Disability And Health | Health Affairs

About one in four US adults, and two in five adults ages sixty-five and older, have a disability. The October 2022 issue of Health Affairs focuses on the relationship between disability and health. Recognizing varied author preferences regarding language surrounding disability, the articles in this issue variously use person-first language (“person with a disability”) and identity-first language (“disabled person”). In their overview article, Lisa Iezzoni and coauthors describe six areas of “persistent health and health care inequities for disabled Americans” and note that this is “discouraging, given the nearly half-century of civil rights laws intended to achieve equity for disabled people.” In a second overview article, Monika Mitra and coauthors describe the prevalence of disability across different populations and “recommend policy changes to advance equity and reduce disparities for all people with disabilities in the US.”

Care Delivery

Personal care aides, primarily funded by Medicaid, play a major role in assisting people with disability with their everyday activities. Susan Chapman and coauthors determine that fewer personal care aides are available in more rural areas and that “the gap between the potential need for personal care aide services and the aide supply [is] greatest in southern states.”

In focus groups conducted by Tara Lagu and coauthors, many primary care and specialist physicians expressed explicit bias against people with disabilities and reported strategies for discharging them from their practices. “Physicians raised concerns about the expense of providing physical and communication accommodations, including insufficient reimbursement for physicians’ efforts and competing demands for staff time and other practice resources,” the authors report.

Rocco Friebel and Laia Maynou investigate the treatment of people with developmental disability in hospitals in the English National Health Service. They find that patients with developmental disability are disproportionately affected by patient safety incidents and are “up to 2.7-fold more likely to experience harm compared to patients without a diagnosed developmental disability.”

Despite the regulations of the Affordable Care Act and the Americans with Disabilities Act regarding communication accessibility, Tyler James and coauthors find 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 accept federal funding are noncompliant with requirements to provide sign language interpretation, as are 77 percent of mental health entities that do not receive federal funds.

Lisa Meeks and coauthors examine mistreatment of physicians with disabilities from both coworkers and patients, including threats of physical harm and offensive 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 population of physicians.”

The COVID-19 pandemic disrupted when and how people obtain medical care. Analyzing data from 2020, Ilhom Akobirshoev and coauthors conclude that after demographic characteristics are controlled for, adults with any disability were about 50 percent more likely to report having delayed medical care during the pandemic than people without a disability.

Specific Populations

An analysis of survey data by Willi Horner-Johnson and coauthors shows that pregnant women with self-reported disabilities are slower to begin prenatal care, more likely to have a preterm birth, and more likely to have a low-birthweight baby than pregnant women who do not report having a disability. The authors also find that using self-reported disability status reveals a higher rate of disability among pregnant women than rates found using diagnosis codes.

Transgender adults experience poorer health, on average, than cisgender adults. Madeline Smith-Johnson finds that transgender adults also report higher rates of disability than cisgender adults, with the disparity remaining even after various demographic, socioeconomic, and health behavior factors are controlled for.

Laurin Bixby and colleagues analyze data on the more than 1.2 million people incarcerated in the US and find that two-thirds of those in state or federal prisons have a disability. More than half report a nonpsychiatric disability, including more than 20 percent with a cognitive disability and more than 10 percent with blindness or low vision.

Although there have been substantial efforts to reduce the number of elderly adults in nursing homes, Ari Ne’eman and colleagues find little change in nursing home use for people with disabilities who are younger than age sixty-five. Compared with older nursing home residents, younger residents are more likely to be men, be members of a racial or ethnic minority, and reside in a lower-quality and for-profit nursing home.

Acknowledgments

Health Affairs thanks Javier Robles of Rutgers University and Lisa Iezzoni of Harvard Medical School for serving as theme issue advisers. 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.