Health outcome disparities among subgroups of people with disabilities: A scoping review

BackgroundA growing body of research has found that people with disabilities experience lower health status and an excess burden of disease relative to the general US population. However, the population of people with disabilities is quite diverse. Thus, it is important to understand health differences between subgroups of people with disabilities in order to most effectively target interventions to address disparities. An initial step in this process is reviewing and synthesizing available research addressing these subgroup differences.ObjectivesTo conduct a scoping review of literature to describe recent research activity that has examined health outcome disparities within populations of people with disabilities.MethodsWe searched for relevant articles in MEDLINE, PsycINFO, and CINAHL databases. Three staff independently reviewed abstracts according to inclusion criteria. Two authors then independently extracted data from each included article.ResultsFor many of the health outcomes of interest, there was no published literature in relation to key disparity factors (e.g. race, income) within the population of people with disabilities. The health outcomes most frequently examined were diabetes and heart disease. The most frequently examined disparity factors were the type of disabling condition and gender.ConclusionsThere are significant gaps in available research. Building a body of research that identifies disparities and potentially vulnerable subgroups may improve understanding of the causes of disparities and contribute to efforts to improve quality of life and health outcomes for individuals with disabilities.     

Young people, gender and smoking in the United Kingdom

Over the last decade, gender has emerged as a significant differentiatorof smoking prevalence among young people in developed countries.Some attention has also been given to gender difference.s inmotives for taking up smoking. Compared to recent work on adultsmoking, the literature on smoking among young people has failedto take up the challenge of the analysis of gender differencesto highlight an interpretation of young people's smoking asa rational response to material and social pressures. This paperdraws mainly on questionnaire data from an ongoing UK studyof Adolescent Health and Parenting to outline an alternativeto the usual health education approach to young people's smoking.in this alternative model, the main factors associated withyoung people's smoking are material circumstances, life satisfactionand stress, including dissatisfaction with parental relationships,and peer sociability. Smoking is associated with poor reportedhealth status. The relationship between social factors and smokingin young men and women shows some significant differences, withyoung women being significantly more likely to smoke for stress-relatedreasons. Qualitative materialfrom a follow-up interview studyis indicative of the processes underlying the statistical associationsfound in the questionnaire     

Depressive symptoms and their relationship with endogenous reproductive hormones and sporadic anovulation in premenopausal women

PurposeTo determine whether depressive symptoms are associated with ovulation or reproductive hormone concentrations in eumenorrheic women without a reported diagnosis of clinical depression.MethodsA prospective cohort of 248 regularly menstruating women, aged 18 to 44 years (27.3 ± 8.2) were evaluated for depressive symptoms at baseline using the 20-item Center for Epidemiological Studies Depression (CES-D) scale and categorized dichotomously (<16, no depressive symptoms [92%] vs. ≥16, depressive symptoms [8%]). Serum concentrations of estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured up to eight times per cycle for up to two menstrual cycles. Linear mixed models estimated associations between depressive symptoms and hormone concentrations, whereas generalized linear mixed models assessed their relationship with sporadic anovulation.ResultsNo significant associations were identified between depressive symptoms and reproductive hormone levels (all P > .05) or the odds of sporadic anovulation (adjusted odds ratio, 1.1; 95% confidence interval, [0.02–5.0]), after adjusting for age, race, body mass index, perceived stress level, and alcohol consumption.ConclusionsDespite reported associations between mental health and menstrual cycle dysfunction, depressive symptoms were not associated with reproductive hormone concentrations or sporadic anovulation in this cohort of regularly menstruating women with no recent (within 1 year) self-reported history of clinical depression.     

The impact of people with disabilities choosing their services on quality of life outcomes

Background

In recognition of the importance of services and supports that are defined and chosen by the recipient with disabilities, there has been a shift toward person-centered services. Quality person-centered services not only aim to ensure people have control over their own lives, but also to improve individually defined outcomes.

Food insecurity of people with disabilities who were Medicare beneficiaries during the COVID-19 pandemic

BackgroundDuring the COVID-19 pandemic, 54 million people in the United States were food insecure (2020). People with disabilities (PWD) who were Medicare beneficiaries were especially vulnerable to food insecurity prior to the pandemic.ObjectiveThe aim of this study was to explore COVID-19 pandemic food insecurity among PWD who were Medicare beneficiaries.MethodsWe conducted a secondary analysis of the United States Census Bureau COVID-19 Household Pulse Survey data about the food security of 70,171 PWD who were Medicare beneficiaries (under 65), and a comparison group of 1.1 million non-Medicare beneficiaries (under 65). Data were weighted using frequency person-weights.ResultsOnly 44.3% of PWD who were Medicare beneficiaries had enough of the foods they wanted to eat during the pandemic. Reasons for food insecurity included: could not afford to purchase more food (56.9%); stores did not have the food they wanted (31.4%); afraid to go out to get more food (30.0%); could not get out to get more food (21.5%); and could not get food delivered (8.5%). PWD who were Medicare beneficiaries were more likely to be food insecure than non-Medicare beneficiaries. There were also disparities in food insecurity among PWD who were Medicare beneficiaries themselves with household size, Medicaid beneficiaries, gender, race, education, martial status, household income, and Supplemental Nutrition Assistance Program (SNAP) all impacting food security.ConclusionsA multipronged approach that addresses not only food-related public health, but also other systems and structures is critical to end food insecurity.     

Epidemiological surveillance of Creutzfeldt-Jakob disease in the United Kingdom

Systematic epidemiological surveillance of Creutzfeldt-Jakob disease was carried out in England and Wales covering the years 1970–1984. The results of this work provide a basis from which to assess any change in the pattern of Creutzfeldt-Jakob disease following the occurrence of Bovine Spongiform Encephalopathy. The methodology, early results and problems of the current systematic national survey of CJD, initiated in May 1990, are discussed.     

Solidarity, Society and the Welfare State in the United Kingdom

Political argument and institutions in the UnitedKingdom have frequently been represented as the products of ablend of nationalistic conservatism, liberal individualism andsocialism, in which consensus has been prized over ideology. This situation changed, as the standard story has it, with therise of Thatcherism in the late 1970s, and again with the arrivalof Tony Blair's ``New Labour' pragmatism in the late 1990s. Solidarity as an element of political discourse makes itsappearance in the UK late in the day. It has been most stronglylinked to the Third Way debate, as framed most influentially inthe work of Prof. Anthony Giddens.In this paper we review the history and pre-history of the debateon solidarity in the UK, focussing mostly on its implications forwelfare state reform. In particular we discuss the proposals forthe long-term care of the Elderly issued by the Royal Commissionon long-term care in 1999. In this context we critically examinethe idea that solidarity is a new concept in British politicalculture, and that it is a concept which has real political ``bite'in the project of welfare reform. We examine this through aconsideration of Giddens's attempted synthesis of politicalargument and social theory.     

International Recruitment of Nurses: Policy and Practice in the United Kingdom

Objective. To synthesize information about nurse migration into and out of the United Kingdom in the period to 2005, and to assess policy implications.
Principal Findings. There has been rapid growth in inflow of nurses to the United Kingdom from other countries. In recent years, 40–50 percent of new nurse registrants in the United Kingdom have come from other countries, principally the Philippines, Australia, India, and South Africa. Outflow has been at a lower level, mainly to other English-speaking developed countries—Australia, the United States, New Zealand, Ireland, and Canada. The United Kingdom is a net importer of nurses. The principal policy instrument in the United Kingdom, the Code of Practice on International Recruitment, has not ended the inflow of nurses to the United Kingdom from sub-Saharan Africa.
Conclusions. Given the increasing globalization of labor markets, it is likely that the historically high levels of inflow of internationally recruited nurses to the United Kingdom will continue over the next few years; however the "peak" number reached in 2002/2003 may not be repeated, particularly as large-scale active international recruitment has now been ended, for the short term at least. New English language tests and other revised requirements for international applicants being introduced by the Nurses and Midwives Council from September 2005 may restrict successful applications from some countries and will also probably add to the "bottleneck" of international nurse applicants. Demographic-driven demand for health care, combined with a potential reduction in supply of U.K. nurses as many more reach potential retirement age means that international recruitment is likely to remain on the policy agenda in the longer term, even with further growth in the number of home-based nurses being trained.     

广东省佛山市男男性行为者抑郁状况、性行为特征及关联研究

目的 了解广东省佛山市男男性行为者(MSM)的抑郁状况、性行为特征及关联.方法 通过同伴推动抽样法募集在佛山市居住至少6个月≥18岁的MSM,调查采用Zung抑郁自评量表及自行设计的问卷,对所有指标计算粗的人群比例、估计总体的比例及其95％置信区间(CI),用logistic回归模型分析抑郁症状和相关因素的关联.结果 共募集佛山市249名MSM,平均年龄(31.9±8.5)岁,教育年限以7～9年(43.5％)和10～12年(25.9％)居多.已婚者占49.7％;56.7％是双性恋,63.3％的首次性行为对象为异性,42.3％和34.1％的人在公园/公厕和网络上寻找性伴.估计的总体抑郁症状发生率为34.8％(95％CI:28.2 ～ 42.3).与抑郁症状有关联的因素为低年龄(OR=3.31,95％CI:1.39～7.86)、小学及以下文化程度(OR=2.23,95％CI:1.01～4.93)、同性性行为方式为口交(OR=3.09,95％CI:1.10～8.70)、在实体场所寻找性伴(OR=2.38,95％CI:1.20～4.75).结论 佛山市MSM的抑郁症状与社会人口学和性行为特征有关,对该人群进行心理干预时要考虑社会人口学和性行为因素.     

Telehealth information and communication technology access for family caregivers of people with intellectual and developmental disabilities and mental health needs

BackgroundTelehealth is increasingly used to deliver mental health services. However, the potential benefits of telehealth for people with intellectual and developmental disabilities and mental health needs (IDD-MH) may not be fully realized. This study addresses gaps in knowledge about access to information and communication technologies (ICTs) for individuals with IDD-MH from the perspective of their family caregivers.ObjectiveWhat factors are associated with access to ICTs among family caregivers of people with IDD-MH who use START services?MethodsRetrospective analysis of cross-sectional interview data gathered for START use at the onset of COVID-19. START is a crisis prevention and intervention evidence-based model for people with IDD-MH implemented across the USA. To assess needs during COVID-19, START coordinators conducted interviews with 1455 family caregivers between March and July 2020. A multinomial regression model examined correlates of ICT access, as indicated by an index (poor, limited, and optimal access). Correlates included the level of IDD, age, gender, race, ethnicity, rural setting of the person with IDD-MH, and caregiver status.ResultsAge (ages 23–30 years) and sole caregiver status were significantly associated with limited access (both p ≤ .001). Age (ages 23–30 years and ≥31 years, p < .001), race (Black or African American, p = .001), ethnicity (Hispanic, p = .004), and sole caregiver status (p < .001) were significantly associated with poor access.ConclusionsDisparities existed in ICT access for adults, specific racial/ethnic groups, and sole caregiver households. Healthcare policy related to telehealth must consider how ICT access can be equitable for all users with IDD-MH.     

Caregiving in the shadows: National analysis of health outcomes and intensity and duration of care among those who care for people with mental illness and for people with developmental disabilities

BackgroundThe health impacts of caring for people with mental illness (MI) and developmental disabilities (DD) are not well understood.ObjectiveThe present study explored whether health outcomes differed between MI and DD caregivers, and if intensity and duration of care moderated health outcomes.MethodsNationally representative 2016 Behavioral Risk Factor Surveillance System survey data were used to explore how caring for people with MI (n = 1071) and DD (n = 888) impacted general health status and physical and mental health days, and whether intensity and duration of care moderated health outcomes. Logistic regression models and cumulative logistic regression models were used to model health outcomes.ResultsCaregivers had worse health (p = 0.0001) and more poor physical (p < 0.0001) and mental health days (p < 0.0001) than non-caregivers. Relative to DD caregivers, MI caregivers had worse health status (p = 0.02) and more poor physical (p = 0.02) and mental (p = 0.003) health days. As intensity of care increased, MI caregivers had more poor physical health days (p = 0.04) than DD caregivers and as duration of care increased, MI caregivers had worse health status (p = 0.03) than DD caregivers.ConclusionsAlthough the care provided to adults with DD was more intense and for a longer duration, MI caregivers had poorer health outcomes and were more impacted by intensity and duration of care. Implications for supporting MI and DD caregivers are discussed.     

Exploring the disparity in tangible outcomes of internet use between persons with disabilities and persons without disabilities in South Korea

BackgroundSocietal inequalities caused by the digital divide between people with disabilities and people without disabilities are a social justice issue. Internet use to acquire beneficial outcomes has increasingly been the focus of the digital divide.ObjectiveThis study investigates the extent to which outcomes of Internet use differ between individuals with (PWD) and without disabilities (PWOD) and determinants of outcomes of Internet use.MethodsWe conducted a series of multiple linear regression analyses using cross-sectional data of 1762 PWD and 5491 PWOD from the Digital Divide Survey conducted in Korea in 2018.ResultsWe determined gaps in Internet access, skill, motivation, and outcomes between PWD and PWOD. PWOD reported significantly higher Internet access, skill, and motivation, and they also acquired more beneficial outcomes on all outcome domains than PWD. Further, PWOD with higher education degrees, higher household incomes, higher motivation towards Internet use, and greater digital skills acquired more beneficial outcomes of Internet use. Moreover, disability status, motivation to use the Internet, and digital skills were the most salient determinants of outcomes of Internet use, both collectively and specifically out of the five domains.ConclusionThe government should move forward to closing the gap in outcomes of Internet use between PWD and PWOD by providing programs and interventions to promote Internet use and enhance digital skills as well as by increasing web accessibility and incentives system.     

Marital status and bed occupancy in health and social care facilities in the United Kingdom

The purpose of the study was to test the hypothesis that marriage and physical health are positively related.A secondary analysis was performed of census data on all individuals aged 15 y and over occupying beds in general health and social care facilities (excluding mental health) in England and Wales, Scotland, and Northern Ireland in 1971, 1981 and 1991.Using bed occupancy in health and social care facilities as a proxy for ill health, this paper investigates the relationship between marital status and physical health in the United Kingdom. The findings, expressed as the proportion of individuals (excluding staff and visitors) aged 15 y and over within these facilities, suggest that: a) Whether considered separately or together, married men and women are healthier than non-married men and women, as reflected in their much lower use of health and social care beds; b) This positive relationship between marriage and health has increased steadily since the 1970s; c) Within the non-married population, whereas the single are most at risk among men, the widowed are most at risk among women; d) In contrast to the married and widowed, there are some consistent age-specific gender differences among the divorced and single, with men of working age at much higher risk than women of working age.This study confirms research findings elsewhere that marriage and physical health are positively related. Throughout the United Kingdom, not only are married people healthier than non-married people, as reflected in their much lower use of health and social care beds, but this relationship holds irrespective of gender.     

The COVID-19 pandemic and quality of life outcomes of people with intellectual and developmental disabilities

BackgroundPeople with intellectual and developmental disabilities (PWIDD) are contracting and dying of COVID-19 at significantly greater rates than nondisabled people and people with other disabilities. Despite the increased risk of COVID-19 for the IDD community, there has been less attention drawn to the impact of the pandemic on people with IDD, especially beyond their health and safety. Yet, PWIDD also face unique challenges as a result of the pandemic compared to other populations.ObjectiveThe purpose of this study was to explore the impact of the COVID-19 pandemic on the quality of life outcomes of PWIDD.MethodsWe conducted a secondary analysis of Personal Outcome Measures® interviews from 2019 to 2020 (n = 2284).ResultsThere were significant differences in the following quality of life outcomes of PWIDD between 2019 and 2020: continuity and security; interact with other members of the community; participate in the life of the community; intimate relationships; and, choose goals.ConclusionsOur findings suggest the COVID-19 pandemic has negatively hindered the quality of life outcomes of PWIDD in a number of different areas. While the pandemic has been undoubtably hard on the IDD community, in many ways it has simply intensified an underfunded and fractured IDD service system. However the IDD service system evolves during and after the pandemic, it must be done in a way that prioritizes the quality of life of PWIDD and what is most important to them.