Disability doesn't discriminate: health inequities at the intersection of race and disability

Doubly Marginalized: The Interplay of Racism and Disability in Outcomes for Minoritized People With Down Syndrome

BACKGROUND

Intersectionality, or the multidimensional influence of social identity and systems of power, may drive increased morbidity and mortality for adults of color with Down syndrome. We documented racial and ethnic differences in death and hospitalizations among Medicaid-enrolled adults with Down syndrome and assessed the interaction of racial-ethnic group and Down syndrome.

METHODS

Our sample consisted of 119,325 adults with Down syndrome and >3.2 million adults without intellectual disability enrolled in Medicare at any point from 2011 to 2019. We calculated age-adjusted mortality and hospitalization rates by racial-ethnic group among those with Down syndrome. We examined the additive interaction between Down syndrome and racial and ethnic group on mortality and hospitalization rates.

RESULTS

Among those with Down syndrome, age-adjusted mortality rate did not differ between Black and White racial groups (rate ratio: 0.96, 95% confidence interval [CI] = 0.92, 1.01), while the mortality rate was lower for Pacific Islanders (0.80), Asian (0.71), Native (0.77), and mixed-race groups (0.50). Hospitalization rates were higher for all marginalized groups compared to the White group. When assessing the interaction between racial-ethnic group and Down syndrome, Black, Native Americans, and mixed-race groups exhibited a negative additive interaction for mortality rate, and all groups except Native Americans exhibited positive additive interaction for hospitalization.

CONCLUSIONS

Increased hospitalization rates for adults with Down syndrome from marginalized racial and ethnic groups suggest worse health and healthcare. Similar mortality rates across racial and ethnic groups may result from an increased infant mortality rate in marginalized groups with Down syndrome, leading to reduced mortality among those surviving to adulthood.

Prevalence of unintended pregnancy and associated factors among pregnant women with disabilities in Ethiopia: from the social model of disability perspective

Background

In low-income countries, women with disabilities face numerous challenges in accessing sexual and reproductive health services and experience high unintended pregnancy rates and adverse pregnancy outcomes, with 42% of cases ending in abortion. However, little is known about unintended pregnancy among women with disabilities in Ethiopia. Therefore, this study aimed to assess the prevalence of unintended pregnancy and associated factors among women with disabilities in the Central Regional State of Ethiopia.

Methods

A community-based cross-sectional study was conducted from December 2023 to February 2024, and multistage random sampling was used to enroll 572 study participants. The sample size was proportionally allocated to each zone, district and kebele. The Kobo Toolbox was used for data collection and cleaning, and the Statistical Package for Social Science version 26 was used for analysis. The multivariable analysis was used to identify the factors significantly associated with unintended pregnancy using an adjusted odds ratio (AOR), a 95% confidence interval (CI), and a p-value less than 0.05.

Results

The prevalence of unintended pregnancy was 43.8% (95% CI: 39.5, 47.8) in the Central Ethiopia Regional State, Ethiopia. The significantly associated factors were household size (AOR = 4.6, 95% CI: 2.6, 7.9), awareness of pregnancy intention (AOR = 2.4, 95% CI:1.4, 4.1), domestic violence (AOR = 5.9, 95% CI: 3.4, 10.4), accessibility of service (AOR = 2.4, 95% CI: 1.2, 5.4), discrimination by care providers (AOR = 2.1, 95% CI: 1.5, 2.9), disability-unfriendly health facility structure (AOR = 1.5, 95% CI: 1.2, 2.40), and negative community attitudes (AOR = 2.7, 95% CI: 1.7, 4.3). The overall direction of the associated variables' effect was positive.

Conclusion

This study sheds light on the need for disability-inclusive and sensitive healthcare services. Therefore, to achieve universal access to sexual and reproductive healthcare targeted under the Sustainable Development Goals, the Minister of Women and Social Affairs, Ministry of Health, Regional Health Bureau, and health facilities authorities should pay attention to improving awareness on pregnancy intention and domestic violence and ensuring accessible, inclusive, and equitable maternal health care for women with disabilities.

Changes in LEND trainees' understanding and application of diversity, equity, inclusion, and justice principles

Objectives

To assess changes in trainees' knowledge and application of Diversity, Equity, Inclusion, and Justice (DEIJ) concepts after participating in a midwestern academic medical center Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program. LEND is a federally funded year-long program training individuals of various disciplines (e.g., speech pathology, family advocacy, psychology) to better support the health of individuals with disabilities.

Methods

Trainees (n = 46) answered questions about their knowledge and application of DEIJ topics before and after program participation in 2021-2022 and 2022-2023. Changes in trainees' responses were examined using paired-samples t-tests.

Results

Thirty-six (78%) participants identified as White, 7 (15%) as Black, 2 (4%) as Asian, and 2 (4%) as more than one race. Three (7%) participants identified as Hispanic/Latino. Over the one-year program, trainees' perceived knowledge increased [t(45) = 5.84, p < .001, Mdiff = .59, Cohen's D = 0.86]. Regarding articulating definitions of DEIJ terms, trainees' summed scores following program participation also improved [t(45) = 4.71, p < .001, Mdiff  = 2.37, Cohen's D = 0.70]. However, their comfort with addressing prejudicial statements and discussing and combating "-isms" (application of DEIJ skills) did not increase [t(45) = 1.74, p = .09, Mdiff  = 0.17, Cohen's D = 0.26].

Conclusions for practice

LEND program participation positively impacted trainees' perceived DEIJ knowledge and ability to define DEIJ terms. However, future refinements to the curriculum will be needed to improve trainees' application of skills and to develop a more nuanced understanding of equity, intersectionality, inclusion, and belonging.

Disease Burden in the Context of Disasters: Insights from Over 6.7 million Respondents in the Bangladesh Disaster-Related Statistics of 2021

OBJECTIVES

The objective of this study was to explore the burden of disasters and adverse health outcomes during and following disasters in Bangladesh.

METHODS

We analyzed 6 788 947 respondents' data from a cross-sectional and nationally representative 2021 Bangladesh Disaster-related Statistics (BDRS). The key explanatory variables were the types of disasters respondents faced, while the outcome variables were the disease burden during and following disasters. Descriptive statistics were used to determine disease burden. A multilevel mixed-effects logistic regression model assessed the association between disease burden and disaster types, along with socio-demographic characteristics of respondents.

RESULTS

Nearly 50% of respondents experienced diseases during disasters, rising to 53.4% afterward. Fever, cough and diarrhea were prevalent during and after disasters, with increases in skin diseases, malnutrition, and asthma post-disaster. Vulnerable groups, such as children aged 0-4, hijra individuals, those with lower education, people with disabilities, and rural residents, especially in Chattogram, Rangpur, and Sylhet divisions, were most affected. Floods, cyclones, thunderstorms, and hailstorms significantly increased disease likelihood during and after disasters.

CONCLUSIONS

The study underscores the complex relationship between disasters and health outcomes in Bangladesh, stressing the need for targeted public health interventions, improved health care infrastructure, and evidence-based policies to mitigate disaster-related health risks.

Mental health outcomes across the reproductive life course among women with disabilities: a systematic review

PURPOSE

This systematic review examined literature on mental health outcomes among women with disabilities living in high-income countries within the context of reproductive health, spanning menstruation through menopause.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, CINAHL, and PsycINFO databases for studies published through June 2023. Eligible studies were observational, quantitative, and included a comparison group without disabilities.

RESULTS

A total of 2,520 studies were evaluated and 27 studies met inclusion criteria. These studies assessed mental health during prepregnancy, pregnancy, postpartum, and parenting among women with and without disabilities. None of the studies examined reproductive health time periods related to menstruation, fertility, or menopause. Women of reproductive age with disabilities were more likely to have poor mental health outcomes compared to women without disabilities. During pregnancy and the postpartum, women with disabilities were at greater risk of diagnosed perinatal mental disorders and psychiatric-related healthcare visits. Findings also suggested mental distress and inadequate emotional and social support related to parenting among women with disabilities. The greatest risks of poor mental health outcomes were often observed among women with intellectual and developmental disabilities and among women with multiple types of disabilities, compared to women without disabilities.

CONCLUSIONS

Routine reproductive healthcare visits provide significant prevention and treatment opportunities for poor mental health among women with disabilities. Further research examining mental health outcomes within the context of reproductive health, especially understudied areas of menstruation, fertility, parenting, and menopause, among women with disabilities is needed.

Top Ten Tips Palliative Care Clinicians Should Know About Providing Care for People With Disabilities

Palliative care (PC) clinicians are well poised to help people with disabilities (PWD) live well in the context of serious illness. PC prioritizes person-centered care with a focus on function, autonomy, and quality of life. This approach aligns with principles of high-quality care for PWD. An understanding of the unique experiences and needs of PWD can advance the delivery of comprehensive, equitable PC for this population. In this article, we provide 10 tips to help PC clinicians develop an informed disability lens in their approach to care.

Racial and ethnic disparities in psychological care for individuals with FASD: a dis/ability studies and critical race theory perspective toward improving prevention, assessment/diagnosis, and intervention

Fetal alcohol spectrum disorders (FASD) are among the most common neurodevelopmental disorders and substantially impact public health. FASD can affect people of all races and ethnicities; however, there are important racial and ethnic disparities in alcohol-exposed pregnancy prevention, assessment and diagnosis of FASD, and interventions to support individuals with FASD and their families. In this article we use the Dis/Ability Studies and Critical Race Theory (Dis/Crit) framework to structure the exploration of disparities and possible solutions within these three areas (prevention, diagnosis, intervention). Dis/Crit provides a guide to understanding the intersection of dis/ability and race, while framing both as social constructs. Following the Dis/Crit framework, the systemic, historical, and contemporary racism and ableism present in psychological care is further discussed. We aim to elucidate these racial and ethnic disparities within the fields of psychology and neuropsychology through the Dis/Crit framework and provide potential points of action to reduce these disparities.