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Health Disparities

Health Disparities between Women with Physical Disabilities* and Women in the General PopulationCROWD logo

Prepared by the Center for Research on Women with Disabilities, May 2005

* "Women with physical disabilities" refers to women who have limitations in mobility or self-care due to conditions such as cerebral palsy, postpolio, spina bifida, spinal cord injury, neuromuscular diseases, amputation, joint and connective tissue disorders, stroke, or traumatic brain injury.


What are health disparities?

According to the American Public Health Association,1 health disparities are differences that occur by gender, race and ethnicity, education level, income level, disability, geographic location, and/or sexual orientation.

Some health disparities are unavoidable, such as health problems that are related to a person's genetic structure.

However, other health disparities are potentially avoidable, especially when they are related to factors such as living in low-income neighborhoods or having unequal access to medical care and information.

Common areas in which disparities have been documented include:

  • Lack of physicians in rural areas
  • Unequal treatment for minorities
  • Lack of diversity among health care providers
  • Low health literacy
  • Lack of insurance
  • Exposures to environmental risks
  • Poverty and cancer

How do people with disabilities fare in these areas?

Disability adds a whole new dimension to the concept of health disparities. For people with disabilities, there are significant differences in each of these areas.

  • People with disabilities tend to make greater use of health care services than people in general. Although there have been no studies of how they are affected by the lack of physicians in rural areas, it would follow that there would be a disproportionate negative effect on people with disabilities living in rural areas.
  • Women with disabilities are often denied reproductive and other types of health care, or given substandard care compared to women with uncomplicated health care needs. We have documented this disparity in our National Study of Women with Physical Disabilities.
  • Opportunities for people with disabilities in the health care professions are extremely limited. Many schools that offer degrees in medicine, nursing, or the allied health professions have policies, either written or traditional, that prevent the admission of people with any type of functional limitations.
  • Although there have been no studies of health literacy among people with disabilities compared to people without disabilities, we know that people with disabilities face numerous barriers in obtaining health information. This is particularly evident in reproductive health for women with disabilities.
  • Several studies have documented the lack of health insurance among women with disabilities. Compared to women in general, women with disabilities are significantly less likely to be employed or married, two of the principal avenues by which women have access to health insurance.
  • Environmental risks are generally understood to be caused by man-made contaminants. Little attention has been paid to the disproportionate negative effect of environmental pollution on the health of people with disabilities. The environment of people with disabilities, however, also includes malfunctioning assistive devices and pervasive architectural barriers. These factors have not entered the discussion of disparities due to exposure to environmental risks.
  • Poverty is one of the defining characteristics of the population of women with disabilities. Although there have been no studies of the association of poverty and cancer in this population, there is evidence of barriers to cancer screening services.

For what health conditions are there disparities for women with physical disabilities?

The most significant health disparities exist among women with physical disabilities for the following conditions:

  • Depression

    • Women with severe mobility impairments compared to women without impairments are more than six times as likely to experience depression (51.0% versus 8.5%).7, 8
    • According to the National Institute of Mental Health, nearly twice as many women (12.0 percent) as men (6.6 percent) are affected by a depressive disorder each year.9 While major depressive disorder can develop at any age, the average age at onset is the mid-twenties.10
    • Chapter 6 of Healthy People 2010 asserts that a greater number of women with disabilities (30 percent) reported "feelings such as sadness, unhappiness, or depression that prevent them from being active" compared to women without disabilities (8 percent).11
    • Analysis of data from the 1994-95 National Health Interview Survey indicated that younger women (those aged 18-44) with three or more functional limitations were more likely to be depressed (38 percent) than women without disabilities (4 percent) and were eight times more likely to report that they had experienced "major depression" in the past year.12
    • CROWD data from a convenience sample of women with physical disabilities show a one-year prevalence of 51 percent of the women had scores in the mildly depressed range or higher on the BDI-II. Women classified as depressed were more likely to have multiple sclerosis, to be younger, or to have a shorter duration of disability. Only 44 percent of the women with scores exceeding the BDI-II cut-off for significant depressive symptomatology had received recent treatment for depression, with Hispanic women being the least likely to report receiving treatment.7
    • More...
  • Diabetes

    • Women with severe mobility impairments compared to women without impairments are more than five times more likely to have diabetes (36.3% versus 7.1%). 7, 17
    • National Health Interview Survey data from 2002 indicate that 6.1 percent of women aged 18 and over have diabetes.4 The problem is more severe in women aged 45 and over, and women who are black or hispanic.5 Another source reports that 8.7 percent of women aged 20 and over have diabetes.6
    • CROWD data show that 36.3 percent of a convenience sample of women with physical disabilities report having diabetes.3
    • More...
  • Osteoporosis

    • Women with severe mobility impairments compared to women without impairments are five times more likely to have osteoporosis (25.5% versus 5.3%).7, 8
    • National Health and Nutrition Examination Survey data from 1999-2000 indicate that 3.1 percent of women under 65 have ever been told they have osteoporosis, compared to 9.6 percent of women aged 65-74 years and 23.7 percent of women aged 75 and older. Non-Hispanic White women over 20 years of age were four times as likely (6.9 percent) to have ever been told they have osteoporosis as non-Hispanic Black women (1.7 percent) and Mexican American women (1.7 percent).2
    • CROWD data show that 25.5 percent of a convenience sample of women with physical disabilities aged 18-83 report having osteoporosis.3
    • More...
  • Obesity

    • Women with severe mobility impairments compared to women without impairments are nearly twice as likely to be obese (47.6% versus 24.3%).12 , 17
    • National Health Interview Survey data from 2002 indicate that 21.4 percent of women aged 18 and over are obese.13 Another source using the same data claims the statistic is 22.9 percent.14 Substantially more women than men are obese. The problem is most severe for women aged 45-74 and women who are black or hispanic.13
    • CROWD data show that 47.6 percent of a convenience sample of women with physical disabilities report having a BMI of 30 or greater.3 Another study that used NHIS data for women with functional limitations found that 43.2 percent of women with three or more limitations were obese.11
    • More...
  • Hypertension

    • Women with severe mobility impairments compared to women without impairments are nearly twice as likely to have hypertension (56.2% versus 21.4%).3, 15
    • National Health Interview Survey data from 2002 indicate that 21.4 percent of women aged 18 and over have hypertension.15 This problem is more severe among women age 45 and over and women who are black.16
    • CROWD data show that 56.2 percent of a convenience sample of women with physical disabilities report having hypertension.3
    • More...

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References

1 American Public Health Association, National Public Health Week, April 5-11 ,2004, Eliminating Health Disparities: Communities Moving from Statistics to Solutions, Toolkit.

2 National Center for Health Statistics, Centers for Disease Control and Prevention. National Health and Nutrition Examination Study (NHANES) 1999-2000. http://www.cdc.gov/nchs/data/nhanes/gendoc.pdf. Accessed on June 1, 2005.

3 Nosek MA, Hughes RB, Petersen NJ, et al. Secondary conditions in a community-based sample of women with physical disabilities over a 1-year period. Arch Phys Med Rehabil. 2006;87:320-7.

4 Lethbridge-Çejku M, Schiller JS, Bernadel L. Summary health statistics for U.S. Adults: National Health Interview Survey, 2002. National Center for Health Statistics. Vital Health Stat 10(222). 2004. Table 8. Age-adjusted percents (with standard errors) of selected diseases and conditions among persons 18 years of age and over, by selected characteristics: United States, 2002.

5 U.S. Department of Health and Human Services, Health Resources and Services Administration. Women's Health USA 2004. Rockville, Maryland: U.S. Department of Health and Human Services, 2004. http://mchb.hrsa.gov/whusa04/pages/ch2.htm#diabetes. Accessed on June 1, 2005.

6 National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States, 2003. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, 2003. Rev. ed. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, 2004. http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm#7. Accessed on June 1, 2005.

7 Hughes RB, Robinson-Whelen S, Taylor HB, Petersen N, Nosek MA. Characteristics of depressed and non-depressed women with physical disabilities. Arch Phys Med Rehabil. 2005;80:473-9.

8 Health Resources and Services Administration. Women’s Health USA 2007. Rockville, Maryland: U.S. Department of Health and Human Services; 2007.

9 Narrow WE. One-year prevalence of depressive disorders among adults 18 and over in the U.S.: NIMH ECA prospective data. Population estimates based on U.S. Census estimated residential population age 18 and over on July 1, 1998. Unpublished table. http://www.nimh.nih.gov/publicat/numbers.cfm. Accessed on June 1, 2005.

10 American Psychiatric Association. Diagnostic and Statistical Manual on Mental Disorders, fourth edition (DSM-IV). Washington, DC: American Psychiatric Press, 1994.

11 U.S. Department of Health and Human Services. Healthy People 2010: Understanding and improving health and objectives for improving health. 2 ed. Washington, DC: U.S. Government Printing Office, 2000. http://www.healthypeople.gov/Document/HTML/Volume1/06Disability.htm

12Chevarley F, Thierry JM, Gill CJ, Ryerson AB, Nosek MA. Health, preventive health care, and health care access among women with disabilities in the 1994-1995 National Health Interview Survey. Women’s Health Issues. 2006;16(6):297-312.

13 U.S. Department of Health and Human Services, Health Resources and Services Administration. Women's Health USA 2004. Rockville, Maryland: U.S. Department of Health and Human Services, 2004. http://mchb.hrsa.gov/whusa04/pages/ch2.htm#obesity

14 Lethbridge-Çejku M, Schiller JS, Bernadel L. Summary health statistics for U.S. Adults: National Health Interview Survey, 2002. National Center for Health Statistics. Vital Health Stat 10(222). 2004. Table 31. Age-adjusted percent distributions (with standard errors) of body mass index among persons 18 years of age and over, by selected characteristics: United States, 2002.

15 Lethbridge-Çejku M, Schiller JS, Bernadel L. Summary health statistics for U.S. Adults: National Health Interview Survey, 2002. National Center for Health Statistics. Vital Health Stat 10(222). 2004. Table 2. Age-adjusted percents (with standard errors) of selected circulatory diseases among persons 18 years of age and over, by selected characteristics: United States, 2002.

16 U.S. Department of Health and Human Services, Health Resources and Services Administration. Women's Health USA 2004. Rockville, Maryland: U.S. Department of Health and Human Services, 2004. http://mchb.hrsa.gov/whusa04/pages/ch2.htm#hypertension

17 Pleis JR, Lethbridge-Çejku M. Summary health statistics for U.S. adults: National health interview survey, 2005. Vol 10(232): National Center for Health Statistics; 2006. http://www.cdc.gov/nchs/data/series/sr_10/sr10_232.pdf. Accessed on Jan. 7, 2008.

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