11/20 Health Disparities Flashcards
(47 cards)
______ defines disability as an umbrella term for impairments of body functions and structure, activity limitations, and participation restrictions.
World Health Organization
ICF model provides what view of disability vs. medical model.
Broader view beyond diagnosis: activity, body function, participation, personal factors, social roles, self-care, environment barriers, motor, cognition, and affective.
Medical model just health and body and function: motor and cognitive and affect.
The international classification of functioning disability and health (ICF) framework:
____ is distinct from disability and
________ is an interaction between feature of a person and features of the society in which a person lives
Health is distinct from disability and
Functioning/disability is an interaction between features of a person and features of the society in which the person lives
___% adults in US has a disability
26%
Most serious difficulty walking stairs, then issues concentrating.
Adults ID not well captured in cognitive questions
Are adults with IDD well represented in US health data?
No they are invisible
Health Inequalities
Systematic, socially produced, and important differences in health between groups that are unnecessary and unjust.
Groups based on identity or other characteristic historically linked to discrimination or exclusion
Examples of Racial and Ethnic Disparities
Infant mortality, life expectancy, prevalence of chronic disease, and insurance coverage
Disparities remain regardless of income, health insurance, and access to care
Disparities constant over time between Black and White and growing between White and Hispanic groups.
Compared to people without disabilities, people with IDD have…
Poorer overall health
More health risks
More specialized health care needs
National Surveillance:
Lack of IDD health data and wanted to do something
What sources did it use?
What populations did it compare?
Sources: 1) Behavior risk factor surveillance survey (BRFSS) 2) National Core Indicators (NCI)
Populations: no disability, disability, IDD
Behavior Risk Factor Surveillance System (BRFSS)
Random dial telephone survey (Health-related risk behaviors, Chronic health conditions Use of preventative services)
In 2010, two questions screened for disability (did not have 6 questions, that came later).
(1) ‘‘Are you limited in any way in any activities because of physical, mental, or emotional problems?’’
(2) ‘‘Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?’
National Core Indicators
What were the 3 sources of information?
Quality Management protocol for DD service delivery system
Coordinated nationally by Human Services Research Institute with 25 state participating in 2009-2010
Standard instrument, interviewer training, and methodology (random sample of adult)
Three source of information: self-report, proxy (informant), and service coordinator (file).
Issue with NCI data?
85% should be mild, but breakdown was more even, 35.7% mild. Oversampling of moderate to profound groups.
Developmental disability vs. disability in general
Developmental disability: more likely to not exercise and have inadequate emotional support than general disability or no disability
Disability in general: more likely to smoke or have large BMI
Common Health Risks Among Adults with IDD:
Sedentary
H-pylori bacterial infection
Obesity
Constipation
Poor nutrition Gastroesophageal reflux (GERD)
Inadequate emotional support
Social Determinants of Health
Examples
Conditions in places where people live, learn, work, and play impact health risks and outcomes
Economic stability
Neighborhood and built environment
Education access and quality
Social and community context
Healthcare access and quality
Administrative Health Data Preconception Health:
15-44yo with physical, sensory, and IDD
* IDD (n = 8,986) included ASD and ID
– social determinants of health
– physical health status
– psychosocial well-being
– history of assault
– teratogenic medication use
Compared to women without disability…
with disability: worse SES, mood/anxiety, asthma, stable/unstable chronic med conditions, diabetes, teratogenic meds
Highest in DD: most disadvantaged, mood/anxiety, psychotic disorders, other mental illness, self-harm, substance use, teratogenic meds, history of assault.
Intersectionality
People from marginalized identity groups who also have disabilities confront an enormous health disparity amplifying phenomenon.
Women’s Health at the intersection of disability, race, and ethnicity
2016 Behavioral Risk Factor Surveillance System (BRFSS), data from 50 states, district of Columbia, and 3 territories
N=59,317 women ages 18-44 years
37,942 (64.0%) White women, non-Hispanic
6,662 (11.2%) Black women, non-Hispanic 9,162 (15.5%) Hispanic women (of any race), and
5,551 (9.4%) women from other races and ethnicities (e.g.,
Asian, American Indian, Pacific Islander, multi-racial)
What were the 6 questions?
In disability group if you said “yes” to any of these:
1. Are you deaf or do you have serious difficulty hearing?
2. Are you blind or do you have serious difficulty seeing, even when wearing glasses?
3. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?
4. Do you have serious difficulty walking or climbing stairs?
5. Do you have difficulty dressing or bathing?
6. Because of a physical, mental, or emotional condition, do you
have difficulty doing errands alone such as visiting a doctor’s
office or shopping
2016 Behavioral Risk Factor Surveillance System (BRFSS):
In each racial and ethnic group, women with disabilities had and reported…
sig. less education,
less likely to be married, and less likely to be employed
over-represented in the lowest income categories and under-represented in the highest income categories
fair/poor health, no dental visit past year, smoking/binge drinking, obesity, lack of exercise, mental distress, diabetes, current asthma
National Vital Statistics System 2005–2017 US Multiple Cause
of Death Mortality files, age 18+
Compared ID (n=22,512) to not-ID (n=32,738,229)
Landes et al. (2021) revised the underlying cause of death for the ____% of death certificates that had an ID erroneously reported as their underlying cause of death
23.9%
Non-ID: 74 years
All ID: 61.1 years
Mild/mod: 63.6 years
Severe/profound: 57.2 years
Adults with ID…
___X more likely to die from choking
___X more likely to die from pneumonitis
___X more likely to die from influenza and pneumonia
___X more likely to die from unspecified causes.
Choking, pneumonitis, influenza and pneumonia, unspecified causes
26.3x
20.8x
5.9x
4x
Women live significantly longer than men in US (7 years) BUT why not in ID?
Maybe protected against factors that hurt men more? Hard to say…
74, 70.9 (Male), 77.4 (Female)
ID:
61.1, 60.1 (Male), 62.3 (Female)
Are mortality disparities across race/ethnicity in US similar in ID as not ID groups?
Yes
ID white: 62.7
Black: 55.5
Hispanic: 52.8
Other: 53.8
Leading cause of death not ID vs. Mild/mod vs. severe/profound
1 cause in everyone is heart disease
2 cause in not ID and mild/mod is malignant neoplasm. Respiratory causes in severe/profound.
3 Not ID: Dementia/Alzheimers
Mild/Mod: Diabetes mellitus
Severe/profound: Pneumonitis and influenza pneumonia
