About one in four U.S. adults and two in five adults age sixty-five and older have a disability. October 2022 issue Health matters focuses on the relationship between disability and health. Recognizing the authors’ diverse preferences for language around disability, the articles in this issue variously use person-first language (‘disabled person’) and identity-first language (‘disabled person’). In their review article, Lisa Iezzoni and co-authors describe six areas of “persistent health and health care disparities for Americans with disabilities” and note that this is “disheartening given nearly half a century of civil rights laws designed to achieve justice for people with disabilities. ” In a second review article, Monica Mitra and coauthors describe the prevalence of disability among different populations and “recommend policy changes to promote equity and reduce disparities for all people with disabilities in the US.”
Delivery of care
Personal care aides, primarily funded by Medicaid, play a major role in helping people with disabilities with their daily activities. Susan Chapman and co-authors determined that there are fewer personal care aides in more rural areas and that “the gap between the potential need for personal care assistance services and the availability of assistance [is] the largest in the southern states.
In focus groups conducted by Tara Lagu and coauthors, many primary care physicians and specialists expressed an explicit bias toward people with disabilities and reported strategies for excluding them from their practices. “Physicians expressed concern about the costs of providing physical and communication accommodations, including insufficient reimbursement of physician efforts and competing demands on staff time and other practice resources,” the authors report.
Rocco Friebel and Laia Maynou research the treatment of people with developmental disabilities in NHS England hospitals. They found that patients with developmental disabilities were disproportionately affected by patient safety incidents and were “up to 2.7 times more likely to experience a disability compared to patients without a diagnosed developmental disability.”
Despite provisions of the Affordable Care Act and the Americans with Disabilities Act regarding communication accessibility, Tyler James and co-authors found that a significant number of mental health and substance use treatment facilities are not accessible to deaf or hard of hearing patients. Forty-one percent of mental health facilities that receive federal funding do not meet the requirements to provide sign interpretation, as do 77 percent of mental health facilities that do not receive federal funds.
Lisa Meeks and co-authors examine mistreatment of physicians with disabilities by both colleagues and patients, including threats of physical harm and disparaging remarks related to a disability. They report that “64 percent of physicians with disabilities experienced some form of mistreatment in 2019, putting them at much greater risk of mistreatment than the general physician population.”
The COVID-19 pandemic has disrupted when and how people receive medical care. Analyzing data from 2020, Ilhom Akobirshoev and coauthors concluded that after controlling for demographic characteristics, adults with any disability were about 50 percent more likely to report delaying medical care during the pandemic than people without disabilities.
An analysis of study data by Willi Horner-Johnson and co-authors shows that pregnant women with self-reported disabilities start prenatal care more slowly, are more likely to have a preterm birth, and are more likely to have a low birth weight baby than pregnant women who do not report disability. The authors also found that using self-reported disability status revealed higher rates of disability among pregnant women than levels ascertained using diagnosis codes.
Transgender adults have poorer health on average than cisgender adults. Madeline Smith-Johnson found that transgender adults also reported higher rates of disability than cisgender adults, a disparity that remained even after controlling for various demographic, socioeconomic, and health behavioral factors.
Lorin Bixby and colleagues analyzed data on more than 1.2 million US inmates and found that two-thirds of those in state or federal prisons have a disability. More than half reported a nonpsychiatric disability, including more than 20 percent with cognitive impairment and more than 10 percent with blindness or low vision.
Although significant efforts have been made to reduce the number of elderly people in nursing homes, Ari Neiman and colleagues found little change in nursing home use for people with disabilities who were under the age of sixty-five. Compared with older nursing home residents, younger residents are more likely to be male, to be members of a racial or ethnic minority, and to live in a lower-quality, for-profit nursing home.
Health matters thanks Javier Robles of Rutgers University and Lisa Iezzoni of Harvard Medical School for serving as subject matter advisors. We also thank the Ford Foundation, the Robert Wood Johnson Foundation, and the John D. and Catherine T. MacArthur Foundation for their financial support of this issue.