Care delivery, population health, and more.
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Dear John,

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."

Read The Issue

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.

Read More

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.

Read More

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.

Read More

Order The Issue

Join Health Affairs Unlimited to access our current and past issues
.

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Attend These Events

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More than thirty years after the Americans with Disabilities Act (ADA)
was signed into law, people with disabilities continue to face
inequities in the health care system with respect to access and
outcomes.

Disparities in education, employment, housing, and transportation are
also barriers to achieving health equity.

We invite you to join us for a full month of events highlighting our
theme issue on disability and health, which include:

* A free in-person, community-based event

and video premiere at Main Street Connect, an accessible and inclusive
apartment complex and community center in Rockville, Maryland. If you
can't attend in-person, you can also join virtually.

* A Journal Club with coauthor Susan A. Bayer about assessing self-care
needs and worker shortages in rural areas
.

* A Professional Development event on disability, health, and
accessibility in health services research
.

Get access to the full breadth of Health Affairs events on Disability &
Health. Use discount code HAInsider10 to get $10 off your membership

to Health Affairs Unlimited.

View Full Event Schedule

 

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Listen To This Podcast

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This month, we'll feature authors included in the Disability & Health
theme issue, including Tara Lagu, Madeline Smith-Johnson, and more.

Recently, we've covered topics like surprise billing
,
dual eligible coverage
,
and mental health care delivery
.

Starting this month, to help increase accessibility of our content, we
are offering transcripts of our podcasts
.
Scripts can be found on individual episode pages.

In addition, we are now posting our podcast to our YouTube channel
.

Listen

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About Health Affairs

Health Affairs is the leading peer-reviewed journal
at the intersection of health,
health care, and policy. Published monthly by Project HOPE, the journal
is available in print and online. Late-breaking content is also found
through healthaffairs.org , Health Affairs Today
, and Health Affairs Sunday
Update .  

Project HOPE is a global health and
humanitarian relief organization that places power in the hands of local
health care workers to save lives across the globe. Project HOPE has
published Health Affairs since 1981.

Copyright © Project HOPE: The People-to-People Health Foundation, Inc.

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