Research Paper
Disability and unmet health care needs in Canada: A longitudinal analysis

A variation of this study was presented by the author at the 2011 annual meeting of the Canadian Association on Gerontology.
https://doi.org/10.1016/j.dhjo.2014.09.010Get rights and content

Abstract

Background

The rate of unmet health care needs is quite high for the general population in Canada; however, the rate is even higher for the subset of people with disabilities. To date, there is a gap in the research utilizing longitudinal data to measure the unmet health care needs of Canadians.

Objective/hypothesis

The purpose of this research is to compare the rate of unmet health care needs of people with disabilities to people without disabilities over 15 years.

Methods

Longitudinal data from waves 1 to 8 (1994/95 to 2008/09) of the National Population Health Survey in Canada (NPHS) were analyzed using a growth curve modeling approach.

Results

Respondents with disabilities have two to three times the rate of unmet health care needs compared to respondents without disabilities. Unmet health care needs increase over time, and at a faster rate for all disability types except work-related disability. Personal reasons for unmet health care needs decrease over time and there is no significant difference between respondents with disabilities and respondents without disabilities. The opposite was found for structural reasons, which increase over time, and, people with disabilities have higher rates of structural-based unmet health care needs (45% higher) at baseline.

Conclusions

The incidence of disability in the population increases over time while at the same time the rate of unmet health care needs are higher for people with disabilities. The combination of these factors suggests that, in the absence of intervention, Canadians can expect more unmet health care needs in the future.

Section snippets

A life course perspective on disability and unmet health care needs

The definition of disability status in the NPHS is similar to that used by the World Health Organization (WHO), that is, disability occurs when a person experiences activity limitations and restrictions in participation.20 Critical disability theorists argue that disability needs to be viewed as a continuum and not a dichotomy.21 Therefore, people are neither disabled nor non-disabled, that is ability status falls somewhere between the two. The interplay of different identities and how they

Methods

The data for this research come from Cycles 1 to 8 (1994/95 to 2008/09) of the NPHS, a longitudinal survey administered by Statistics Canada. The target population of the NPHS includes people living in households in all provinces and territories, except those residents on Aboriginal reserves, Canadian Forces Bases, or in remote areas. One person from each household was selected to participate in the survey and followed through each cycle.26

Respondents in the 1994/95 survey were included if they

Characteristics of the sample

Table 2 provides a summary of the characteristics of the sample in 1994/95. Almost 16% of the population self-report a disability. Within the group of respondents who report a disability, 24.5% (3.9% of total population) reported a WRD, 27.7% (4.4% of total population) reported a DDI, and 47.8% (7.6% of total population) reported a DOR.

Prevalence of disability status

Although not shown in a table, the prevalence of disability status increases over time: the prevalence of disability increases from 15.9% in 1994/95 to 27.6% in

Discussion

This research provides a longitudinal analysis of unmet health care needs based on cause of disability status and examines the differences and similarities among respondents with different types of disability. In general, rates of unmet health care needs for all groups increase but the rate of increase is not constant over time. Similar to the findings by McColl et al7 and in the WHO World Report on Disability,4 respondents with disabilities are more likely to report unmet health care needs

Conclusion

It is important to identify the prevalence of the unmet health care needs of people with disabilities and to understand how their needs change over time. As other research has indicated, the rates of disability in the population and the rates of unmet health care needs continue to increase. It is apparent, from this research and the research of others, that there is something about disability that makes people more likely to report an unmet health care need, and there is variation in accounts

Acknowledgments

I would like to thank the following people for their editorial assistance and analytical support for this research: Lori Campbell, Ph.D., Margaret Denton, Ph.D., Peri Ballantyne, Ph.D., Michael Boyle, Ph.D., Kathy Georgiades, Ph.D., Laura Duncan, M.A., Hmwe Kyu, Ph.D., Marisa Young, Ph.D., and analysts from the McMaster Research Data Centre – James Chowhan, Ph.D. and Peter Kitchen, Ph.D. I would also like to thank the two anonymous reviewers for their comments and suggestions.

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    This research was funded through a Social Science and Humanities Research Council of Canada (SSHRC) Doctoral Fellowship, an Ontario Graduate Scholarship, and a SSHRC-funded SEDAP (Social and Economic Dimensions of an Aging Population) grant.

    The author declares no conflict of interest.

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