Self-reported short sleep duration among US adults by disability status and functional disability type: Results from the 2016 Behavioral Risk Factor Surveillance System

BackgroundShort sleep duration is associated with an increased risk of chronic disease and all-cause death. A better understanding of sleep disparities between people with and without disabilities can help inform interventions designed to improve sleep duration among people with disabilities.ObjectiveTo examine population-based prevalence estimates of short sleep duration by disability status and disability type among noninstitutionalized adults aged ≥18 years.MethodsData from the 2016 Behavioral Risk Factor Surveillance System were used to assess prevalence of short sleep duration among adults without and with disabilities (serious difficulty with cognition, hearing, mobility, or vision; any difficulty with self-care or independent living). Short sleep duration was defined as <7 h per 24-h period. We used log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) while adjusting for socioeconomic and health-related characteristics.ResultsAdults with any disability had a higher prevalence of short sleep duration than those without disability (43.8% vs. 31.6%; p < .001). After controlling for selected covariates, short sleep was most prevalent among adults with multiple disabilities (PR 1.40, 95% CI: 1.36–1.43), followed by adults with a single disability type (range: PR 1.13, 95% CI: 1.03–1.24 [for independent living disability] to PR 1.25, 95% CI: 1.21–1.30 [for mobility disability]) compared to adults without disability.ConclusionsPeople with disabilities had a higher likelihood of reporting short sleep duration than those without disabilities. Assessment of sleep duration may be an important component in the provision of medical care to people with disabilities.     

The effects of the COVID-19 pandemic on the psychosocial well-being of people with disabilities

BackgroundBefore the COVID-19 pandemic, people with mobility, vision, hearing, and cognitive disabilities were at a higher risk of lower psychosocial well-being than people without disabilities. It is, therefore, of great importance to investigate whether the pandemic has exacerbated this difference.ObjectiveThis study examines whether people with disabilities (categorized as mobility, vision, hearing, cognitive, and any disabilities) report more COVID-19-related negative effects on psychosocial well-being (loneliness, decreased social contact, decreased hope for the future, concerns about being infected) than people without disabilities.MethodsWe analyzed population-based data from the Finnish Health, Welfare, and Services (FinSote) survey carried out in 2020–2021 (N = 22 165, age 20+). Logistic regression models were applied, controlling for the effects of age, sex, partnership, living alone, and education.ResultsAll disability groups, except those with vision disabilities, reported significantly more often that the pandemic increased loneliness than people without disabilities. There were no significant differences between the disability groups and people without disabilities in decreased social contacts. People with only mobility and cognitive disabilities reported significantly more often that the pandemic decreased their hope for the future than those without disabilities. All disability groups were more often concerned about being infected than people without disabilities, but this effect was not significant among people 75 or older.ConclusionThe psychosocial well-being of people with specific types of disabilities should receive special attention during crises like the COVID-19 pandemic.     

Birth intentions among US fathers with disabilities

BackgroundMen’s birth intention is an indicator of their sexual health and plays an important role for their child’s health and development; however, birth intendedness in fathers with disabilities has been unknown.ObjectiveThis study examines disparities in birth intendedness among fathers with and without disabilities and explores whether the differences vary by marital status or race/ethnicity.MethodsData from the 2011–2017 National Survey of Family Growth (NSFG) were used to examine pregnancy intendedness for fathers with (n = 380) and without disabilities (n = 1,324) about their last birth in the five years preceding the interview. Multinomial regression models estimated the odds ratios of fathers’ disability status on birth intention controlling for covariates. Interaction effects of disability status by marital status or race/ethnicity were also tested.ResultsFathers with disabilities were 1.89 (95% CI = 1.21, 2.95) times as likely to report their last birth as unwanted versus intended compared to those without disabilities after adjusting for covariates. Although married fathers without disabilities were less likely to report unintended birth than their unmarried counterparts, the protective effect of marriage was not evident among fathers with disabilities.ConclusionsDisabled fathers are at a higher risk of unintended birth compared to nondisabled fathers. These findings highlight the need to increase access to family planning services for disabled men. Further research is needed to better understand the risk factors that contribute to disabled fathers’ unintended birth and how these are linked to their child and family well-being.     

Disability and sleep duration: Evidence from the American Time Use Survey

BackgroundRegular short and long sleep durations are associated with increased mortality and morbidity. While previous research shows significant sleep disparities between people with and without disabilities, less is known about the association between different types of disability and high-risk sleep using nationally representative data.ObjectiveWe examine the association between short and long sleep durations and having a work disability or an impairment in sensory, cognitive, or physical functioning among a nationally representative sample of working-age adults in the United States.MethodsWe estimate multinomial logistic regression models using data from the 2003–2012 American Time Use Survey to identify how different types of disabling conditions – net of other sociodemographic factors – relate to the likelihood of reporting short (6 h or fewer) or long (9 h or more) sleep, versus mid-range (between 6 and 9 h) sleep.ResultsFor respondents with work disabilities versus those without work disabilities, the relative risk of short and long sleep is 1.4 and 1.5 times (respectively) that of those with mid-range sleep. The risk of short and long sleep durations is also higher among respondents with cognitive, physical, or multiple impairments.ConclusionsIndividuals with disabilities are less likely than those without disabilities to have optimal sleep durations. These results demonstrate the importance of health promotion services among this population, with specific attention to sleep hygiene interventions.     

Prolonged postpartum length of hospital stay among women with disabilities

BackgroundPrior studies have found higher proportions of cesarean deliveries and longer postpartum hospital stays among women with disabilities compared to women without disabilities. However, no research has assessed how length of stay may differ for women with different types of disability while also considering mode of delivery.ObjectiveTo examine the association of disability status and disability type with length of stay, taking into account disability-related differences in mode of delivery.MethodsWe conducted a retrospective cohort study using linked maternal and infant hospital discharge and vital records data for all births in California between 2000 and 2012 (n = 6,745,201). We used multivariable regression analyses to assess association of disability status and type with prolonged length of stay (>2 days for vaginal delivery or >4 days for cesarean) while controlling for covariates.ResultsWomen with disabilities had significantly elevated adjusted odds of prolonged length of stay compared to women without disabilities (aOR = 1.40, 95% CI = 1.32–1.49). Adjusted odds were highest for women with vision disabilities (aOR = 1.67, 95% CI = 1.46–1.90), followed by women with IDD (aOR = 1.53, 95% CI = 1.30–1.80), and women with physical disabilities (aOR = 1.41, 95% CI = 1.32–1.50). Women with hearing disability had the lowest adjusted odds of prolonged length of stay (aOR = 1.17, 95% CI = 1.03–1.33).ConclusionsProlonged length of stay did not appear to be due solely to the higher proportion of cesarean deliveries in this population. Further research is needed to better understand the reasons for prolonged length of stay among women with disabilities and develop strategies to assist women with disabilities in preparing for and recovering from childbirth.     

Cigarette smoking among college students with disabilities: National College Health Assessment II,Fall 2008–Spring 2009

BackgroundPeople with disabilities are 1.5 times more likely to smoke than their peers without disabilities, intensifying risk of health related disparities and further loss of function. When compared with the general population, college students also have a higher smoking prevalence. This study explores smoking rates among college students with disabilities.Objective/hypothesisCollege students with disabilities have an increased likelihood of smoking, as compared with students without disabilities. Type of disability also influences smoking rates.MethodsThis study explores the association between smoking and disability using multiple regression analyses and data from the National College Health Assessment II (NCHA II), Fall 2008–Spring 2009 (N = 79,915). People with disabilities comprised 15.6% of the total sample: 3.4% reported a physical disability, 8.3% reported a mental disability, 2.5% reported a sensory disability, and 3.7% reported a learning disability.ResultsSmoking prevalence among those reporting disabilities was 23.1% versus 15% in those without disabilities. Those reporting mental disabilities had the highest rates (29.9%), followed by those with learning disabilities (23.7%), sensory disabilities (19.8%), and physical disabilities (16.4%). Students with disabilities were 1.23 times more likely to report current smoking than those without any disabilities, controlling for other factors (OR 1.23, 95% CI 1.16–1.30).DiscussionResults are consistent with previous research regarding the general adult population. Epidemiologic data demonstrating differences in risk behaviors for young adults with disabilities are important in allocation of resources. Findings of this study highlight the need for tailored smoking cessation programs for college students with disabilities.     

Physical activity levels of children in special schools

Objective.Children's physical activity (PA) has been studied extensively, but little information is available on those with disabilities. We sought to examine the PA of children with disabilities during physical education (PE) and recess while simultaneously documenting environmental conditions.Method.Five schools designed for students with four types of special needs (physical disability, mild intellectual disability, hearing impairment, and visual impairment) participated. We used the System for Observing Fitness Instruction Time (SOFIT) to code the PA of children in grades 4 to 6 during both PE and recess and to document teacher behavior and lesson context in PE. Observations were conducted during 2 school days over a 2-week period.Results.Children accrued little moderate-to-vigorous physical activity (MVPA) during PE (7.8 min) and recess (8.9 min). Activity levels varied across disability types, with differences attributed to lesson context and teacher behavior. Children with physical disabilities were the least active during both PE and recess.Conclusions.Children with disabilities accrue little PA at school. Increased PE frequency and lesson intensity, more PA opportunities during non-structured school time, and collaborations with home and community agencies are needed to reach PA recommendations.     

Disability in two health care systems: access, quality, satisfaction, and physician contacts among working-age Canadians and Americans with disabilities

BackgroundAn overarching question in health policy concerns whether the current mix of public and private health coverage in the United States can be, in one way or another, expanded to include all persons as it does in Canada. As typically high-end consumers of health care services, people with disabilities are key stakeholders to consider in this debate. The risk is that ways to cover more persons may be found only by sacrificing the quantity or quality of care on which people with disabilities so frequently depend. Yet, despite the many comparisons made of Canadian and U.S. health care, few focus directly on the needs of people with disabilities or the uninsured among them in the United States. This research is intended to address these gaps. Given this background, we compare the health care experiences of working-age uninsured and insured Americans with Canadian individuals (all of whom, insured) with a special focus on disability. Two questions for research guide our inquiry: (1) On the basis of disability severity level and health insurance status, are there differences in self-reported measures of access, utilization, satisfaction with, or quality of health care services within or between the United States and Canada? (2) After controlling covariates, when examining each level of disability severity, are there any significant differences in these measures of access, utilization, satisfaction, or quality between U.S. insured and Canadian persons?MethodsCross-sectional data from the Joint Canada/United States Survey of Health (JCUSH) are analyzed with particular attention to disability severity level (none, nonsevere, or severe) among three analytic groups of working age residents (insured Americans, uninsured Americans, and Canadians). Differences in three measures of access, one measure of satisfaction with care, one quality of care measure, and two varieties of physician contacts are compared. Multivariate methods are then used to compare the healthcare experiences of insured U.S. and Canadian persons on the basis of disability level while controlling covariates.ResultsIn covariate-controlled comparisons of insured Americans and Canadians, we find that people with disabilities report higher levels of unmet need than do their counterparts without disabilities, with no difference in this result between the nations. Our findings on access to medications and satisfaction with care among people with disabilities are similar, suggesting worse outcomes for people with disabilities, but few differences between insured U.S. and Canadian individuals. Generally, we find higher percentages who report having a regular physician, and higher contact rates with physicians among people with disabilities than among people without them in both countries. We find no evidence that total physician contacts are restricted in Canada relative to insured Americans at any of the disability levels. Yet we do find that quality ratings are lower among Canadian respondents than among insured Americans. However, bivariate estimates on access, satisfaction, quality, and physician contacts reveal particularly poor outcomes for uninsured persons with severe disabilities in the United States. For example, almost 40% do not report having a regular physician, 65% report that they need at least one medication that they cannot afford, 45% are not satisfied with the way their care is provided, 40% rate the overall quality of their care as fair or poor, and significant reductions in contacts with two types of physicians are evident within this group as well.ConclusionBased on these results, we find evidence of disparities in health care on the basis of disability in both Canada and the United States. However, despite the fact that Canada makes health insurance coverage available to all residents, we find few significant reductions in access, satisfaction or physician contacts among Canadians with disabilities relative to their insured American counterparts. These results place a spotlight on the experiences of uninsured persons with disabilities in America and suggest further avenues for research.     

Perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise

BackgroundInformation regarding factors that affect the initial step to exercise behavior change among persons with physical disabilities or chronic health conditions is available in the literature but much less is known regarding perceived benefits and barriers to exercise among those who are regularly active.ObjectiveThe purpose of this study was to examine the perceived benefits and barriers to exercise among persons with physical disabilities or chronic health conditions within action or maintenance stages of exercise.MethodsParticipants (n = 152) completed the Exercise Benefits and Barriers Scale (EBBS). For data analyses, disabilities and health conditions were grouped as neuromuscular, orthopedic, cardiovascular/pulmonary, or multiple conditions. Multivariate analysis of variance (MANOVA) was conducted to determine if mean differences on EBBS benefits and barriers scores existed among disability types, between sexes, among age groups, and between physical activity levels. Sum scores were computed to determine the strongest benefit and barrier responses.ResultsNo significant mean differences in EBBS scores were found between disability types, sexes, age groups, or physical activity levels (p > 0.05). Strongest benefit responses varied by group. Strongest barrier responses were the same for all demographic groups: “Exercise tires me,” “Exercise is hard work for me,” and “I am fatigued by exercise.”ConclusionsEBBS scores were similar across disability/health condition, sex, age, and physical activity level. Primary benefits reported were in the areas of improved physical performance and psychological outlook whereas the primary barriers were in the area of physical exertion.     

Breast and Cervical Cancer Screening Disparities Associated with Disability Severity

BackgroundPrior research has noted disparities between women with and without disabilities in receipt of timely screening for breast and cervical cancer. Some studies suggest greater disparities for women with more severe disabilities, but the research to date has yielded inconsistent findings. Our purpose was to further examine differences in receipt of breast and cervical cancer screening in relation to severity of disability.MethodsWe analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses examined whether Pap smears and mammograms had been received within the recommended timeframe according to U.S. Preventive Services Task Force Guidelines. We compared four groups of women aged 18 to 64 years, categorized by presence and complexity of disability: 1) No limitations, 2) basic action difficulties only, 3) complex activity limitations only, and 4) both basic and complex activity limitations.FindingsWomen both with and without disabilities fell short of Healthy People 2020 goals for breast and cervical cancer screening. Overall, women with disabilities were less likely to be up to date with both mammograms and Pap tests. The magnitude of disparities was greater for women with complex limitations. Disparities in Pap testing, but not mammography, remained significant when controlling for demographic, geographic, and socioeconomic factors.ConclusionsWomen with more complex or severe disability were less likely to be up to date with breast and cervical cancer screenings. Targeted efforts are needed to reduce barriers to breast and cervical cancer screening for women with significant disabilities, especially those who also experience other socioecological disadvantages.     

Disparities in Health Care Access and Receipt of Preventive Services by Disability Type: Analysis of the Medical Expenditure Panel Survey

ObjectiveTo examine differences in access to health care and receipt of clinical preventive services by type of disability among working-age adults with disabilities.ConclusionsThere are differences in health care access and receipt of preventive care depending on what type of disability people have. More in-depth research is needed to identify specific causes of these disparities and assess interventions to address health care barriers for particular disability groups.     

Perceived impacts of COVID-19 on wellbeing among US working-age adults with ADL difficulty

BackgroundThe COVID-19 pandemic has disproportionately impacted people with disabilities. Working-age adults with ADL difficulty may face unique challenges and heightened health risks because of the pandemic. It is critical to better understand the impacts of COVID-19 on social, financial, physical, and mental wellbeing among people with disabilities to inform more inclusive pandemic response policies.ObjectiveThis study compares perceived COVID-19 physical and mental health, social, and financial impacts for US working-age adults with and without ADL difficulty.MethodsWe analyzed data from a national survey of US working-age adults (aged 18–64) conducted in February and March 2021 (N = 3697). We used logistic regression to compare perceived COVID-19-related impacts on physical and mental health, healthcare access, social relationships, and financial wellbeing among those with and without ADL difficulty.ResultsAdults with ADL difficulty were more likely to report negative COVID-19 impacts for many but not all outcomes. Net of covariates, adults with ADL difficulty had significantly greater odds of reporting COVID-19 infection (OR = 2.1) and hospitalization (OR = 6.7), negative physical health impacts (OR = 2.0), and negative impacts on family relationships (OR = 1.6). However, they had significantly lower odds of losing a friend or family member to COVID-19 (OR = 0.7). There were no significant differences in perceived impacts on mental health, ability to see a doctor, relationships with friends, or financial wellbeing.ConclusionsWorking-age adults with ADL difficulty experienced disproportionate health and social harm due to the COVID-19 pandemic. To address these disparities, public health response efforts and social policies supporting pandemic recovery must include disability perspectives.     

Distribution of secondary medical problems, impairments, and participation limitations among adults with disabilities and their relationship to health and other outcomes

BackgroundThe purpose of this study was to describe the distribution and relationship of 16 secondary medical problems, impairments, and participation limitations among adults with disabilities to demographic characteristics, self-reported health, satisfaction with life, and social participation.MethodsData were analyzed for 4175 respondents to the disability supplements of the 2001 and 2003 Washington State Behavioral Risk Factor Surveillance Survey Disability Supplement.ResultsOf persons with disabilities, 87% reported at least 1 secondary medical problem, impairment, or participation limitation, with a mean of 4.1. Conditions were unevenly distributed in the 73% of those with disabilities with more than 1 condition: a cluster of one-fourth of this group had an average of 9.7 conditions and the remaining three-fourths averaged 3.9 conditions, with no strong correlations among conditions in either cluster. Number and type of condition were related to age, gender, income, and social participation among people with disabilities and explained part of the relationship of disability status to health and life satisfaction.ConclusionThe data provide evidence that prevention and treatment of secondary medical problems, impairments, and participation limitations may reduce disability-related disparities in health and well-being.     

Paradigm Shifts in Disability and Health: Toward More Ethical Public Health Research

Disability is often considered a health outcome disproportionately experienced by minority groups. It is also possible to view people with disabilities as a minority group that itself experiences health disparities.Calls to reduce these disparities necessitate the inclusion of people with developmental disabilities in research, although resulting ethical issues can thwart scientific progress. Using disability rights principles can help address ethical challenges and promote safe, respectful public health research. Examples include applying human rights frameworks, providing accommodations, attending to power, countering legacies of deficits-based models of disability, and transforming access to science more broadly.Collectively, these strategies can encourage broader engagement in safe, respectful, inclusive public health research aimed at promoting the health and well-being of people with developmental disabilities.Disability is Often Considered a health outcome that minority groups disproportionately experience; for example, African Americans and Native Americans are at greater risk for fetal alcohol syndrome, which can result in developmental disability.1–3 However, disability and health are not mutually exclusive. It is possible to view people with developmental disabilities as a minority group that itself experiences health disparities. Like other minorities, people with developmental disabilities experience marginalization and decreased expectations and opportunities. This results in inequalities in relationships, education, community access, health and health care, quality of life, and civic, economic, and political participation.4 These social conditions and their consequences as social determinants of health are similar to those that other marginalized groups experience.5Developmental disabilities involve lifelong impairment in physical, learning, language, or behavioral conditions that begin before the age of 22 years and that affect functioning (e.g., intellectual disability, cerebral palsy, autism spectrum disorder, spina bifida, hearing loss). Almost 14% of children and 5 to 6 million people of all ages in the United States have a developmental disability.6–8 Among children, attention-deficit/hyperactivity disorder and learning disabilities may be especially prevalent; what is known about adults is largely restricted to those with intellectual disability.8,9Like other minorities, individuals with developmental disabilities experience substantial preventable health disparities. These disparities cast a wide net, covering preventable injuries, vulnerability in emergencies, health behaviors, health care experiences, health outcomes, and health service and health promotion program accessibility.5,10 For example, only about 50% of adults with developmental disabilities exercise compared with 75% of the general population11; people with developmental disabilities experience increased rates of obesity11,12; and autistic adults have about twice the odds of experiencing unmet health care needs and using the emergency department.13 As with reducing health disparities among other minorities, understanding the origins of these disparities and addressing them requires attention to the lived experience of developmental disability.     

Pap,Mammography, and Clinical Breast Examination Screening Among Women with Disabilities: A Systematic Review

BackgroundResearch has found some disparities between U.S. women with and without disabilities in receiving clinical preventive services. Substantial differences may also exist within the population of women with disabilities. The current study examined published research on Pap smears, mammography, and clinical breast examinations across disability severity levels among women with disabilities.MethodsInformed by an expert panel, we followed guidelines for systematic literature reviews and searched MEDLINE, PsycINFO, and Cinahl databases. We also reviewed in-depth four disability- or preventive service-relevant journals. Two reviewers independently extracted data from all selected articles.FindingsFive of 74 reviewed publications of met all our inclusion criteria and all five reported data on Pap smears, mammography, and clinical breast examination. Articles classified disability severity groups by functional and/or activity levels. Associations between disability severity and Pap smear use were inconsistent across the publications. Mammography screening fell as disability level increased according to three of the five studies. Results demonstrated modestly lower screening, but also were inconsistent for clinical breast examinations across studies.ConclusionEvidence is inconsistent concerning disparities in these important cancer screening services with increasing disability levels. Published studies used differing methods and definitions, adding to concerns about the evidence for screening disparities rising along with increasing disability. More focused research is required to determine whether significant disparities exist in cancer screening among women with differing disability levels. This information is essential for national and local public health and health care organizations to target interventions to improve care for women with disabilities.     

Indicators of poor mental health and stressors during the COVID-19 pandemic,by disability status: A cross-sectional analysis

BackgroundEvidence from previous public health emergencies indicates that adults with disabilities have higher risk for morbidity (physical and mental) and mortality than adults without disabilities.ObjectiveTo provide estimates of mental health indicators and stressors for US adults by disability status during April and May 2020, shortly following the emergence of the COVID-19 pandemic.MethodsWe analyzed data from Porter Novelli View 360 opt-in Internet panel survey conducted during the weeks of April 20th and May 18th^, 2020 among 1004 English-speaking adults aged ≥18 years without and with disabilities (serious difficulty with hearing, vision, cognition, or mobility; any difficulty with self-care or independent living). Weighted logistic regression was used to test for significant differences between calculated prevalence estimates at the P ≤ .05 level.ResultsOne in four adults reported any disability. Adults with any disability were significantly more likely than adults without disability to report current depressive symptoms, frequent mental distress, suicidal ideation, and COVID-19-related initiated or increased substance use (all p values < .0001). Adults with disabilities also reported significantly higher levels of stressors, such as access to health care services (p < .0001), difficulty caring for their own (or another’s) chronic condition (p < .0001), emotional or physical abuse from others (p < .001), and not having enough food (p < .01).ConclusionsThe disproportionately high levels of poor mental health indicators among adults with disabilities as compared to those without highlight the importance of delivering timely mental health screening and treatment/intervention during and after the COVID-19 pandemic to persons with disabilities.     

中国精神残疾与伤害致残共患特征分析

目的 探讨精神残疾与伤害致残的关系, 以及我国两种残疾共患的多重残疾人群其残疾严重程度和卫生服务利用情况。方法 利用2006年第二次全国残疾人抽样调查和2009年残疾监测追踪调查数据, 提取精神残疾合并伤害致残的数据资料进行统计描述分析, 并加入权重使其结果推至全国。结果 我国2.7%的精神残疾共患因伤害导致的视、听、言语、肢体和/或智力残疾, 1.8%的伤害致残合并精神残疾, 高于普通人群伤害致残(0.94%)和精神残疾(0.63%)的现患率。>50%的共患残疾其严重程度为极重度, 46.32%共患残疾者的精神残疾和伤害致残为同年发生。需要精神科治疗的共患残疾中, 有56.25%未接受任何治疗。结论 精神疾病与伤害致残间可能存在密切关系。我国共患残疾者的治疗康复水平有待进一步提高。     

Disparities in prostate cancer diagnosis,treatment, and survival among men with disabilities: Retrospective cohort study in South Korea

BackgroundDisparities in cancer care have not been well documented for individuals with disability.ObjectiveTo investigate potential disparities in the diagnosis, treatment, and survival of prostate cancer (PC) patients according to disability status.MethodsA retrospective cohort study using disability registration data linked to Korean National Health Insurance and national cancer registry data. Totals of 7924 prostate cancer cases among patients with disabilities (diagnosed between 2005 and 2013) and 34,188 PC patients without disability were included.ResultsWhile overall PC stage distribution at diagnosis was similar, unknown stage was more common in patients with severe disabilities compared to those without disabilities (18.1% vs. 16.2%, respectively). People with disabilities were less likely to undergo surgery (33.1% vs. 38.6%, respectively; adjusted odds ratio [aOR] 0.79, 95% confidence interval [CI] 0.74–0.84), and more likely to receive androgen deprivation therapy (ADT) (57.9% vs. 55%, respectively; aOR 1.10, 95% CI 1.04–1.16) compared to those without disabilities. This was more evident for people with severe brain/mental impairment (aORs 0.29 for surgery; 1.52 for ADT). Patients with disabilities had higher overall mortality (adjusted hazard ratio [aHR] 1.20; 95% CI, 1.15–1.25), but only slightly higher PC-specific mortality after adjustment for patient factors and treatment (aHR 1.11, 95% CI 1.04–1.18) than people without disability.ConclusionsPC patients with disabilities underwent less staging work-up and were more likely to receive ADT than surgical treatment. Overall mortality of PC patients with disabilities was greater than those of PC patients without disability, but PC-specific mortality was only slightly worse.     

Access to food and health care during the COVID-19 pandemic by disability status in the United States

BackgroundThe COVID-19 pandemic has impacted people's access to food and health care. People with disabilities may be disproportionately affected by these outcomes due to structural and social barriers.Objective/HypothesisTo examine the relative prevalence of food insufficiency and unmet health care needs among the U.S. residents by vision, hearing, cognition, and mobility disability.MethodsWe used data from the Household Pulse Survey wave conducted from April 14 to April 26, 2021, when questions about functional disability were first included. Participants were asked about difficulty seeing, hearing, remembering or concentrating, and walking or climbing stairs. The outcomes of interest were food insufficiency, delaying needed medical care and not getting needed medical care. Poisson regression models with robust variance adjusted for potential confounders were used to examine the prevalence ratio of each of these outcomes by disability status in separate models for each type of disability.ResultsDuring April 14–26, 2021, 39.5% adults in the U.S. reported cognitive disability, 30.8% reported vision disability, 23.2% reported mobility disability, and 14.9% reported hearing disability. Adults with any type of disability were more likely than those without to experience food insufficiency (range of prevalence rate ratios [PRR]: 1.67–1.96), and delay (range of PRR: 1.48–1.87) or not get (range of PRR: 1.60–2.07) needed medical care.ConclusionsThese disparities suggest there is an urgent need to address the negative impact of the COVID-19 pandemic on people with disabilities. The prioritization of disability data collection is key in achieving that goal.