The objectives of this study were twofold: to investigate the national-level burden of disability in Bangladesh and to identify the associated factors. Our findings reveal that approximately 3% of Bangladesh’s total population experiences some form of disability. The prevalent forms of disability are physical disability, followed by visual impairment and multidimensional disability. Among the demographic segments, higher disability prevalence is observed among males, individuals aged 60 or older, those with no formal education, and those residing in the Khulna, Rajshahi, and Rangpur divisions. Conversely, lower odds of disability were found among unmarried individuals, individuals with comparatively lower educational attainment, and respondents in the Khulna and Rangpur divisions. Conversely, a higher likelihood of disability was identified among respondents with relatively improved household wealth quintiles and those living in communities with moderate to high levels of illiteracy. Notably, these findings hold considerable robustness as they emerge from an advanced statistical model applied to a large, nationally representative sample. The model accounts for a comprehensive range of individual, household, and community-level factors. Therefore, insights reported in this study are poised to inform national-level policymaking and program development.

The documented disability prevalence of approximately 3% in the present study conducted in Bangladesh starkly contrasts with the 16% average disability rate at the global level reported by the WHO in 2022 ¹. Notably, disability prevalence exhibited substantial variation at the national level, ranging from 1.0% to 18.0% ¹⁹. This discrepancy highlights a remarkable advancement within the country’s context, although the absolute number of individuals grappling with disabilities remains significant, encompassing an estimated 4.8 million people ¹⁵. The underlying factors contributing to this relatively diminished prevalence in Bangladesh can be attributed to the comparatively smaller proportion of the aging populace and a higher concentration of rural residents ^2,24. It is essential, however, to acknowledge the ongoing rapid shifts observed in both these indicators within the nation. The surge in urban dwellers and the aging population signals the potential for an escalation in disability prevalence in the forthcoming years ²⁸. This projection can be attributed to a surge in accidents stemming from urbanization and industrialization, alongside the migration from rural to urban settings ^3,7. Additionally, heightened survival rates subsequent to accidents leading to physical impairments, coupled with increased life expectancy amidst various health conditions, collectively contribute to this trajectory ^6,29.

These characteristics are also exhibit a more pronounced presence among individuals with comparatively higher educational backgrounds and white-collar occupations in Bangladesh and other LMICs ^15,30. Moreover, the gradual escalation of disability likelihoods corresponding to household wealth quintiles provides further corroboration for the aforementioned suppositions. While seemingly paradoxical, these observations can be elucidated through a nuanced lens. Increased awareness and accessibility to healthcare services among people with these characteristics can lead to heightened diagnosis rates ³¹. Moreover, heightened educational levels and enhanced socioeconomic status often correlate with increased engagement in activities involving greater risk, whether due to occupation-related hazards or participation in recreational pursuits ³⁰. Paradoxically, despite having improved access to healthcare services, there is a prevailing norm that prioritize the receipt of health care services based on immediate needs, seeking medical attention solely when unwell, rather than prioritizing services that hold potential for sustained long-term health benefits ^8,31. It allows certain conditions to evolve into disabilities over time. Moreover, the extended lifespan typically associated with enhanced educational and economic circumstances can predispose individuals to age-associated disabilities ³¹. Psychosocial stressors, a facet frequently encountered within higher socioeconomic tiers, might also contribute to mental health challenges that can, over time, manifest as disabilities ¹².

The persistent burden of non-communicable diseases in Bangladesh, akin to that in other LMICs, is particularly pronounced among individuals with higher educational achievements, residing in urban areas, and positioned within the upper echelons of wealth quintiles ^28,32. The primary underlying reasons are an increased dependency on Western food and a higher rate of overweight/obesity ³³. Individuals belonging to these categories tend to adopt more hygienic lifestyles, often allocating less time to tending to their physical well-being. People with these characteristics are more likely to report disability, as indicated in this study and in other studies conducted in LMICs ³⁴. A recent Bangladeshi student using the same cohort of disabled individuals we analyzed also reported that around half of them have comorbidities, with highly prevalent comorbidity being chronic conditions, including NCDs ³⁵. The pathways of a higher rate of disability following chronic conditions could be linked with a higher rate of undiagnosed and untreated chronic conditions, with treatment received when disability has already onset.

However, higher likelihoods of disability among individuals in the comparatively lower education and resided in the Khulna, Rajshahi and Rangpur divisions indicate different perspective of these observations. As per the current community structure in Bangladesh, people in the community with lower education predominantly engaged in risky job, have very poor knowledge about health status and likely to accept healthcare services. Similarly, the aforementioned divisions are characterized by lower prevalence of urbanization and industrialization, with inhabitant there are primarily engaged with agriculture ³. They are also less likely to access healthcare services indicating risk of any health conditions are primary undiagnosed and untreated indicating increased likelihoods of disability ³¹. We found a very higher percentage of disability among widowed, divorced, or separated as compared to the normal married or unmarried women. However, the likelihood of disability among this group was found insignificant. This could be attributed to factors such as economic hardship, social isolation, depression, anxiety, and chronic health conditions ^36,37. Unmarried women may face financial challenges, leading to stress and health issues ³⁷. They may also have limited social support, contributing to stress-related health problems. The loss of a spouse or the end of a marriage can trigger depression and anxiety, potentially leading to disability ³⁸. Unmarried women might also have a higher prevalence of chronic health conditions like heart disease, stroke, and diabetes, which can further increase the risk of disability ^37,39. However, there could be other factors involved and further research is necessary to fully understand this phenomenon.

The policy implications of this study is that national actual burden of person with disability is higher with nearly 3% disability which is belong to around 4.6 million people ²¹. The likelihoods of being disabled are higher among comparatively higher educated, higher wealth quintile and better occupation holders. This indicates lower awareness regarding health status ⁴⁰. This suggest needs for awareness building programs to accelerate healthcare services use in regular basis rather than accessing healthcare services when feel unwell.

This study has several strengths. As far we know this is the first study in Bangladesh that explored the national level burden of disability and its corelates based on quite large sample collected by a nationally representative households survey. Recognised procedure were applied to measure disability. Data were analysed by comprehensive statistical modelling with hierarchical structure of the data and sampling weights were considered in all analysis. Therefore, they findings are robust, and can be used in developing national level policies and programs.

However, the primary limitations of this study were the analysis of cross-sectional data, which limited our capacity to established causality and the findings were correlational only. Data were collected by asking questions to the respondents with no chance of validation. This indicates possibility of presence recall bias, though any of such bias is likely to be random. Moreover, other than the factors adjusted in the model, health and environmental factors can contribute to the onset in disability as such they are important to be adjusted in the model. However, these data were not available in the survey, limiting us to do so. However, regardless of these limitations the findings of this study will contribute to the national level policies and program development.