Examining Health Disparities among Adults with Disabilities and What It Means for Public Health
Research suggests that the number of individuals who report having some type of disability is increasing. Research also reports that individuals with disabilities encounter a variety of barriers to health promotion, and disease prevention programming in comparison to individuals without disabilities. Only a limited number of these studies have used nationally representative data; the study used the 2006 Medical Expenditures Panel Survey (MEPS), a nationally representative dataset that provides information about the use, and cost of health insurance coverage and health care, to examine whether disability is associated with higher prevalence rates for common chronic diseases, lower use of preventive care and higher health care expenditures.
Also, this study models the International Classification of Functioning, Disability, and Health (ICF) from the World Health Organization (WHO). This is a framework, (a personal favorite of mine, I might add) which views disability and function as multidimensional, incorporating aspects of the body, person, and society all together. It also defines health and disability separately, a person with a disability can be healthy or unhealthy, but the disability itself does not automatically translate to being unhealthy.
This retrospective analysis compared the health of adults (18 and over) with both physical and cognitive disabilities, (regardless of how the disability was acquired) to individuals with no disability using data from the MEPS. Respondents were classified into either having cognitive limitations (experiences confusion or memory loss, has problems making decisions, or requires supervision for their own safety), physical disabilities (has a functional limitation, uses an assistive device, or has required assistance to perform activities of daily living for 3 or more months), or no disability. Basic demographic information was described, as well as presence of underweight, overweight and obesity, receipt of health insurance, and income (using 2006 poverty thresholds from U.S. Census Bureau). Chi-squared tests, t-tests, and logistic regression were used to evaluate the associations.
Individuals with physical disabilities or cognitive limitations had significantly higher prevalence rates for 7 chronic diseases than people with having no disabilities. These diseases included experiencing more cardiac disease, diabetes, asthma, high blood pressure, and high cholesterol, as well as had a higher association with stroke and arthritis. Results for various outcomes are listed below.
The disability groups were significantly less likely than the no disability group to receive 3 types of preventive care. Those with cognitive limitations had the poorest participation of all three groups in on-time preventive screenings for Pap test, mammograms and dental than those with physical disabilities. Also, this group had significantly increased likelihood for not receiving these services compared to those without disabilities. Those without disabilities are most likely to receive care for Pap test, mammograms, and dental visits, but were least likely to receive flu shots.
Total Medical Expenditures:
Disability groups had higher expenditures than the no disability group, and those with cognitive disabilities had 4.8 times higher than the no disability group; while those with physical disabilities had expenditures 4.3 times higher than those with no disabilities.
Cognitive Limitations: 40.8% male
Physical Disabilities: 39.2% male
No Disabilities: 49.6%
Cognitive Limitations: 59 years
Physical Disabilities: 60.1 years
No Disabilities: 41.7 years
Private Insurance Coverage:
Cognitive Limitations: 44.8%
Physical Disabilities: 57.4%
No Disabilities: 76.1%
Cognitive Limitations: 28.5%
Physical Disabilities: 16.2%
No Disabilities: 5.5%
Overweight or Obese:
Cognitive Limitations: 62.7% (33.3% obese)
Physical Disabilities: 70% (39.9% obese)
No Disabilities: 59.7% (35.7% overweight)
This work confirms previous studies in a couple of ways. Specifically in demonstrating higher prevalence rates among individuals with cognitive limitations and physical disabilities for various chronic and secondary conditions. Also, it reinforces that people with disabilities have a higher prevalence of obesity. It also confirms previous research that people with disabilities report lower health status and is more likely to have a usual source of care.
Not only does the data suggest that adults with disabilities and chronic conditions have poorer health status, but it also shows they receive significantly fewer preventive services. This indicates a dire need for public health interventions that address the unique characteristics of adults with disabilities in improving and maintenance of their health behaviors, especially those related to weight loss, physical activity and disease management. To do this, we will need to consider the physical and social determinants of health for each disability group, as well as their available resources.
It was interesting to me that people with disabilities showed a usual source of care yet still incurred high-total medical expenditures. The reason possibly is that they are receiving care, but possibly not the types of care that could potentially prevent or manage secondary conditions or improve health behaviors. So rather than simply increasing the amount of care, we need to rethink how these services are delivered or what types of services are offered, including considering things, such as environmental access. Yes, consumers themselves need to be educated on how to be proactive versus reactive with their own health, but health care providers and policy makers also need to adopt a similar attitude, and the ICF framework can be helpful in doing this. It can help lead people to see the whole person/situation, and help them see that having a disability does not completely define a person nor does it define a state of health. You can have a disability AND be healthy.
Future research needs to help reveal why healthcare costs are so disproportionate between groups of people with and without disabilities, but also to clearly identify the existing health disparities so that the unique health care and prevention needs of people with disabilities can be acknowledged, and addressed in existing and future public health interventions and programs.
Please send any questions or comments to Blythe Hiss at firstname.lastname@example.org .