Abstract
Background: Surveillance has been insufficient to inform and evaluate public health practices for people with disabilities. No studies have investigated whether there is statistical justification for subdividing the large, heterogeneous group of people with disabilities into subpopulations, for surveillance. Methods: Pooled data from the Medical Expenditures Panel Survey (2004-2010, unweighted n=132,198) included the following disability types: physical, cognitive, visual, hearing loss, and multiple disabilities. We examined differences among the disability subgroups and the no disability group on receipt of flu shot, dental exam, and timely care; insurance status; usual source of care (USOC); mental and physical health; and multiple chronic conditions (MCC). Results: The disability subgroups were sociodemographically heterogeneous and differed from each other and the no disability group on health status (mental, physical, and MCC) and healthcare outcomes (flu shot, dental exam, timely receipt of care, USOC, insurance status). Conclusion: Findings demonstrate that disability subgroups differ in the magnitude of the disparities they experience compared to each other and to people without disabilities. Disability subgroups should be examined separately for public health measures to enable effective tailoring of public health policies and programs to better meet the needs for all people.
Highlights
Recent efforts have highlighted the poor health of people with disabilities (Horner-Johnson, Dobbertin, Lee, & Andresen, 2013; 2014; Reichard, Stolzle, & Fox, 2011); few public health efforts have been directed to or purposefully included this population
While recent support from federal agencies (Centers for Disease Control and Prevention, 2011; U.S Department of Health and Human Services, 2002, 2005) has enabled a substantial increase in the number of intervention studies aimed at improving health outcomes for individuals with disabilities (Naaldenberg, Kuijken, van Dooren, & van Schrojenstein Lantman de Valk, 2013; Seekins, Drum, Kimpton, & al., 2010), a sufficient concomitant surveillance effort has not been undertaken to inform which interventions are needed to address the disparities experienced among these subgroups and to evaluate the effects of interventions and other public health practices on this population
We summarized the statistically significant bivariate differences in sociodemographic and health and healthcare outcomes among the five disability groups. (We do not highlight the differences between individuals within each disability subgroup and those without disabilities because these differences are already well-established and is not the specific focus of this work; the findings for the no disability group are included in Table 1, for reference)
Summary
Recent efforts have highlighted the poor health of people with disabilities (Horner-Johnson, Dobbertin, Lee, & Andresen, 2013; 2014; Reichard, Stolzle, & Fox, 2011); few public health efforts have been directed to or purposefully included this population. Purposeful and comprehensive expansion of surveillance efforts specific to people with disabilities is required to best address the health disparities that individuals with disabilities experience (Krahn, Walker, & Correa DeAraujo, 2015). These efforts are necessary to enumerate individuals with disabilities and to guide public health action inclusive of people with disabilities. Results: The disability subgroups were sociodemographically heterogeneous and differed from each other and the no disability group on health status (mental, physical, and MCC) and healthcare outcomes (flu shot, dental exam, timely receipt of care, USOC, insurance status). Disability subgroups should be examined separately for public health measures to enable effective tailoring of public health policies and programs to better meet the needs for all people
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