Drug and alcohol use disorders among adults with select disabilities: The national survey on drug use and health

Nonfatal injury emergency department visits and inpatient hospitalizations among persons under age 65 with an intellectual and developmental disability or deaf or hard of hearing disability

BACKGROUND

Vulnerable populations at risk of injury include persons with intellectual and developmental disabilities (IDD), and persons who are deaf or hard of hearing (DHH). The purpose of this study was to describe and compare emergency department and inpatient hospitalization (ED + IP) injury rates and rate ratios by injury type among persons under age 65 with IDD or with DHH to those without IDD or DHH.

METHODS

This is a descriptive population-based retrospective cross-sectional study of injuries among patients under the age of 65 with an IDD disability or a DHH disability using Kentucky ED + IP discharge datasets from 2019 to 2023. Injury rates and injury rate ratios were calculated for those under the age of 65 with an IDD or a DHH disability and without an IDD or a DHH disability, using number of persons under age 65 with or without the related disability as the denominator.

RESULTS

The overall injury rate was lower for persons under age 65 with an IDD or DHH compared to those without those disabilities in 2023 (1 and 3 per 100,000 population, respectively). IDD or DHH disability types had significantly lower overall ED + IP injury rate ratios compared to those without those disabilities (IDD: 0.667 [95% CI: 0.640-0.694], DHH: 0.658 [95% CI: 0.633-0.683]). When ED + IP injury type rate ratios were compared, IDD or DHH persons had higher injury rate ratios for self-harm (IDD: 8.740 [95% CI: 7.783-9.815], DHH: 1.7846 [95% CI: 1.402-2.272]), assault (IDD: 1.386 [95% CI: 1.173-1.637], DHH: 1.310 [95% CI: 1.115-1.540]), unintentional falls (IDD: 1.540 [95% CI: 1.436-1.633], DHH: 1.283 [95% CI: 1.201-1.372]), and drug poisonings (IDD: 2.401 [95% CI: 2.103-2.740], DHH:1.620 [95% CI: 1.391-1.886]) compared to those without such disabilities. Those with IHH or DHH who were treated for injuries incurred triple the charges of patients without these conditions (~$17,086 IDD; $19,550 DHH; and $5,216 no IDD or DHH disabilities).

CONCLUSIONS

These findings have implications for health policy at the state and federal level. Clinical care interventions to reduce assault, self-harm, drug poisonings and unintentional injuries and healthcare utilization in persons with IDD or DHH should be publicly funded or covered by health insurance.

Health disparities and injection drug use behaviors among adults with and without disabilities in the National Survey on drug use and health, 2015-2019

BACKGROUND

Little is known about the prevalence of injection drug use in people with disabilities (PWD) when compared by disability type and to other adults without disabilities.

OBJECTIVE OR HYPOTHESIS

The prevalence of past-year injection drug use will be higher in adults with a reported disability than adults without any reported disability.

METHODS

This study consisted of secondary analyses of data from the 2015-2019 National Survey of Drug Use and Health. The analytic sample comprised 214,505 US adults. Self-reported past-year injection drug use represented the outcome of interest. Disability status and socioeconomic characteristics were conceptualized as predictors, and sex and age were used as controls.

RESULTS

Past-year prevalence of self-reported injection drug use was 0.24 % (95 % CI, 0.22-0.27) in adults without a disability but 0.66 % (95 % CI, 0.59-0.73) in adults with a disability. All disability types examined were associated with increased odds of reporting past-year injection drug use, but the strongest association was observed for disability related to difficulty concentrating (AOR, 4.90; 95 % CI, 3.92-6.14). Adjusted odds of past-year methamphetamine injection were more than three times as high in adults with a disability, compared to those without a disability (AOR, 3.21; 95 % CI, 2.37-4.33) and more than two times as high in adults with a disability for cocaine injection (AOR, 2.77; 95 % CI, 1.84-4.15).

CONCLUSION

Disability status is associated with injection of various types of drugs, and a variety of disability types are associated with higher odds of injection drug use.

Considerations for Achieving Health Equity Through Substance Misuse Prevention

Disparities in health care access and quality of care like affordability and the lack of a properly trained workforce are associated with a greater risk for substance misuse. In pursuing health equity, the behavioral health workforce must ensure interventions are accessible and meaningful to all populations and allocate resources to those with the highest burden of substance use-related consequences. Behavioral health clinicians can support efforts to achieve equity by engaging with upstream, community-level prevention efforts aimed at providing culturally responsive prevention services. Coordination across the continuum of care that includes cultural humility, trauma-informed approaches, diverse perspectives, and community engagement can lead to more equitable and accessible care. This article describes health equity in the context of substance misuse prevention, considers health equity across the continuum of behavioral health services, and provides an overview of promising practices that align clinical care with prevention work to promote healthy, equitable community conditions.

Self-Reported Disability Type and Risk of Alcohol-Induced Death - A Longitudinal Study Using Nationally Representative Data

BACKGROUND

Disability is associated with alcohol misuse and drug overdose death, however, its association with alcohol-induced death remains understudied.

OBJECTIVE

To quantify the risk of alcohol-induced death among adults with different types of disabilities in a nationally representative longitudinal sample of US adults.

METHODS

Persons with disabilities were identified among participants ages 18 or older in the Mortality Disparities in American Communities (MDAC) study (n = 3,324,000). Baseline data were collected in 2008 and mortality outcomes were ascertained through 2019 using the National Death Index. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were estimated for the association between disability type and alcohol-induced death, controlling for demographic and socioeconomic covariates.

RESULTS

During a maximum of 12 years of follow-up, 4000 alcohol-induced deaths occurred in the study population. In descending order, the following disability types displayed the greatest risk of alcohol-induced death (compared to adults without disability): complex activity limitation (aHR = 1.7; 95% CI = 1.3-2.3), vision limitation (aHR = 1.6; 95% CI = 1.2-2.0), mobility limitation (aHR = 1.4; 95% CI = 1.3-1.7), ≥2 limitations (aHR = 1.4; 95% CI = 1.3-1.6), cognitive limitation (aHR = 1.2; 95% CI = 1.0-1.4), and hearing limitation (aHR = 1.0; 95% CI = 0.9-1.3).

CONCLUSIONS

The risk of alcohol-induced death varies considerably by disability type. Efforts to prevent alcohol-induced deaths should be tailored to meet the needs of the highest-risk groups, including adults with complex activity (i.e., activities of daily living - "ALDs"), vision, mobility, and ≥2 limitations. Early diagnosis and treatment of alcohol use disorder within these populations, and improved access to educational and occupational opportunities, should be considered as prevention strategies for alcohol-induced deaths.

The risk of drug overdose death among adults with select types of disabilities in the United States - A longitudinal study using nationally representative data

BACKGROUND

Disability is associated with increased risk of drug overdose mortality, but previous studies use coarse and inconsistent methods to identify adults with disabilities. This investigation makes use of the U.S. Department of Health and Human Services disability questions to estimate the risk of drug overdose death among U.S. adults using seven established disability categories.

METHODS

The longitudinal Mortality Disparities in American Communities study was used to determine disability status among a nationally representative sample of adults age ≥18 in 2008 (n = 3,324,000). Through linkage to the National Death Index, drug overdose deaths were identified through 2019. Adults in mutually-exclusive disability categories (hearing, vision, cognitive, mobility, complex activity, ≥2 limitations) were compared to adults with no reported disabilities using adjusted hazard ratios (aHRs) and controlling for demographic and socioeconomic covariates.

RESULTS

The risk of drug overdose death varied considerably by disability type, as adults in some disability categories displayed only marginally significant risk, while adults in other disability categories displayed substantially elevated risk. Compared to non-disabled adults, the risk of drug overdose death was highest among adults with ≥2 limitations (aHR = 3.0, 95% CI = 2.8-3.3), cognitive limitation (aHR = 2.6, 95% CI = 2.3-2.9), mobility limitation (aHR = 2.6, 95% CI = 2.3-2.9), complex activity limitation (aHR = 2.3, 95% CI = 1.8-2.9), hearing limitation (aHR = 1.6, 95% CI = 1.3-1.9), and vision limitation (aHR = 1.3, 95% CI = 1.0-1.7).

CONCLUSIONS

The examination of specific disability categories revealed unique associations that were not apparent in previous research. These findings can be used to focus overdose prevention efforts on the populations at greatest risk for drug-related mortality.