Washington Group Short Set Research Articles

Electoral participation of people with and without disabilities in urban communities in Cameroon and Senegal.

The right to participate in political processes is fundamental to democratic governance, economic development and human rights. We assessed participation in political processes and also explored factors associated with voting at the most recent election for people with and without disabilities. We conducted cross-sectional survey in four cities in Senegal and three in Cameroon in 2021. Disability was assessed using the Washington Group Short Set of questions. Univariate and multiple regression analyses were conducted to identify the factors associated with voting at the most recent elections. Among 4180 participants in Cameroon and 4171 in Senegal, disability prevalence was 9.77% and 10.89%, respectively. More than half of the participants had voted at the most recent elections in both Cameroon (52.31%) and Senegal (58.27%). Participants with an interest in politics, having all the key documents or registered with a political party were more likely to have voted in both countries. Adjusting for socio-demographic characteristics, people with disabilities were less likely to have voted compared to those without disabilities in Cameroon (odds ratio [OR] = 0.58 [0.40, 0.84]) and in Senegal (OR = 0.36 [0.26, 0.44]). There is an urgent need to address the socio-political and environmental factors that have been identified so as to close the disability gaps in voting and ensure equitable opportunities and levels of political participation between people with and without disabilities. This article contributes to the existing knowledge base on the political participation of people with and without disabilities in Cameroon and Senegal.

Performance of the Washington Group questions in measuring blindness and deafness.

The Washington Group Short Set (WGSS) questions are intended to measure the severity of disability and disability status in US federal surveys. We used data from the 2010-2018 National Health Interview Survey to examine the performance of the WGSS visual disability and hearing disability questions in capturing blindness and deafness. We found that the WGSS questions failed to capture 35.7% of blind adults and 43.7% of deaf respondents as having a severe disability, or, per their recommended cut point, as being disabled. Coupled with evidence demonstrating the poor performance of the WGSS questions in estimating the size of the overall disability population, we contend that results from this study necessitate a halt in the use of the WGSS questions to measure disability in US federal surveys.

The association of disability and medical financial hardship among cancer survivors in the US.

136 Background: Medical financial hardship (MFH) in cancer survivors is well-documented. Little is known about how disability impacts healthcare needs and costs in cancer survivorship. We examined associations of disability and MFH among survivors in the US. Methods: We identified cancer survivors ≥18 years with (n=2,795) and without (n=12,263) a disability from the National Health Interview Survey 2019 to 2022. The Washington Group Short Set, a validated six-item measure intended to describe the functional status of adults (e.g. disability in seeing, hearing, or walking) was used to identify those with disabilities. MFH was categorized into three domains: 1) material (e.g. problems paying medical bills), 2) psychological (e.g. worrying about medical bills), and 3) behavioral (e.g. delaying/forgoing care due to cost). Adjusted logistic regressions were used to examine associations of disability and MFH among cancer survivors. Results: Cancer survivors with a disability were more likely to experience any MFH (57.2% vs. 47.0%, p<0.05) or any individual domain (Material: 26.4% vs. 13.3%, p<0.05; Psychological: 50.5% vs. 43.0%, p<0.05; Behavioral: 23.2% vs. 12.9%, p<0.05) compared with those without a disability. In addition, survivors with a disability were more likely to report experiencing multiple domains of MFH (29.1% vs. 15.9%; p<0.05). Conclusions: Cancer survivors with a disability face higher risks of MFH. Our findings can inform interventions alleviating MFH in this especially vulnerable population. Association of disability with medical financial hardship among cancer survivors, National Health Interview Survey 2019-2022. Cancer Survivors with a Disabilityn = 2,795 Cancer Survivors without a Disabilityn = 12,263 AME(95% CI) AME(95% CI) Any material financial hardship 26.4(24.7, 28.0) 13.3(12.5, 14.2) Any psychological financial hardship 50.5(49.1, 52.0) 43.0(42.0, 44.0) Any behavioral financial hardship 23.2(21.7, 24.7) 12.9(12.0, 13.7) Any MFH 57.2(55.8, 58.6) 47.0(46.0, 48.0) 1 domain of MFH 57.2(55.8, 58.6) 47.0(46.0, 48.0) 2+ domains of MFH 29.1(27.5, 30.6) 15.0(14.1, 15.8) Note: In adjusted analyses, covariates included age, sex, race/ethnicity, marital status, education, family income as % of Federal Poverty Level, insurance, year, and survey design; AME=Average Marginal Effect; CI = Confidence Interval.

Differences in need for and access to eye health services between older people with and without disability: A cross-sectional survey in four districts of northern Uganda.

Eye health and disability are both common among older people, and it is important to understand how disability relates to visual health status and access to services. While people with disabilities face barriers to accessing health services, few studies have measured participants' functional status in domains other than vision and little evidence exists on how disability impacts eye health services access. This paper describes how visual impairment and access to eye health services differ between people aged 50 years and above with and without disability in Karamoja, Uganda, and explores the factors driving that difference. This was a cross-sectional survey among individuals aged 50 years and above. A standardised eye health survey was conducted, with additional questions on personal and health characteristics. Ophthalmologists conducted a vision examination, and recorded participants' self-reported functional difficulties using the Washington Group Short Set Enhanced. Descriptive analyses were conducted using Stata, and multivariate models constructed to explore relationships. 21.7% of respondents self-reported some sort of functional difficulty. Twenty-five percent of individuals with a non-visual functional difficulty are also blind, and a further 29% experience a lower level of VI. In a multivariate model, blindness was associated with self-reported difficulties seeing, but not any other type of difficulty. Blindness was also associated with age, not being married, and living in a smaller household. Access to cataract surgery was associated with non-visual functional difficulties, male gender, and having a regular household income. This study confirms that in the study area, disability and visual impairment are common among people aged 50 years and above, access to eye health services is low, and self-reported functional difficulties are not associated with lower access to services.

Differences in Health Status between People with and without Disabilities in Ecuadorian Prisons

People with disabilities experience significant health inequalities and inequities compared to people without disabilities. However, there is little evidence on the frequency of health conditions and their association with disability in the prison context. The aim of this study was to compare the proportions and associations between various health conditions and different disability indicators. A secondary analysis of existing data from the Ecuador Prison Census 2022 was conducted. The variable of interest was based on three disability indicators from the six-item Washington Group Short Set on Functioning. A cross-tabulation was carried out to estimate the proportion of prisoners with different disability indicators by gender. These proportions were also calculated for different health conditions. Moreover, we analyzed the association between each of the three disability indicators and the different health conditions using multivariable logistic regression. A total of 30,612 incarcerated persons were included in the analysis, revealing that 8% had disabilities. According to gender, a higher proportion of women had disabilities (10.7% vs. 8.5%), some difficulty functioning (33.8% vs. 28.0%), and multiple disabilities (2.4% vs. 2.0%) compared to men. Furthermore, people with disabilities had a higher proportion of health conditions compared to those without a disability. Strong and very strong evidence of associations were found between different disability indicators and several health conditions, while a lower odds of drug use was observed in people with disabilities and multiple disabilities compared to their counterparts, and no evidence of association was found with Human Immunodeficiency Virus (HIV) infection. Our results reflect the health inequalities and inequities experienced by prisoners with disabilities. This highlights the need to implement targeted policies within prisons and to include prisoners with disabilities in the country’s agenda.

Did high frequency phone surveys during the COVID-19 pandemic include disability questions? An assessment of COVID-19 surveys from March 2020 to December 2022

ObjectivesIn the midst of the pandemic, face-to-face data collection for national censuses and surveys was suspended due to limitations on mobility and social distancing, limiting the collection of already scarce...

Measuring disability among U.S. adolescents and young adults: A survey measurement experiment

ObjectiveDisability is identified in surveys using various question sets, with little understanding of reliability across these measures, nor how these estimates may vary across age groups, including adolescents and young adults (AYA). The purpose of this study was to assess AYA prevalence of disability using two disability question sets and reliability of these measures. MethodsAYA participants in the Policy and Communication Evaluation (PACE) Vermont Study completed a single-item disability question used in the National Survey on Health and Disability (NSHD) and Urban Institute’s Health Reform Monitoring Survey (HRMS) and a six-item set on functioning (Washington Group-Short Set, WG-SS) from the National Health Interview Survey (NHIS) and National Survey on Drug Use and Health (NSDUH) in 2021. Prevalence was estimated for any disability and each disability domain in adolescents (ages 12–17) and young adults (ages 18–25) and compared with U.S. national estimates in NHIS and NSDUH. ResultsUsing the WG-SS, the prevalence of any disability was 17.0 % in PACE Vermont adolescents and 22.0 % in young adults, consistent with the national prevalence of adolescents in NSDUH (17.9 %) but higher than estimates of young adults in NHIS (3.9 %) and NSDUH (12.9 %). The single-item question provided lower estimates of disability (adolescents: 6.9 %; young adults: 18.5 %) than the WG-SS, with low positive agreement between measures. DiscussionThe prevalence of disability in AYAs varies depending on measures used. To improve disability surveillance, it may be necessary to validate new disability questions, including among AYAs, to capture a broader range of disability domains.

Psychological distress and mental health diagnoses in adults by disability and functional difficulty status: Findings from the 2021 national health interview survey

BackgroundEvidence suggests that disabled people have worse mental health than non-disabled people, but the degree to which disability contributes to mental health is unclear. ObjectiveThis paper uses 2021 National Health Interview Survey (NHIS) data to estimate the association between disability and depression and anxiety diagnoses as well as psychological distress among adults. MethodsWe calculated disability population prevalence and mental health diagnoses and associated symptoms among 28,534 NHIS respondents. Logistic regressions estimated the odds of depression or anxiety diagnoses and recent psychological distress, controlling for disability and mental health diagnoses. We measured disability using binary and continuum measures of functional disability with the Washington Group Short Set on Functioning. ResultsDisabled people have significantly greater odds of both depression and anxiety diagnoses compared to non-disabled people. Those with high functional disability have 552 % greater odds of an anxiety diagnosis (95 % CI: 5.61–7.58; p < 0.01) and 697 % greater odds of a depression diagnosis (95 % CI: 6.97–9.12; p < 0.01) compared to those with no functional disability. Similarly, those with any level of functional disability are more likely to have elevated psychological distress in the past 30 days compared to those with no functional disability. ConclusionsFindings support the idea that mental health is worse for disabled people compared to non-disabled people, with increasing functional disability associated with worse mental health. This suggests that mental health is not being adequately addressed for those with the greatest functional disability. Future work should seek to better understand the systemic causes of disparities.

Long-term impact of COVID-19 hospitalisation among individuals with pre-existing airway diseases in the UK: a multicentre, longitudinal cohort study - PHOSP-COVID.

The long-term outcomes of COVID-19 hospitalisation in individuals with pre-existing airway diseases are unknown. Adult participants hospitalised for confirmed or clinically suspected COVID-19 and discharged between 5 March 2020 and 31 March 2021 were recruited to the Post-hospitalisation COVID-19 (PHOSP-COVID) study. Participants attended research visits at 5 months and 1 year post discharge. Clinical characteristics, perceived recovery, burden of symptoms and health-related quality of life (HRQoL) of individuals with pre-existing airway disease (i.e., asthma, COPD or bronchiectasis) were compared to the non-airways group. A total of 615 out of 2697 (22.8%) participants had a history of pre-existing airway diseases (72.0% diagnosed with asthma, 22.9% COPD and 5.1% bronchiectasis). At 1 year, the airways group participants were less likely to feel fully recovered (20.4% versus 33.2%, p<0.001), had higher burden of anxiety (29.1% versus 22.0%, p=0.002), depression (31.2% versus 24.7%, p=0.006), higher percentage of impaired mobility using short physical performance battery ≤10 (57.4% versus 45.2%, p<0.001) and 27% had a new disability (assessed by the Washington Group Short Set on Functioning) versus 16.6%, p=0.014. HRQoL assessed using EQ-5D-5L Utility Index was lower in the airways group (mean±SD 0.64±0.27 versus 0.73±0.25, p<0.001). Burden of breathlessness, fatigue and cough measured using a study-specific tool was higher in the airways group. Individuals with pre-existing airway diseases hospitalised due to COVID-19 were less likely to feel fully recovered, had lower physiological performance measurements, more burden of symptoms and reduced HRQoL up to 1 year post-hospital discharge.

Cognitive Testing and Piloting of the Bangla Version of the Washington Group Short Set Questionnaire on Functioning Among Adolescent Girls and Women With Disabilities in Selected Sub-districts of Bangladesh.

Introduction This study focuses on the cognitive testing and piloting of the Bangla version of the Washington Group Short Set Questionnaire on Functioningamong adolescent girls and women with disabilities in selected sub-districts of Bangladesh. The Washington Group on Disability Statistics developed the questionnaire as a tool to assess the functioning and disability status of individuals. The adaptation of this questionnaire to Bangla is crucial for capturing accurate data on the experiences of adolescent girls and women with disabilities in Bangladesh. Materials and methods The research employs a two-phase approach, starting with cognitive testing to ensure the linguistic and cultural relevance of the translated questionnaire. This phase involves engaging with a sample of the target population to assess the comprehension, clarity, and appropriateness of the questions. Subsequently, a pilot study was conducted in selected sub-districts to evaluate the feasibility and validity of the Bangla version of the Washington Group Short Set Questionnaire on Functioningin real-world settings. Both of the tests were conducted in March 2023. Results There were different types of participants with different types of disabilities. Information processing, meaning, understanding the questions, thinking, and answering speed or time were different between groups, even though they were different from person to person.The initial assessments indicate strong consistency in responses. Participants demonstrated a favorable response rate, indicating potential effectiveness for broader implementation. Conclusion The current study aims to contribute to disability data collection methodologies, particularly in the context of adolescent girls and women in Bangladesh. The research seeks to empower policymakers, researchers, and advocacy groups with a robust instrument of disability screening. Researchers and clinicians may rely on our accurate and validated Washington Group Short Set Questionnaire on Functioningtranslation into Bangla when working with adolescent girls and women with disabilities.

Functional difficulties in children and youth with autism spectrum disorder: analysis of the 2019 Canadian Health Survey on Children and Youth.

This study examined the prevalence of functional difficulties and associated factors in Canadian children/youth aged 5 to 17 years diagnosed with autism spectrum disorder (ASD). We analyzed data from the 2019 Canadian Health Survey on Children and Youth (CHSCY), a nationally representative survey of Canadian children/youth that used the Washington Group Short Set on Functioning (WG-SS) to evaluate functioning in six daily tasks. For each functional domain, binary outcomes were derived (no/some difficulty, a lot of difficulty/no ability). We used logistic regression to identify associations between demographic characteristics, educational experiences, and perceived mental and general health and the most common functional difficulties, namely those related to remembering/concentrating, communication and self-care. All estimates were weighted to be representative of the target population. The bootstrap method was used to calculate variance estimates. Analysis of the records of 660 children/youth with ASD revealed that the most common functional difficulties were remembering/concentrating (22%; 95% CI: 18-27), communicating (19%; 95% CI: 15-23) and self-care (13%; 95% CI: 10-17). Lower perceived mental health was associated with increased functional difficulties with remembering/concentrating. ASD diagnosis at a lower age and lower perceived general health were associated with increased functional difficulty with communication. Parental expectations for postsecondary education were associated with decreased functional difficulty for self-care. One or more functional difficulties from the WG-SS was present in 39% of Canadian children/youth aged 5 to 17 years with ASD. Functional difficulties with remembering/concentrating, communication and self-care were most common.

Maternal disability and initiation and duration of breastfeeding: analysis of a Canadian cross-sectional survey

BackgroundThe World Health Organization recommends breastfeeding as the best method for infant feeding. Known risk factors for breastfeeding non-initiation and early cessation of breastfeeding are diverse and include low breastfeeding self-efficacy, poverty, smoking, obesity, and chronic illness. Although women with disabilities experience elevated rates of these risk factors, few studies have examined their breastfeeding outcomes. Our objective was to examine breastfeeding non-initiation and early cessation of breastfeeding in women with and without disabilities.MethodsWe used data from the 2017–2018 Canadian Community Health Survey. Included were n = 4,817 women aged 15–55 years who had a birth in the last five years, of whom 26.6% had a disability, ascertained using the Washington Group Short Set on Functioning. Prevalence ratios (aPR) of breastfeeding non-initiation, and of early cessation of any and exclusive breastfeeding before 6 months, were calculated for women with versus without disabilities. We also examined disability by severity (moderate/severe and mild, separately) and number of action domains impacted (≥ 2 and 1, separately). The main multivariable models were adjusted for maternal age, marital status, level of education, annual household income level, and immigrant status.ResultsThere were no differences between women with and without disabilities in breastfeeding non-initiation (9.6% vs. 8.9%; aPR 0.88, 95% CI 0.63, 1.23). Women with disabilities were more likely to have early cessation of any (44.4% vs. 35.7%) and exclusive breastfeeding before 6 months (66.9% vs. 61.3%), with some attenuation in risk after adjustment for sociodemographic factors (aRR 1.15, 95% CI 0.99, 1.33 and aRR 1.07, 95% 0.98, 1.16, respectively). Disparities were larger for women with moderate/severe disabilities and disabilities in ≥ 2 domains, with differences attenuated by adjustment for socio-demographics.ConclusionsWomen with disabilities, and particularly those with moderate/severe and multiple disabilities, could benefit from tailored, accessible breastfeeding supports that attend to the social determinants of health.

Access to Reproductive Health Services Among People With Disabilities

People with disabilities face inequitable access to reproductive health (RH) services, yet the national prevalence of barriers to access experienced across disability types and statuses is unknown. To assess the national prevalence of barriers to RH access experienced by people with disabilities. This cross-sectional study analyzed results of an online probability-based national survey of RH experiences that was conducted from December 2021 to January 2022. The national sample consisted of English- and Spanish-speaking panel members of a market research firm. Panelists were invited to participate in a survey on their RH experiences and opinions. These participants were aged 15 to 49 years and assigned female at birth (AFAB). Weighted proportions were estimated, and bivariable and multivariable regression analyses were performed to assess associations between disability status and barriers to accessing RH services. Using 5 of the 6 Washington Group Short Set on Functioning items, 8 dichotomous disability indicators were created: (1) vision, (2) hearing, (3) mobility, (4) activities of daily living, (5) communication, (6) overall disability status (a lot or more difficulty functioning in ≥1 domain), (7) some difficulty functioning (below the disability threshold; some or more difficulty functioning in ≥1 domain), and (8) multiple disabilities (a lot or more difficulty functioning in ≥2 domains). Number and types of barriers (logistical, access, cost, privacy, and interpersonal relationship) to accessing RH services in the past 3 years. After exclusion, the final sample included 6956 people AFAB, with a mean (SD) age of 36.0 (8.3) years. Of these participants, 8.5% (95% CI, 7.6%-9.5%) met the disability threshold. Participants with disabilities compared with those without disabilities were disproportionately more likely to be non-Hispanic Black (18.8% [95% CI, 14.4%-24.1%] vs 13.2% [95% CI, 11.9%-14.5%]) or Hispanic or Latinx (completed survey in English: 18.1% [95% CI, 14.0%-23.0%] vs 14.6% [95% CI, 13.3%-16.0%]; completed survey in Spanish: 8.9% [95% CI, 6.2%-12.8%] vs 6.2% [95% CI, 5.4%-7.1%]) individuals, to identify as LGBTQAI (lesbian, gay, bisexual, transgender, queer [or questioning], asexual [or allied], intersex; 16.4% [95% CI, 12.3%-21.6%] vs 11.8% [95% CI, 10.6%-13.1%]), to live below the federal poverty level (27.3% [95% CI, 22.3%-32.8%] vs 10.7% [95% CI, 9.7%-11.9%]), and to ever experienced medical mistreatment (49.6% [95% CI, 43.7%-55.5%] vs 36.5% [95% CI, 34.8%-38.2%]). Among those who had ever tried to access RH services (n = 6027), people with disabilities vs without disabilities were more likely to experience barriers (69.0% [95% CI, 62.9%-74.5%] vs 43.0% [95% CI, 41.2%-44.9%]), which were most often logistical (50.7%; 95% CI, 44.2%-57.2%) and access (49.9%; 95% CI, 43.4%-56.4%) barriers. The disability domains with the highest proportion of people who experienced 3 or more barriers in the past 3 years included activities of daily living (75.3%; 95% CI, 61.1%-85.6%), communication (65.1%; 95% CI, 49.5%-78.1%), and multiple (59.9%; 95% CI, 45.6%-72.7%) disabilities. This cross-sectional study found large disparities in access to RH services among people AFAB with disabilities. Findings indicated a need to alleviate barriers to RH care, including improving the transportation infrastructure and reinforcing patient-centered approaches that engender inclusivity in health care settings.

Pre-Pregnancy Health Risks by Presence and Extent of Disability, 2019–2020

IntroductionPrior studies have shown that, compared to non-disabled women, women with disabilities have a higher burden of preconception mental and physical health risks that are associated with adverse pregnancy outcomes. This cross-sectional study assesses how the extent of disability relates to pre-pregnancy health risks. MethodsThis study used 2019-2020 PRAMS data from 22 sites that included the Washington Group Short Set of Questions on Disability (n=37,006). In 2023, associations between extent of disability (none [reference group], some difficulty, or a lot of difficulty) and preconception health risks were examined using multivariable Poisson regression with robust standard errors to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) while controlling for sociodemographic characteristics. Preconception health risks included smoking, heavy drinking, high blood pressure, diabetes, no multivitamin use, and experiencing physical abuse, depression, or obesity. Individual risks were analyzed, as well as the total number of risks experienced. ResultsOf respondents, 33.6% had some difficulty and 6.3% had a lot of difficulty. The likelihood of experiencing preconception health risks increased with extent of disability. Compared to respondents with no difficulty, those with some or a lot of difficulty had a higher prevalence of experiencing 1-2 health risks (aPR=1.13, 95%CI 1.09,1.18; aPR=1.20; 95%CI 1.53,2.25) and 3+ health risks (aPR=1.86, 95%CI 1.53,2.25; aPR=2.42, 95%CI 1.98,2.97), respectively. ConclusionsDisabled women, especially those with more difficulty, are vulnerable to preconception health risks that could potentially be mitigated before conception. These findings highlight the need for enhanced efforts to support preconception health of disabled women.

Variation in identifying children and adolescents with disability and developmental disability in population-based public health surveys

BackgroundThe term “developmental disability” (DD) is inconsistently defined and applied depending on purpose and across sources, including in legislation. ObjectiveThis project aimed to identify existing definitions of disability and DD and to determine the extent to which each definition could be operationalized to produce prevalence estimates using data from U.S. national surveys. MethodsUsing data among children <18 years from the 2016–2018 National Health Interview Survey (NHIS) and National Survey of Children's Health (NSCH), we estimated the prevalence of two definitions of disability (Washington Group Short Set on Functioning, American Community Survey) and seven definitions of DD [Health and Human Services (ever/current), Developmental Disabilities Assistance and Bill of Rights Act of 2000 (1+, 2+, or 3+ components), and Diagnostic and Statistical Manual of Mental Disorders, 5th ed (ever/current)]. Complex sample design variables and weights were used to calculate nationally representative prevalence. ResultsDisability (NHIS: 5.2–6.3%; NSCH: 9.2–11.9%) and DD prevalence (NHIS: 0.6–18.0% and NSCH: 0.2–22.2%) varied depending on the definition and data source. For the same definition, NSCH prevalence estimates tended to be higher than NHIS estimates. ConclusionsThe substantial variability in estimated prevalence of disability and DD among children in the United States may be in part due to the surveys not representing all components of each definition. Different or additional questions in national surveys may better capture existing definitions of disability and DD. Considering the data collection goals may help determine the optimal definition to provide useful information for public health action.

Differences between persons with and without disability in HIV prevalence, testing, treatment, and care cascade in Tanzania: a cross-sectional study using population-based data

BackgroundPersons with disability may have a higher HIV prevalence and be less likely than persons without disability to know their HIV-positive status, access antiretroviral therapy (ART), and suppress their HIV viral load (HIV care cascade). However, studies examining differences between persons with and without disability in HIV prevalence and the HIV care cascade are lacking. Using the Tanzania HIV Impact Survey (THIS) data collected between October 2016 and August 2017, we assessed differences in HIV prevalence and progress towards achieving the 2020 HIV care cascade target between persons with and without disability.MethodsUsing the Washington Group Short Set (WG-SS) Questions on Disability, we defined disability as having a functional difficulty in any of the six life domains (seeing, hearing, walking/climbing, remembering/ concentrating, self-care, and communicating). We classified respondents as disabled if they responded having either “Some Difficulty”, “A lot of difficulties” or “Unable to” in any of the WG-SS Questions. We presented the sample characteristics by disability status and analyzed the achievement of the cascade target by disability status, and sex. We used multivariable logistic regressions, and adjusted for age, sex, rural-urban residence, education, and wealth quintile.ResultsA total of 31,579 respondents aged 15 years and older had HIV test results. Of these 1,831 tested HIV-positive, corresponding to an estimated HIV prevalence of 4.9% (CI: 4.5 — 5.2%) among the adult population in Tanzania. The median age of respondents who tested HIV-positive was 32 years (with IQR of 21—45 years). HIV prevalence was higher (5.7%, 95% CI: 5.3—7.4%) among persons with disability than persons without disability (4.3%, 95% CI: 4.0 — 4.6%). Before adjustment, compared to women without disability, more women with disability were aware of their HIV-positive status (n = 101, 79.0%, 95% CI: 68.0—87.0% versus n = 703, 63.0%, 95% CI: 59.1—66.7%) and accessed ART more frequently (n = 98, 98.7%, 95% CI: 95.3—99.7% versus n = 661, 94.7%, 95% CI: 92.6—96.3%). After adjusting for socio-demographic characteristics, the odds of having HIV and of accessing ART did not differ between persons with and without disability. However, PLHIV with disability had higher odds of being aware of their HIV-positive status (aOR 1.69, 95% 1.05—2.71) than PLHIV without disability. Men living with HIV and with disability had lower odds (aOR = 0.23, 95% CI: 0.06—0.86) to suppress HIV viral loads than their counterparts without disability.ConclusionWe found no significant differences in the odds of having HIV and of accessing ART between persons with and without disability in Tanzania. While PLHIV and disability, were often aware of their HIV-positive status than their non-disabled counterparts, men living with HIV and with disability may have been disadvantaged in having suppressed HIV viral loads. These differences are correctable with disability-inclusive HIV programming. HIV surveys around the world should include questions on disability to measure potential differences in HIV prevalence and in attaining the 2025 HIV care cascade target between persons with and without disability.

Free Time in Old Age: Does Health Status Determine the Choice of Leisure Activities in Indonesia?

This paper examines which leisure activities appear more attractive to older people, considering health status, disability and demographic-socio-economic and environmental variables. It employed data from Survei Penduduk Antar Sensus (SUPAS), the nationwide survey, conducted in 2015 by Indonesia's national statistical office. The sample selected 228,718 individuals aged 60 years old and above. Leisure activities were differentiated between active, sedentary, and no leisure activities. Health is measured with both health status and disability. Disability measures were adopted from Washington Group Short Set on Functioning-Enhanced (WG-SS Enhanced). Our multinomial regression models confirmed that health status was correlated with the choice of leisure activities in old age. Compared to older persons in good health, those reported in poor health without disruption to daily life were more likely to participate in sedentary or active leisure, but those with disruption to daily life were less likely to do so. Older persons with disability were disadvantaged in participating in either passive or active leisure. However, among all selected variables, employment and source of finance had the highest odds ratios and confounded the relationship between health and leisure activity.

What cut-off(s) to use with the Washington Group short set of questions?

The Washington Group short set (WG-SS) questions are increasingly integrated into national household surveys, censuses, and international survey programs. They enable the monitoring of disability rights and the production of internationally comparable statistics. Disability statistics on prevalence and inequalities can be estimated using different cut-offs on the degree of functional difficulties based on the WG-SS. This commentary discusses what cut-offs to adopt for the purpose of investigating and monitoring disability gaps. We recommend a three-way disaggregation comparing persons with (a) no difficulty, (b) some difficulty and (c) a lot of difficulty or unable to do. In cases where sample sizes are small for disaggregated analysis, we recommend comparing persons with no difficulty to persons with any level of difficulty (i.e. persons with any disability).

Determinant of functional disability in instrumental activities of daily living among elderly living in a rural area in Bali: a crosssectional study

Introduction: Little do we understand about factors associated with functional disability in instrumental activities of daily living among the elderly living at home. This study aimed to explore the prevalence and determinant factors of functional disability in instrumental activities of daily living (IADL) among the elderly living in a rural area in Bali.&#x0D; Method: Using a cross-sectional design, 1,053 elderly aged 60 years and above living in a rural area in Bali were recruited. A structured interview by trained data collectors was conducted. Questionnaires used were the Lawton IADL Scale, the 5-item of Geriatric Depression Scale, and the adoption of questionnaires for vision, hearing, and communication problems from the Washington Group Short Set of Questions on Disability. A logistic regression model was applied to explore determinant factors.&#x0D; Results: Findings indicated that 26.1% of participants aged 75+ and 52.3% were female. Eight percent (8%) experienced functional disability in IADL, 1.9% lived alone, 11.8% indicated depression, 5.1%, 4.7%, and 1.6% of them had vision loss, hearing impairment, and communication problems, respectively. The strongest determinant factor for functional disability in IADL was depression (OR 7.869; 95% CI 4.657-13.296), followed by age (OR 4.602; 95% CI 2.764-7.663), and hearing impairment (OR 2.903; 95% CI 1.190-7.083).&#x0D; Conclusions: Depression is the strongest determinant factor for functional disability in IADL. Health professionals in rural areas should actively screen for depression to increase the ability of the elderly to fulfill their IADLs.&#x0D; Keywords: aged, depression, epidemiology, Indonesia

Who is disabled? On whether the functional definition of disability targets the same individuals as the subjective definition

With the increased attention to disability as a vulnerability criterion in the Sustainable Development Goals, international organizations and NGOs within the international development sector have started to pay explicit attention to persons with disabilities, including the collection of data on persons with disabilities. The Washington Group Short Set of Questions, which focuses on functional limitations, has been gaining popularity as an assessment tool for disability. This set of questions reflects a categorization of disability that does not necessarily correspond with subjective disability assessments, such as the yes/no question (“do you have a disability?”) which many development actors have used in their assessment tools when they collect disability data This study compares the subjective and the functional limitations assessment tools for disability to answer the question: do they identify the same individuals as persons with disabilities? Based on a survey carried out amongst persons with disabilities in Cambodia, we included both the Washington Group Short Set and a subjective question asking respondents to self-identify their disability type. We find that, although all respondents self-identified as disabled, not all respondents would be considered disabled according to the Washington Group Short Set of questions. In addition, there is little overlap between specific disability types according to a subjective classification method and the domains of functioning measured through the Washington Group methodology. Our findings affirm that categorization as abled or disabled depends on the tool used. This is important, as the assessment approach chosen by those collecting disability data can shape the design choices of policies and programs, and determine who benefits.