Does life expectancy vary by disability status in LMICs?: A systematic review and meta-analysis.

BACKGROUND: People with disabilities on average experience health care barriers, poorer health and higher mortality. OBJECTIVES: This study aims to review and synthesise life expectancy (LE) and years of life lost (YLL) comparing people with disabilities to those without in low and middle-income countries (LMICs). METHOD: A systematic review was conducted across six databases. Longitudinal studies with a comparator group that measured LE in or YLL between people with and without disabilities in LMICs were eligible for inclusion. Two reviewers independently assessed study eligibility, extracted data and assessed the risk of bias. Meta-analyses were undertaken using R 4.3.3. The study assessed heterogeneity with I2 and publication bias with a funnel plot. Sub-group and meta-regression analyses were performed, and the risk of bias was evaluated. RESULTS: Twelve full-text articles were included in this meta-analysis. The pooled mean LE was lower in people with disabilities (57.98 years; 95% confidence intervals [CI]: 53.40-62.95) compared with people without disabilities (70.86 years; 95% CI: 64.06-78.38). The overall weighted years of YLL in people with disabilities was 15.84 years (95% CI: 11.1-22.61). There was no significant difference in YLL between men (16.33 years; 95% CI: 11.49-23.21) and women (13.7 years; 95% CI: 8.45-22.22). CONCLUSION: The average LE in people with disabilities was substantially lower compared to those without disabilities in LMICs. This inequity highlights that health systems and public health efforts are failing to meet the needs of people with disabilities and must be improved to become more inclusive. CONTRIBUTION: The study emphasises the need for inclusive policies and robust research in the health system to address health disparities.