“One in four noninstitutionalized U.S. adults (25.7%, representing an estimated 61.4 million persons) reported any disability (Table 1) (Figure). Mobility was the most prevalent disability type (13.7%), followed by cognition (10.8%), independent living (6.8%), hearing (5.9%), vision (4.6%), and selfcare (3.7%). Prevalences of any disability, hearing, mobility, and independent living disabilities were higher among older adults, whereas prevalence of cognitive disability was highest among middle-aged (11.9%) and young adults (10.6%), and lowest among older adults (9.5%). Among middle-aged and older adults, the prevalences of vision disability (6.1% and 6.6%, respectively) and self-care disability (5.5% in both) were similar. Among all age groups, the prevalences of any disability and of each type were higher among women than among men, with the exceptions of hearing and self-care. The reported prevalence of hearing disability was higher among men than among women for all age groups (young adults: men = 2.4% versus women = 1.6%; middle-aged adults: 7.6% versus 4.2%; and older adults: 19.4% versus 11.3%), and the reported prevalences of self-care disability were approximately the same. Generally, among young and middle-aged adults, the highest prevalences of any disability and of each type were reported among AI/AN [American Indian/Alaskan Native] and persons in the “other race/multiracial” group, whereas the lowest prevalences were reported among Asians. Among older adults, approximately half of AI/AN (54.9%), Hispanics (50.5%), and persons in the “other race/multiracial” group (49.9%) reported any disability. Within each age group, the prevalences of any and each disability type declined with decreasing poverty. Across all age groups, higher prevalences of any disability and of each type were generally reported in the South compared with other U.S. Census regions.”
Source: Okoro, C. A., Hollis, N. D., Cyrus, A. C., & Griffin-Blake, S. (2018). Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults – United States, 2016. MMWR. Morbidity and mortality weekly report, 67(32), 882–887. doi.org/10.15585/mmwr.mm6732a3
“In 2016, for each disability type, prevalences of health insurance coverage, having a usual health care provider, and receiving a check-up during the preceding 12 months increased with increasing age group, whereas, with the exception of persons with a vision disability, the prevalence of having an unmet health care need because of cost decreased (Table 2). Young and middle-aged adults with a vision disability had the lowest prevalences of having health insurance coverage (74.9% and 81.3%, respectively), a usual health care provider (64.0% and 82.3%, respectively), and, among younger adults, of having received a check-up during the preceding 12 months (58.0%). Within these age groups, adults with a self-care disability had the highest prevalences of having health insurance coverage (83.1% and 88.8%, respectively) and a usual health care provider (76.3% and 89.0%, respectively), similar to middle-aged adults with an independent living disability (89.0%). The prevalences of having received a routine check-up during the past 12 months were higher among young adults with a mobility disability (69.1%) and middle-aged adults with a self-care disability (81.6%). Having a health care need that was unmet because of cost considerations was most prevalent among younger adults with an independent living disability (36.7%) and middle-aged adults with a vision disability (35.5%), and was least prevalent among younger and middle-aged adults with a hearing disability (31.2% and 24.1%, respectively). Most health care access measures were similar by disability type among older adults, with the exception of having an unmet health care need because of cost, which ranged from 7.3% (hearing) to 14.0% (self-care).”
Source: Okoro, C. A., Hollis, N. D., Cyrus, A. C., & Griffin-Blake, S. (2018). Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults – United States, 2016. MMWR. Morbidity and mortality weekly report, 67(32), 882–887. doi.org/10.15585/mmwr.mm6732a3
“More than sixty-one million Americans had a disability as of 2016.1 Disparities in health care access and quality have been observed across many groups of people with disabilities and in a variety of clinical environments.2–5 People with disabilities also have been found to be less likely to report satisfaction with their care compared to people without disabilities.6–8 Disparities in access to health care and the quality of that care have been associated with worse physical health and greater burden of chronic disease for people with disabilities compared to their nondisabled peers.9,10
“Disparities in health care persist despite the Americans with Disabilities Act (ADA) of 1990 and the ADA Amendments Act of 2008, which mandate equal access to health care services. Multiple factors contribute to these disparities: physical inaccessibility of care settings;11,12 inadequate accommodations for communication needs;6,7 and pervasive ableism in medicine,13–15 including physicians’ implicit and explicit biases, attitudes, and behavior toward people with disabilities.16–18“
Source: Tara Lagu, Carol Haywood, Kimberly Reimold, Christene DeJong, Robin Walker Sterling, and Lisa I. Iezzoni, ‘I Am Not The Doctor For You’: Physicians’ Attitudes About Caring For People With Disabilities, Health Affairs 2022 41:10, 1387-1395
“All participants reported physical barriers to providing health care for people with disabilities, including inaccessible buildings and equipment. Many participants were forthcoming about the lack of accessibility in their clinics. For example, one rural-practicing primary care physician said, “I know for a fact our building is not accessible.” When asked about access to automatic height-adjustable exam tables, some described these tables as an asset, but others seemed more ambivalent. As a non-rural-practicing primary care physician said, adjustable-height exam tables are “designed to be adjustable for the practitioner, not for the patient’s comfort or the patient’s ability to get in. …They are kind of clunky.” Access to transfer equipment (for example, a Hoyer lift) or accessible weight scales was rare across the groups. Some participants reported using workarounds for physical accommodations, such as low exam tables. In response to the question, “If a wheelchair user comes and cannot stand on a weight scale, what is your approach to taking a weight?,” physicians from two of the three groups reported sending patients to a supermarket, grain elevator, zoo, or cattle processing plant to obtain a weight.”
Source: Tara Lagu, Carol Haywood, Kimberly Reimold, Christene DeJong, Robin Walker Sterling, and Lisa I. Iezzoni, ‘I Am Not The Doctor For You’: Physicians’ Attitudes About Caring For People With Disabilities, Health Affairs 2022 41:10, 1387-1395
“Because of the large numbers of patients in the US who had COVID-19 during spikes, hospitals have faced acute shortages of ventilators, beds, medications, and other critical care resources, leading to the creation or activation of policies regarding crisis standards of care.13 Such policies are intended to provide guidance to health care providers about how to allocate scarce resources during a public health emergency. These policies have often incorporated potentially discriminatory provisions ranging from categorically excluding people with specific disabilities from care to applying prioritization criteria (such as expectations for long-term survival or lower resource use) that disadvantage people with disabilities by giving them lower priority.13–16
“Concerns about discrimination in the implementation of crisis standards of care have prompted state and federal oversight activities by both legislators and regulators during the pandemic, including guidance from the Department of Health and Human Services (HHS) Office for Civil Rights on the application of disability civil rights law to implementing crisis standards of care.14–16 In response, crisis standards of care plans have evolved considerably to remove provisions that discriminate on the basis of disability.13“
Source: Ari Ne’eman, Elizabeth Bell, Monica C. Schneider, and Dara Strolovitch. Identifying And Exploring Bias In Public Opinion On Scarce Resource Allocation During The COVID-19 Pandemic. Health Affairs 2022 41:10, 1513-1522
“Across focus groups, community-based primary care and specialist physicians in urban and rural settings identified a broad range of barriers to caring for people with disabilities. Many physicians also expressed explicit bias toward people with disabilities and described 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. Many participants described caring for very few patients who need accommodations, with little acknowledgment that the barriers to obtaining care and inability to track or respond to accommodation needs could lead to an under-identification of the number of people with disabilities who seek care. This study adds to the understanding of attitudes among community-based physicians toward people with disabilities and provides context to recent survey findings that physicians frequently do not welcome them into their practices.13,18
“Previously, we reported the results of a survey of 714 practicing US physicians (primary care physicians and subspecialists).16–18 We found that only 41 percent of respondents reported that they were “very confident” about their ability to provide the same quality of care to people with disabilities as those without, and just 57 percent strongly agreed that they welcomed people with disabilities into their practices.16 Most physicians reported that they do not use accessible equipment for routine care of patients with chronic, significant mobility limitations; fewer than one-quarter attempted to regularly weigh people with disabilities; and only 40 percent always or usually used accessible exam tables or chairs.18 There were clear gaps in knowledge about requirements of the ADA: 36 percent reported knowing “little or nothing” about their legal responsibilities under the ADA, and nearly 70 percent reported that they were at risk for ADA-related lawsuits.17 Taken together, the focus groups and survey responses provide a substantive and deeply concerning picture of physicians’ attitudes and behaviors relating to care for people with disabilities.
“Prior research also suggests that physicians feel burdened by time constraints in their practices, even when accommodations are not involved.29,30 As we report in the results, some of the participants reported that their practice settings do not provide sufficient administrative or clinical support for the care of people with disabilities. Our physician survey found that 13.6 percent and 31.1 percent of participants, respectively, felt that time constraints were a large or moderate barrier to caring for people with disabilities.17“
Source: Tara Lagu, Carol Haywood, Kimberly Reimold, Christene DeJong, Robin Walker Sterling, and Lisa I. Iezzoni, ‘I Am Not The Doctor For You’: Physicians’ Attitudes About Caring For People With Disabilities, Health Affairs 2022 41:10, 1387-1395
“Focus-group responses identified several barriers to providing care for people with disabilities: physical accommodations; communication accommodations; knowledge, experience, and skills; structural barriers; and attitudes toward people with disabilities (with a subtheme describing discharging people with disabilities from their practices or denying care to them). Themes were intersecting, overlapping, and multidimensional. We previously published findings relating to two subthemes (not described here): physicians’ attitudes toward people with obesity20 and reproductive health access for people with intellectual disability.28“
Source: Tara Lagu, Carol Haywood, Kimberly Reimold, Christene DeJong, Robin Walker Sterling, and Lisa I. Iezzoni, ‘I Am Not The Doctor For You’: Physicians’ Attitudes About Caring For People With Disabilities, Health Affairs 2022 41:10, 1387-1395
“Although there is robust international research literature adopting the SOL approach, prior studies of the extra costs of disability relating to the U.S. population are sparse. Drawing on four nationally representative surveys of the U.S. population, we aimed to fill this gap. We found that, on average, U.S. households with adults aged 18 to 69 that have a work limitation require 29% more income to achieve a comparable SOL to those households without disabled members. We also found that married households with at least one adult with a disability have lower extra costs than single households. This lower estimate for married adults, consistent with prior research (Morris & Zaidi, 2020), may be due to greater household economies of scale as well as the ability to obtain informal care in a partnership that decreases the need to purchase caregiving services. This is also supported by a recent study by Brucker (2020), which found marriage is a protective factor for poverty when at least one adult in the household has a disability.
“We also found a slightly higher estimate of the costs of disability (37%) when defining disability as the reporting of one or more of six daily living limitations. The wide variability in extra costs between disability types (e.g., from 8% for individuals with hearing limitations to 29% for individuals with cognitive difficulties) may be attributable to a number of factors, including the severity of the disability, the presence of comorbidities, the need for caregiving services, as well as differences in the generosity, accessibility, and availability of public support for adults with different kinds of limitations. These total cost estimates can serve as a benchmark for future studies, particularly those exploring the impacts of policy changes. We further identify variation in the cost estimates across household and impairment types. Single adults, which represent a disproportionate share of the population with disabilities, were estimated to have higher costs than those who were married with disabilities.
“After identifying these quantitative estimates, we calculated disability-adjusted FPLs both to demonstrate the applicability of the estimates to the measurement of poverty and to show how this adjustment could extend eligibility for major safety net programs in the United States that use the OPM, including SNAP, Medicaid, and health insurance subsidies. Here, we demonstrated that the share of the adult population with disabilities counted as living at or under the FPL would increase by nine percentage points or by an estimated 2.2 million people with disabilities if the poverty measure adjusted for disability. We further observed similar increases in the poverty rate when calculating poverty at alternative levels that are used as eligibility cutoff points for major health and social welfare programs. This suggests that, if the poverty measures were adjusted for the extra costs of disability, many more individuals with disabilities would be eligible for these programs and services.”
Source: Morris, Z. A., McGarity, S. V., Goodman, N., & Zaidi, A. (2021). The Extra Costs Associated With Living With a Disability in the United States. Journal of Disability Policy Studies. doi.org/10.1177/10442073211043521
“Among people in state and federal prisons in 2016, an estimated 40.4 percent reported a psychiatric disability, and 56.0 percent reported a nonpsychiatric disability (exhibit 1). Overall, an estimated 66 percent of incarcerated people were disabled. Exhibit 1 presents the distribution of specific types of disability and shows that bipolar, depressive, and anxiety disorders were especially common among psychiatric disabilities, as were cognitive disability, attention deficit hyperactivity disorder, and having been enrolled in “special education” among nonpsychiatric disabilities.
“There were disparities in disability by race and ethnicity (exhibit 2). Among the state and federal prison population in 2016, an estimated 58.3 percent of Black, 57.9 percent of Hispanic, 75.0 percent of White, 65.8 percent of other race, and 77.6 percent of multiracial people were disabled. Of the total state and federal prison population, approximately 42 percent were racially minoritized, disabled people (data not shown).
“A higher estimated percentage of incarcerated women reported disability (79.5 percent) compared with incarcerated men (64.6 percent) (exhibit 2). Although women were more likely to be disabled than men, men made up the overwhelming majority of people in prisons as of 2016. Among people incarcerated in state and federal prisons, an estimated 93 percent were men and 7 percent were women (data not shown). Of the total state and federal prison population, an estimated 60 percent were disabled men, 33 percent were nondisabled men, 6 percent were disabled women, and 1 percent were nondisabled women (data not shown).”
Source: Laurin Bixby, Stacey Bevan, and Courtney Boen. The Links Between Disability, Incarceration, And Social Exclusion. Health Affairs 2022 41:10, 1460-1469.
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