Disabilities, Disparities in Access to Care Affect 1 in 4 US Adults

CDC has released an analysis of 2016 data from its Behavioral Risk Factor Surveillance System (BRFSS), which shows that 1 in 4 noninstitutionalized US adults report living with a disability. The incidence of disability, assessed using a set of questions designed by HHS, is up from 2013 levels, when 1 in 5 adults reported a disability using a different set of survey questions.

The most prevalent disability type reported in 2016 was related to mobility (13.7%), followed by cognition (10.8%), independent living (6.8%), hearing (5.9%), vision (5.9%), and self-care (3.7%). More women than men had disabilities related to mobility, cognition, independent living, and vision, while men reported more hearing disabilities, and self-care disabilities were approximately the same among men and women.

Among people aged 64 and under, the highest prevalence of any disability was found among American Indians and Alaska Natives and among people who identified themselves as “other race” or multiracial, and the lowest prevalence was reported among Asian adults. Among people aged 65 or older, approximately half of American Indians and Alaska Natives (54.9%), Hispanics (50.5%), and those who reported that they were multiracial or other race (49.9%) had any disability.

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In all age groups, disability prevalence was higher in the South—potentially because chronic conditions including arthritis and heart disease that can lead to disability have a greater prevalence in the region—and poverty was linked with a higher prevalence of each disability type.

Older age was linked—for people with each type of disability—with having health insurance, having a regular healthcare provider, and receiving a check-up during the past year, while younger adults (aged 64 or under) with vision disabilities had the lowest prevalence of insurance or usual care providers. Having a healthcare need that went unmet because of cost was most prevalent among younger adults with an independent living disability and middle-aged adults with a vision disability.

Understanding these disparities in access to care, says the CDC, could help identify interventions that would improve access, receipt of necessary services, and care coordination. Such interventions, the report notes, could help to improve health behaviors, prevent secondary conditions, and delay the progression of disability.

That’s an objective shared by the University of Michigan, which recently announced a new program that will seek to promote better care for patients who are managing physical disabilities together with other health conditions.

The program—the Investigating Disability Factors and Promoting Environmental Access for Healthy Living (IDEAL) rehabilitation research and training program—will launch in October of 2018 with $4.3 million in funding from the National Institute on Disability, Independent Living and Rehabilitation Research. The IDEAL program will seek to identify environmental factors (including policy factors) that can help people of all racial and socioeconomic backgrounds and with all types of long-term disabilities live healthier lives as they age.

“We’re going to examine and identify key gaps in existing literature and, using national insurance claims databases, look at the trajectories for existing individuals,” said Michelle Meade, PhD, associate professor of physical medicine and rehabilitation at Michigan Medicine, in a statement announcing the new program. “We’ll look at factors such as gender, age, hospitalizations, geography, current health care policies and so on.”

IDEAL will also seek to develop interventions—from setting up family medicine clinics that will be responsive to this patient population’s needs to investigating the deployment of autonomous vehicles that would provide transportation to necessary care — and serve as a national resource center to improve outcomes for people who have long-term disabilities.

Reference

Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of disabilities and health care access by disability status and type among adults—United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67:882-887. doi: 10.15585/mmwr.mm6732a3