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

Prior presentations: A summary of this work was presented at the 2012 Annual Meeting of the American Public Health Association.
https://doi.org/10.1016/j.dhjo.2013.09.003Get rights and content

Abstract

Background

A 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.

Objectives

To conduct a scoping review of literature to describe recent research activity that has examined health outcome disparities within populations of people with disabilities.

Methods

We 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.

Results

For 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.

Conclusions

There 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.

Section snippets

Study rationale

Approximately 19% of the US population has a disability.3 Prevalence of disability increases with age such that most people will experience some type of disability during their lifetime.3, 4 A 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.5, 6, 7 These studies and others have examined the health disparities experienced by people with disabilities compared to other demographic

Objectives

The purpose of this study was to conduct a scoping review of literature to describe recent research activity that has examined health outcome disparities within populations of people with disabilities. Scoping reviews use broad key questions and aim to describe the extent, range, and nature of research activity in a specific subject area as a means of mapping the landscape of the field.9 Our review sought to explicate what disability research has occurred and where gaps currently exist. We

Protocol

Scoping reviews use systematic review methods for identifying potentially relevant evidence and assessing it for inclusion. This scoping review used guidelines described by international leaders in systematic review methodology. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement informed the steps and flow of the review.10 The Cochrane Collaboration Handbook informed the development of key questions and criteria for included studies.11 Reporting of

Results

Our search methods retrieved 4248 unique references for review. At the abstract review stage, 239 articles were selected for full-text review. During full text review, we identified 29 articles for inclusion in the present analysis (see Fig. 1).

Summary of the literature landscape

While most variables we assessed have not been well studied, our review reveals concentrations of research on some health outcomes (diabetes, heart disease, cancer, respiratory disease, and accidents/injuries) and disparity factors of interest (disability type, disability severity, age, gender, race, income, and education). In other words, studies are clustered in a few areas, leaving a significant lack of research in other areas. With regard to intersections of variables, a few emerging areas

Conclusions

There are many significant gaps in research on health disparities among people with disabilities. Most of the disparity factors and health outcome intersections examined in this scoping review are typified by little to no data. More research is needed to understand which groups are most at risk and what factors are associated with health disparities between subgroups of people with disabilities. Future research should use rigorous methods and clear and consistent definitions of terms. Building

Acknowledgments

We thank Dolores Judkins of OHSU libraries for her guidance and consultation on our electronic search strategies. We also thank Colleen Kidney and Erin Stack for their assistance in reviewing abstracts and articles for inclusion.

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    Funding: This work was supported by grant #H133A080031 from National Institute on Disability and Rehabilitation Research/DOE. However, the contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.

    Conflicts of interest: The authors report no conflicts of interest.

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