness and physical disability has been explored (11). factors and assess the pattern and geographical distribution using
Non-communicable diseases (NCDs) like cardiovascular and data from the most recent NFHS, 2019–2021.
musculoskeletal disorders account for 66.5% of disability-adjusted
life years (DALYs) in low and middle-income countries (12, 13).
According to the 2019 Global Burden of Disease (GBD)
report from 369 countries, road accidents accounted for nearly Methods
5.1% DALYs among people aged 25 to 49. In contrast, ischemic
heart disease and stroke were the leading causes of DALYs Study setting
among people aged 50 to 75. Both contribute to shifting
the burden due to “Years lived with disability” because of India is the world’s second-most populous country (1.3 billion
NCDs and injuries (14). India is undergoing an epidemiologic population), with 28 states and eight union territories (UTs).
shift that increases the burden of NCDs (15). As of aging The Department of Empowerment of Persons with Disabilities
populations and changing lifestyles, NCDs are quickly expanding, (Divyangjan) was carved out of the Ministry of Social Justice
the prevalence and likelihood of developing non-communicable and Empowerment in 2012 to ensure greater focus on policy
diseases would increase exponentially, resulting in an increase in matters and to address disability issues effectively. It acts as a
DALYs (16). Increased life expectancy is a result of demographic nodal department for greater coordination among stakeholders,
projection, which also causes a rise in chronic disease onset, that organizations, state governments and related central ministries.
further adversely impacts people’s overall health (17). This suggests Consequently, the schemes have intended to increase accessibility
that DALY is a comprehensive measurement that quantifies specific through the supply of aids and assistive devices and educational and
diseases and injuries in relation to NCD (18). economic empowerment through skill development and financial
The “bio-psycho-social model” encompassing one’s assistance. India has eight national institutes and 20 composite
surroundings, personal attributes, quality of life, and self- regional centers, which provide services like early detection and
sufficiency has shifted disability from a medical to a social model intervention, counseling and medical rehabilitation to PwDs (25).
(19). International Classification of Functioning, Disability and
Health (ICF) has classified disability into the hearing, visual,
speech, mental and locomotor (1). The most common form
in India is locomotor disability (20). Locomotor and hearing Study design and study population
disabilities are significantly more common in Indian men than in
Indian women (21). We conducted secondary data analysis on the NFHS-5 dataset.
A person with a disability (PwD) generally experiences adverse Initially, the proposal was submitted to Demographic Health
socioeconomic outcomes, poverty and physiologic stress, and Survey (DHS), after which authorization to use data was obtained.
inequity in access to essential resources such as education, health NFHS surveys capture data on the health and welfare of the
care facilities, employment, and social participation (22). Women Indian population through a nationally representative sample.
with disability face challenges with access to reproductive and We included all family members in the households surveyed.
sexual health services and information (23). As India prepares Transgender data were also provided, but we excluded them from
for the next decennial census and in light of its pledge to the the analysis due to their small population size (n = 180, 0.01%),
Committee on the Rights of Persons with Disability and Sustainable which could lead to inconsistency in this study.
Development Goals (SDG), there is a need to provide an overview
of the disability rates in India (24). Only a tiny portion of the PwD
population in India receives government assistance (7). Moreover,
Sample size and sampling technique

Abbreviations: aPR, Adjusted Prevalence Ratio; BCC, Behavior change Villages and census enumeration blocks were chosen from
communication; BPL, Below poverty level; CAPI, Computer-assisted districts in rural and urban areas, respectively, through a two-
personal interview; CI, Confidence Interval; CRPD, Committee on the stage sampling procedure. Data collection was done using CAPI
Rights of Persons with Disability; DHS, Demographic Health Survey; ICF, (Computer-assisted personal interview) from June 2019 to April
International Classification of Functioning, Disability, and Health; IEC, 2021 with an inbuilt schedule and proper maintenance of
Information education communication; IIPS, International Institute for confidentiality of respondents’ answers. NFHS-5 methodology,
Population Sciences; LMIC, Low-and middle-income countries; NCDs, including selecting households and data collection procedures, has
Non-communicable disease; NFHS, National Family Health Survey; been meticulously described and published elsewhere (26). The
NGO, Non-government organization; NITI Aayog, National Institution questionnaire was administered to the head of the family, and a
for Transforming India; PwD, Persons with Disability; QOL, Quality of Living; total of 28,43,917 participants of all age groups were included in
SDG, Sustainable Development Goals; UTs, Union Territories. our study.

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TABLE 1 Sociodemographic and health-seeking behavioral

Data variables and data sources characteristics of the study population covered in NFHS-5
(N = 28,43,917).
The independent variables for assessing the prevalence of
disability were sociodemographic and health-seeking behaviors Characteristics Categories Frequency Weighted
characteristics. Some of the covariates are age (categorized into (n, %∗ ) frequency
(n, %∗ )
0–14, 15–29, 30–44, 45–59, 60–74, and 75 years and above);
marital status classified as “married” (those who are currently Age 0–14 years 7,65,602 (26.92) 7,53,584 (26.50)

married), “formerly/ever married” (previously ever married 15–29 years 7,39,990 (26.02) 7,42,061(26.09)
including divorced, widowed, not living together, separated), and 30–44 years 5,73,971 (20.18) 5,73,200 (20.16)
“unmarried (never married)”; education according to completed
45–59 years 4,40, 751 (15.50) 4,41,851 (15.54)
years of schooling (“no education”- those who had no formal
schooling, “up to primary”- <5 years of education, “up to 60–74 years 2,61,321 (9.19) 2,69,714 (9.48)
secondary”- 5–9 years, “higher” > 10 years); Below Poverty 75 years and 62,843 (2.19) 63,506 (2.23)
Level (BPL) card holder; health-seeking behavior (public, private, above
non-governmental organization (NGO)/trust hospitals/clinics, and Gender Male 14,10,154 (49.59) 14,07,502 (49.49)
others-which included those who sought treatment from pharmacy (N = 28,43,734)†
outlets, home treatment, and treatment from any other source). Female 14,33,580 (50.41) 14,36,232 (50.51)
In NFHS-5, disability was considered present if the participant
Residence Urban 6,87,284 (24.17) 9,00,407 (31.66)
responded “yes” to the question: “If any household member,
including you, have any disability?” Out of those identified as Rural 21,56,633 (75.83) 19,43,510 (68.34)
“disability present,” it was further classified into sub-categories Educational status No education 12,63,086 (44.44) 12,36,658 (43.51)
“Hearing,” “Speech,” “Visual,” “Mental,” “Locomotor.” (N = 28,42,431)†

Primary 11,08,398 (38.99) 11,01,206 (38.74)

Secondary 1,96,536 (6.91) 1,94,948 (6.86)

Operational definitions
Higher 2,74,411 (9.65) 309,619 (10.89)

We have given the operational definitions of various types of Marital status Unmarried 12,50,853 (43.98) 12,28,826 (43.21)

disability as per the information provided in the NFHS-5 report in Married 14,21,809 (49.99) 14,39,883 (50.63)
Supplementary File 1.
Formerly/ever 1,71,255 (6.02) 1,75,208 (6.16)
married

Region North 5,83,110 (20.50) 3,99,373 (14.04)

Statistical analysis Central 6,86,111 (24.13) 7,21,765 (25.38)

East 4,66,522 (16.40) 6,40,383 (22.52)

STATA 16 (Stata Corp, College Station, Texas, USA) was used
for statistical analysis. Before analyzing, all flagged, missing, and North-east 3,91,078 (13.75) 1,01,557 (3.57)
no information cases were removed while recording variables. West 2,89,723 (10.19) 4,13,100 (14.53)
The NFHS sampling weights were used to justify the differential
South 4,27,373 (15.03) 5,67,738 (19.96)
probabilities of participant selection and ensure the validity of our
study findings. The “svyset” command was used to declare the Religion Hinduism 21,38,965 (75.21) 23,04,244 (81.02)
dataset as survey type and to estimate the population’s weighted Islam 3,62,313 (12.74) 3,88,621 (13.66)
proportion. The burden of disability and its predictors were
Christianity 2,02,918 (7.14) 68,564 (2.41)
estimated using the weighted prevalence and reported with a 95%
confidence interval (CI). Univariate log-binomial regression was Others 1,39,721 (4.91) 82,489 (2.90)

done for all the independent variables with the outcome and Caste Scheduled 5,59,048 (19.66) 6,23,405 (21.92)
reported an unadjusted prevalence ratio (PR) with 95% CI. Other caste

form of disabilities was not specified under the heading “Others” Scheduled 5,31,496 (18.69) 2,69,776 (9.49)
in the categories of disabilities because different types of disabilities tribe
were not clearly mentioned in the NFHS-5 dataset. Therefore, they Other 10,60,884 (37.30) 11,91,536 (42.04)
were excluded from the table of types of disabilities, giving a total backward class
number of persons with disability (n = 11,998). Other 6,92,489 (24.35) 7,55,200 (26.55)
Consequently, multivariable regression was done after checking
Wealth index Poorest 6,36,437 (22.38) 5,69,605 (20.03)
for collinearity among the variables using the variance inflation
factor and reported adjusted PR with 95% CI. Variables with p Poorer 6,28,147 (22.09) 5,69,983 (20.04)
< 0.05 were considered significant. To determine the regional Middle 5,75,696 (20.24) 5,69,127 (20.01)
differences in disabilities, we have assessed the overall prevalence
Richer 5,24,896 (18.46) 5,68,180 (19.98)
of disabilities; along with it, we have shown the nationwide
(Continued)
prevalence of the three most prevalent disabilities as per the current

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TABLE 1 (Continued)
higher education. Unmarried people had 76% more disability
[aPR: 1.76 (1.70–1.82)] than married people. Respondents from the
Characteristics Categories Frequency Weighted
(n, %∗ ) frequency western region [aPR: 1.58 (1.52–1.64)] have 58% more prevalence
(n, %∗ ) of disability compared with the northeast region. People from other
Richest 4,78,741 (16.83) 5,67,022 (19.94) backward castes had a 32% more burden of disability compared
to people from scheduled tribes [aPR:1.32(1.29–1.36)]. Disability
Health insurance Absent 16,22,398 (57.34) 16,82,783 (59.47)
scheme
was 51% higher in the poorest wealth quintile [aPR: 1.51 (1.46–
(N = 28,29,625)† 1.57)] than in the most affluent. Individuals with disabilities favored
Present 12,07,227 (42.66) 11,46,842 (40.53)
NGOs or Trust hospitals/clinics for medical care [aPR: 1.32 (1.13–
1.55)] over visiting pharmacies or taking home treatment.
BPL holder No 14,49,238 (51.04) 15,47,900 (54.52)
Of the total, locomotor disabilities accounted for 44.70% [(95%
(N = 28,39,275)†
CI: 44.31–45.09), n = 51,659] followed by mental [20.28% (95% CI:
Yes 13,90,037 (48.96) 12,91,375 (45.48)
19.96–20.59), n = 23,436] and speech disabilities [14.55 % (95%
Seek healthcare Public facility 16,13,875 (56.75) 13,83,735 (48.66) CI:14.27–14.83, n = 16,812] (Figure 1A). The detailed prevalence
preferably at which of individual disabilities is given in Supplementary File 2. The ages
treatment facility
of 0–14 and 45–59 years had the highest burden of locomotor
Private facility 11,86,216 (41.71) 14,11,897 (49.65) disability (45.50%) and mental disability (22.16%), respectively.
NGO/Trust 10,502 (0.37) 13,288 (0.47) Using the radar plot, we have represented the association of
various types of disability with the age groups. We have given the
Other 33,324 (1.17) 34,997 (1.23)
prevalence of disability in the interval of 10 (0, 10, 20, etc.). E.g.,
BPL, Below Poverty Level; NGO, Non-government organization.
∗ Column percentage, † missing and no information participants were removed. The preponderance of locomotor disability is highest among the 0–
14 years age group. The prevalence pattern of various disabilities
across the age groups is shown in Figure 1B.
study, i.e., locomotor, mental, followed by speech. We have used The detailed prevalence pattern of various disabilities across
QGIS 3.2.1 software (Available from: http://qgis.osgeo.org) (27). To educational status is shown in Figure 1C. Regarding educational
make it nationally representative, we have used weighted data for attainment, hearing and locomotor disability were higher among
our analysis. those who had completed higher levels of education.
Figures 2A–D shows the burden of disability and its pattern
across the states and UTs of India. The overall disability distribution
Ethical consideration in Figure 2A indicates that it is more prevalent in Lakshadweep,
UT (8.88%), followed by Karnataka (5.77%). In the present study,
There is no risk to participants because the current study the regional disparities could be because the composition of the
is based on secondary, anonymized data obtained from DHS. population and the individuals with a disability varies in different
Informed consent for all the respondents was obtained during states. So, the prevalence of disability varies in different states
the survey. The dataset used is duly acknowledged and cited and is found to be higher in Lakshadweep, where the total
wherever needed. This study has been scrutinized and declared for population is less as compared with other states and UTs. For
exemption for review by IEC as there is less than minimal risk and national representativeness, we have used weighted values for data.
no linked identifiers bearing Ref: . . . ICMR-RMRC/IHEC-2022/150. Similarly, the prevalence of locomotor disability (Figure 2B) was
highest in Delhi (57.03%), followed by Dadra and Nagar Haveli
(55.49%). Figure 2C shows the prevalence of mental disabilities,
Results with the highest in Mizoram (42.51%), followed by Goa (41.54%).
Figure 2D shows the highest prevalence of speech disability in
The analysis includes a total of 28,43,917 respondents of all age Sikkim (37.61%), followed by Tripura (23.42%).
groups. The respondents’ mean (SD) age was 30.82 ± 20.62 years.
Of the total, 26.92% were between the ages of 0 and 14 years (n =
7,65,602), 50.41% were females (n = 14,33,580), 75.83% belonged Discussion
to rural residents (n = 21,56,633), and 49.99% were married (n =
14,21,809) (Table 1). The overall prevalence of disability in India based on secondary
The overall prevalence of disability was 4.52 % [(95% CI: 4.48– data analysis of the NFHS-5 survey (2019–21) was 4.52%.
4.55), n = 1,28,528] across all age groups in India. The prevalence Locomotor disabilities accounted for 44.70% of all disabilities,
was highest in the age group of 75 years and above at 6.07% followed by mental and speech disabilities. Age 75 years and
(Table 2). above, male, no, unmarried, belonging to the west region,
Respondents aged 75 years and above had twice [aPR: 2.65 and non-governmental organization were significant independent
(2.50–2.81)] the prevalence of disability compared with 0–14 years determinants. The highest prevalence of locomotor, mental, and
(Table 2). Disability was 2% more among males [aPR: 1.02 (1.00– speech disability was in Delhi, Mizoram and Sikkim, respectively,
1.04)] than females. Regarding education, disability was 62% more whereas the overall prevalence was highest in Lakshadweep/UTs.
common among those who didn’t have any form of schooling In the present study, the overall prevalence of disability was
[aPR: 1.62 (1.56–1.68)] in contrast to those who have completed 4.52%. The result of this study is consistent with the findings of

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TABLE 2 Determinants of disability in the study population covered in NFHS-5 (N = 28,43,917).

Characteristics Disability Univariable Multivariable regression

regression
n %∗ , 95% CI PR, 95% CI aPR, 95% CI p-value
Age of participant†
0–14 years 32,239 4.28 (4.23–4.32) Reference Reference

15–29 years 32,714 4.41 (4.36–4.45) 1.03 (1.01–1.05) 1.57 (1.52–1.61) <0.001

30–44 years 26,047 4.54 (4.49–4.60) 1.06 (1.04–1.09) 2.11 (2.03–2.20) <0.001

45–59 years 19,446 4.40 (4.34–4.46) 1.03 (1.0–1.05) 1.97 (1.89–2.06) <0.001

60–74 years 14,227 5.27 (5.19–5.36) 1.25 (1.21–1.28) 2.30 (2.20–2.40) <0.001

75 and above 3,854 6.07 (5.88–6.26) 1.44 (1.38–1.51) 2.65 (2.50–2.81) <0.001
†
Gender (N = 28,43,734)
Male 64,453 4.58 (4.54–4.61) 1.03 (1.01–1.04) 1.02 (1.0–1.04) 0.014

Female 64,064 4.46 (4.43–4.49) Reference Reference

Residence
Urban 36,143 4.01 (3.97–4.05) Reference Reference

Rural 92,384 4.75 (4.72–4.78) 1.19 (1.17–1.22) 1.01 (0.99–1.04) 0.191

Education (N = 28,42,431) †

No education 62,593 5.06 (5.02–5.10) 1.62 (1.57–1.67) 1.62 (1.56–1.68) <0.001

Primary 48,661 4.42 (4.38–4.46) 1.41 (1.36–1.45) 1.33 (1.29–1.38) <0.001

Secondary 7,361 3.78 (3.69–3.86) 1.20(1.44–1.25) 1.14(1.09–1.19) <0.001

Higher 9,840 3.18 (3.12–3.24) Reference Reference

†
Marital status
Unmarried 58,025 4.72 (4.68–4.76) 1.11 (1.09–1.13) 1.76 (1.70–1.82) <0.001

Married 61,539 4.27 (4.24–4.31) Reference Reference

Formerly/ever married 8,963 5.12 (5.01–5.22) 1.21 (1.17–1.25) 0.96 (0.93–0.99) 0.030

Region†
North 16,951 4.24 (4.18–4.31) 1.11 (1.08–1.15) 1.32 (1.28–1.36) <0.001

Central 32,086 4.44 (4.40–4.49) 1.17 (1.14–1.20) 1.27 (1.23–1.31) <0.001

East 28,520 4.45 (4.40–4.50) 1.17 (1.14–1.21) 1.18 (1.14–1.22) <0.001

North-east 3,890 3.83 (3.71–3.95) Reference Reference

West 20,982 5.08 (5.01–5.15) 1.34 (1.30–1.39) 1.58 (1.52–1.64) <0.001

South 26,099 4.60 (4.54–4.65) 1.21 (1.17–1.25) 1.34 (1.29–1.38) <0.001

Religion †

Hinduism 1,03,079 4.47 (4.44–4.50) 1.17 (1.11–1.23) 1.05 (0.99–1.10) 0.100

Islam 18,461 4.75 (4.68–4.82) 1.24 (1.17–1.31) 1.09 (1.03–1.16) 0.002

Christianity 2,647 3.86 (3.72–4.01) Reference Reference

Others 4,341 5.26 (5.11–5.42) 1.38 (1.30–1.47) 1.38 (1.29–1.48) <0.001

Caste †

Scheduled caste 29,199 4.68 (4.63–4.74) 1.14 (1.11–1.17) 1.25 (1.22–1.29) <0.001

Scheduled tribe 11,115 4.12 (4.04–4.20) Reference Reference

Other backward class 55,310 4.63 (4.59–4.66) 1.13 (1.10–1.16) 1.32 (1.29–1.36) <0.001

Other 32,904 4.36 (4.31–4.40) 1.06 (1.03–1.09) 1.32 (1.28–1.36) <0.001

(Continued)

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TABLE 2 (Continued)

Characteristics Disability Univariable Multivariable regression

regression
n %∗ , 95% CI PR, 95% CI aPR, 95% CI p-value
Wealth index†
Poorest 29,445 5.17 (5.11–5.23) 1.57 (1.53–1.61) 1.51 (1.46–1.57) <0.001

Poorer 28,488 5.00 (4.94–5.05) 1.52 (1.47–1.56) 1.41 (1.36–1.46) <0.001

Middle 27,345 4.80 (4.75–4.86) 1.45 (1.41–1.50) 1.34 (1.29–1.38) <0.001

Richer 24,223 4.26 (4.21–4.32) 1.28 (1.24–1.32) 1.20 (1.16–1.24) <0.001

Richest 19,026 3.36 (3.31–3.40) Reference Reference

Health insurance scheme (N=28,29,625)

Absent 75,425 4.48 (4.45–4.51) Reference Reference

Present 52,417 4.57 (4.53–4.61) 1.02 (1.0–1.04) 1.01 (0.99–1.02) 0.484

BPL holder (N=28,39,275)†

No 62,275 4.02 (3.99–4.05) Reference Reference

Yes 66,105 5.12 (5.08–5.16) 1.29 (1.27–1.31) 1.19 (1.17–1.21) <0.001

Treatment facility †

Public facility 65,717 4.75 (4.71–4.78) 1.21 (1.13–1.30) 1.24 (1.16–1.33) <0.001

Private facility 60,767 4.30 (4.27–4.33) 1.10 (1.02–1.17) 1.14 (1.06–1.23) <0.001

NGO/Trust 662 4.98 (4.62–5.36) 1.28 (1.09–1.49) 1.32 (1.13–1.55) <0.001

Other 1,381 3.94 (3.74–4.15) Reference Reference

PR, Prevalence ratio; aPR, Adjusted prevalence ratio; CI, Confidence interval; BPL, Below poverty level; NGO, Non-government organization.
∗ Row percentage, † p < 0.05.

Myanmar (4.6%) and South Africa (4.9%) (28, 29). Our study health conditions (such as arthritis and spondylosis), chronic health
reported a higher prevalence than in Zimbabwe (2.9%) and conditions, falls, and injuries are some factors that increase the
Cambodia (4%). Some countries reported a higher prevalence susceptibility to disability among older age groups (37). Another
than the national average, including Jordan (13%) and Zimbabwe study found that in the 60–64 age group, only 36% have some
(7%) (30, 31). The burden of disability varies country-wise. Most disability, and 61% are 75 years and above (36). The difference in
surveys conducted in developed countries concentrated on wider this result from the present study could be because of the difference
spheres of participation and the need for services. However, in scales used in disability. And older adults are at high risk of
most surveys done in LMICs typically emphasize impairment developing intellectual and neurological disorders or substance use
questions. The dynamic interaction between health, environmental, problems and are vulnerable to other health-related conditions
and personal contexts that vary among regions contributes to such as hearing loss and osteoarthritis (38). In older adults, aging
the occurrence of disabilities (32). Also, sampling technique, causes a variety of psychological issues, which includes: (1) reduced
type of population involved, sociodemographic characteristics, and proprioception, (2) diminished ability to adapt to environmental
population composition varies. changes, social roles and status, (3) elevated risk of exposure
Our finding suggests a higher prevalence of locomotor to adverse life effects such as retirement from a job, financial
disability, which is higher than the study conducted in Mumbai management and death of relative (39).
(5.57%) (33). The present study highlights that locomotor disability Our findings suggest that men are more prone to have any
was highest among those aged 0–14 years, which is in contrast to the disability as compared to women. However, women aged 65–79
study’s findings, which suggest that it was higher among 40 years or years are 3.3% more likely to have functional limitations than men,
older (34). Although there is limited evidence supporting this, the and with an increase in age of 80 years or older the likelihood
most likely cause could be the rising prevalence of both acquired of disability increases to 15.5% (40). Despite an increase in the
and congenital locomotor disability, including rickets, tuberculosis prevalence of disability with age progression, female dominance
spine, and clubfoot (congenital talipes equinovarus or CTEV) (35). is seen, which contrasts with our study findings. As a result,
Age is a significant predictor of disability and is positively it shows an apparent gender disparity in disability prevalence
associated with disability. The study by Gupta et al. (36) revealed estimates rates. A community-based study in rural Haryana shows
that the prevalence of disability increases with age, with the highest that functional disability was lower in men (35.9%) as compared
in the age group of 75 years and above (63.8%), which is in with women (38.8%), which is also a contrast to our findings
harmony with the results of the current study (36). Degenerative (36). This disparity may be because males are more likely to

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Pattnaik et al. 10.3389/fpubh.2023.1036499

FIGURE 1
Prevalence of different disabilities across sociodemographic characteristics. (A) Doughnut chart for the prevalence of different disabilities across the
population in India based on NFHS-5 (N = 1,15,557). (B) Radar plot showing the prevalence pattern of different disabilities across age groups in India
based on NFHS-5 (N = 1,15,557). (C) The prevalence pattern of different disabilities across educational statuses in India based on NFHS-5 (N =
1,15,557).

encounter accidents and injuries and risk developing NCDs (41). inclusivity, transportation issues, and parents’ and caregivers’ lack
Males’ participation in risky activities and physically demanding of understanding of the importance of obtaining education for their
occupations (mine, electrical and telecommunications, climbing kids (46). Additionally, prior research has shown that the lowest
and working, commercial driving, and so on) could also be a wealth quintile had a much higher risk of death and disability than
possible explanation. their highest wealth counterparts at all ages, which is similar to
The study by Yadav and Singh (42) suggested that adults our current study’s finding. Wealth may be a better predictor of
between the ages of 20 and 25 had a higher prevalence of disability scarce financial resources, exacerbated by a loss of employment,
than children between the ages of 10 and 14. Adults may have retirement, or advancing age (47). People living in poverty may
a higher prevalence of NCDs due to increased risk of road work under hazardous conditions associated with adverse health
traffic accidents (RTAs), self-harm, and behavioral changes like outcomes, including disability. They may also have limited access
alcoholism, tobacco use, and drug abuse (42). to healthcare and education, which puts them at a greater risk of
Our study observed that the disability was higher among developing disabilities (10, 48).
those with lesser years of schooling. Most disabled people were A study shows that unmarried people tend to suffer more from
undereducated, as shown by the study from southwest Turkey and functional limitations, which is in line with our findings. This
in China among community dwellers, including older individuals, observation is also validated by a more comprehensive survey of
in harmony with our study findings (43, 44). Even though the 57 countries worldwide (49, 50). PwD (cognitive impairment or
government mandates a 5% reservation in government-aided mobility difficulties) may appeal less to potential partners due to
institutions and a 4% reserve in government jobs, the prevalence partner selection and independent choices. According to one study,
of disability is higher among those with lower levels of education men refuse to marry disabled women despite their awareness of
(45). These could result from difficulties related to attitude, a lack of their stigma and discrimination. They desire spouses who can give

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Pattnaik et al. 10.3389/fpubh.2023.1036499

FIGURE 2
Prevalence patterns of disability in India based on NFHS-5. (A) Overall prevalence pattern of disability in India, NFHS 5. (B) Distribution of locomotor
disability in India, NFHS 5. (C) Distribution of mental disability in India, NFHS 5. (D) Distribution of speech disability in India, NFHS 5.

the physical support they require while overcoming considerable The study conducted in Chennai among minorities suggested
obstacles to fulfilling their roles as a husband, father, and provider that rates of disability were higher among those belonging to
(51). This also can result from the spouse abandoning their disabled Scheduled Tribes and Scheduled Castes (STs and SCs), which is in
partner, who can no longer support them as a couple (52). contrast with our study findings that is, disability was found to be
The prevalence of disability also varies according to more among those belonging to other backward class (OBCs) (56).
region. Topographically the western part was found to be These communities continue to face economic discrimination and
a potential domain for disability in our study. A regional societal violence in many parts of the country, which frequently
assessment of disability in India revealed that the country’s leads to violence resulting in the death or injury of victims
central zone has the highest percentage of total disability, suggestive of the occurrence of any disability (57).
which contrasts with our findings (53). Despite notable Our analysis reveals that most people with disabilities
advancement in the health index score in a report by NITI have health insurance (58). The Indian government has made
Aayog (National Institution for Transforming India) in provisions for various health insurance schemes for people with
western states like Maharashtra and Gujarat, the rates of disabilities. Two are the Niramaya Health Insurance Scheme
disability were higher in this study (54). However, the level and the Swavlamban Health Insurance Scheme. Whilst the
of healthcare infrastructure is not improving in states such as latter was discontinued for unspecified reasons, the former
Rajasthan, which has a low health index score. According to a provides beneficiaries affordable health insurance (around INR
study, most disabled people in Rajasthan and Gujarat receive 1 lakh plus additional services) (58, 59). Other initiatives that
treatment after the onset of their disability (55). It could be work for the betterment of PWDs include the Deendayal
due to the level of services and facilities the state provides, Disabled Rehabilitation Scheme (DDRS), Sugamya Bharat Abhiyan,
with uncrowded hospitals providing better medical facilities Assistance to Disabled Persons for Purchase / Fitting of Aids /
and treatments. Appliances (ADIP), and the Unique Disability ID Project (UDID).

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Pattnaik et al. 10.3389/fpubh.2023.1036499

Volunteers’ proactive participation, extensive collaboration with in the latent phase, making it difficult to diagnose and hence
NGOs, and comprehensive publicity will draw more public vulnerable to bias. This study has a few more limitations since
attention to these schemes (60). In Bangladesh, a cross-sectional the certificate of the disabled respondents has not been checked,
study reported that most participants visited private clinics or and more than one disability is not given separately in the
hospitals; however, in our research, we discovered that most people dataset. Furthermore, we have not considered NCD as data
with disabilities chose to obtain medical care from NGOs or Trusts, were unavailable.
possibly because it was less expensive than going to the private
hospital, good quality of care, less waiting time, limited government
facility nearby and provision of ancillary services like assistive Conclusion
device (24, 61).
We have also estimated the prevalence and patterns of The overall prevalence of disability in India is 4.5%.
various types of disabilities (Hearing, Speech, Visual, Mental, and Locomotor disability is the most common type of disability
Locomotor) across different sociodemographic statuses, access, and among the population. More intervention strategies should
quality of health services that influence the health and wellbeing of be planned, considering factors like education, health
the population (62). Consistent with previous research, the current promotion and caste so that the services provided by the
study shows disparities in the prevalence of disability types by government can be available and accessible to everyone
age, gender, educational status, region, wealth index, caste, and in need.
treatment facility (63).

Data availability statement

Policy implications Publicly available datasets were analyzed in this study. This
data can be found at: https://www.dhsprogram.com/methodology/
When we look into the interrelationship between disability and survey/survey-display-541.cfm.
covariates, we find that education is strongly linked with disability.
There is a need to shift the emphasis toward health education
through Information, Education and Communication (IEC) and Author contributions
Behavior Change Communication (BCC) strategies. The RPWD
Act 2016 is a fully-fledged initiative by the Indian government SPati, SK, and TR: concept and design. SPati, SK, and TR:
to guarantee equitable services. Community-based rehabilitation monitored analysis and critical revision of the manuscript for
(CBR) is an essential component of this strategy. However, a low important intellectual content. SPati, SK, and TR: administrative
CBR to PWDs ratio, limited resources, and cultural preferences and technical support. JM, SPatt, and RA: acquisition,
impede programmes’ efficiency. Understanding the burden of statistical analysis or interpretation of data, and drafting
disability will be made easier with the help of the recruitment of the manuscript. SPati: supervision. All authors reviewed
of professionally trained personnel, resource allocation, logistical the manuscript.
management, and a CBR database. Despite the government’s
ongoing efforts, a gap still needs to be bridged. Discrimination,
inequality, and social difficulties are still persistent problems. The Acknowledgments
existing gap can be filled through active education and distribution
of disability, how it can be managed, and how it does not The authors thank the National Family Health Survey (NFHS)
make a difference in a society. Dissemination of disability-related for assembling and publishing meticulous, nationally depictive data
initiatives, encouragement of the value of education among those on various health, biomarkers, and healthcare utilization indicators
with congenital disabilities, and methods of vocational employment for the population aged 15–49 years. The authors are also grateful to
at the grassroots level would be beneficial. Accredited Social Health NFHS’s project partners, the International Institute for Population
Activist training and sensitization on raising awareness about Sciences (IIPS), Mumbai.
disability and discussing it with families will significantly impact it.

Conflict of interest
Strength and limitations The authors declare that the research was conducted
in the absence of any commercial or financial relationships
To the best of our knowledge, this is the first study to estimate that could be construed as a potential conflict
the prevalence and determinants of disability across households of interest.
in India. Because the study is based on nationally representative
data from a household survey, it ensures generalizability regarding
the prevalence of various disabilities. However, the cross-sectional Publisher’s note
nature of this study allows it to consider the self-reported incidents
as described by the respondents. It can be challenging to assess All claims expressed in this article are solely those
whether a person has an impairment since it is sometimes of the authors and do not necessarily represent those of

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Pattnaik et al. 10.3389/fpubh.2023.1036499

their affiliated organizations, or those of the publisher, Supplementary material

the editors and the reviewers. Any product that may be
evaluated in this article, or claim that may be made by The Supplementary Material for this article can be found
its manufacturer, is not guaranteed or endorsed by the online at: https://www.frontiersin.org/articles/10.3389/fpubh.2023.
publisher. 1036499/full#supplementary-material

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