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The Lancet. Public Health May 2024Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Globally, 1·3 billion people have a disability and are more likely to experience poor health than the general population. However, little is known about the mortality or life expectancy gaps experienced by people with disabilities. We aimed to undertake a systematic review and meta-analysis of the association between disability and mortality, compare these findings to the evidence on the association of impairment types and mortality, and model the estimated life expectancy gap experienced by people with disabilities.
METHODS
We did a mixed-methods study, which included a systematic review and meta-analysis, umbrella review, and life expectancy modelling. For the systematic review and meta-analysis, we searched MEDLINE, Global Health, PsycINFO, and Embase for studies published in English between Jan 1, 2007, and June 7, 2023, investigating the association of mortality and disability. We included prospective and retrospective cohort studies and randomised controlled trials with a baseline assessment of disability and a longitudinal assessment of all-cause mortality or cause-specific mortality. Two reviewers independently assessed study eligibility, extracted the data, and assessed risk of bias. We did a random-effects meta-analysis to calculate a pooled estimate of the mortality rate ratio for people with disabilities compared with those without disabilities. We did an umbrella review of meta-analyses examining the association between different impairment types and mortality. We used life table modelling to translate the mortality rate ratio into an estimate of the life expectancy gap between people with disabilities and the general population. The systematic review and meta-analysis is registered with PROSPERO, CRD42023433374.
FINDINGS
Our search identified 3731 articles, of which 42 studies were included in the systematic review. The meta-analysis included 31 studies. Pooled estimates showed that all-cause mortality was 2·24 times (95% CI 1·84-2·72) higher in people with disabilities than among people without disabilities, although heterogeneity between the studies was high (τ=0·28, I=100%). Modelling indicated a median gap in life expectancy of 13·8 years (95% CI 13·1-14·5) by disability status. Cause-specific mortality was also higher for people with disabilities, including for cancer, COVID-19, cardiovascular disease, and suicide. The umbrella review identified nine meta-analyses, which showed consistently elevated mortality rates among people with different impairment types.
INTERPRETATION
Mortality inequities experienced by people with disabilities necessitate health system changes and efforts to address inclusion and the social determinants of health.
FUNDING
National Institute for Health and Care Research, Rhodes Scholarship, Indonesia Endowment Funds for Education, Foreign, Commonwealth and Development Office (Programme for Evidence to Inform Disability Action), and the Arts and Humanities Research Council.
Topics: Humans; Disabled Persons; Life Expectancy; Mortality
PubMed: 38702095
DOI: 10.1016/S2468-2667(24)00054-9 -
Journal of Affective Disorders Sep 2023Our study aimed to investigate the association between psychological distress and disability-free life expectancy (DFLE).
BACKGROUND
Our study aimed to investigate the association between psychological distress and disability-free life expectancy (DFLE).
METHODS
In 2006, a cohort study was conducted of 12,365 Japanese individuals aged ≥65 years, who were followed-up for 13 years. Psychological distress was measured using the Kessler 6-item psychological distress scale and was categorized into no (0-4), mild (5-9), moderate (10-12), and serious distress (13-24). The number of participants was 1277 (22.4 %) for mild distress, 330 (5.8 %) for moderate, and 208 (3.6 %) for serious in men, and was 1635 (24.6 %), 467 (7.0 %), and 384 (5.8 %) in women. Sex-specific DFLE was defined as the mean years a person could expect to live without disability and calculated by Interpolated Markov Chain (IMaCh) software.
RESULTS
Compared to no distress, DFLE loss per person was 1.21, 2.61, and 4.43 years for mild, moderate, and serious distress respectively in men. At population level, DFEL loss (i.e., DFLE loss per person×number of participants) was 1545.17, 861.30, and 921.44 years for mild, moderate, and serious distress respectively in men. Accordingly, 46.4 % of the total DFLE loss was attributable to mild distress, 25.9 % to moderate, and 27.7 % to serious in men. Similarly, the results were 42.2 %, 25.4 %, and 32.4 % in women.
LIMITATIONS
Psychological distress was measured only once at baseline, and 2409 participants were excluded from the analysis because of missing data on exposure.
CONCLUSIONS
At population level, almost half of the total DFLE loss could be attributable to mild distress, underscoring the importance of population strategy for all levels of distress in promoting healthy aging.
Topics: Adult; Aged; Female; Humans; Male; Cohort Studies; Disabled Persons; East Asian People; Healthy Life Expectancy; Life Expectancy; Psychological Distress
PubMed: 37263359
DOI: 10.1016/j.jad.2023.05.090 -
Frontiers in Public Health 2024Many previous studies have found that disability leads to cognitive impairment, and in order to better understand the underlying mechanisms between disability and...
OBJECTIVE
Many previous studies have found that disability leads to cognitive impairment, and in order to better understand the underlying mechanisms between disability and cognitive impairment, the present study aimed to investigate the moderating role of social relationships, including their role as mediators between disability and cognitive impairment in depressive symptoms.
STUDY DESIGN
This is a cross-sectional study.
METHODS
A total of 5,699 Chinese older adults from the 2018 China Longitudinal Healthy Longevity Survey (CLHLS) were included in this study, and PROCESS macro was used to perform simple mediator and moderator mediator analyses, which were used to analyze the relationship between depressive symptoms and social relationships between disability and cognitive impairment.
RESULTS
The results of this study showed significant correlations between disability, cognitive impairment, depressive symptoms, and social relationships, and that depressive symptoms mediated the relationship between disability and cognitive functioning [B = -0.232; 95% CI: (-0.304, -0.164)], and that social relationships mediated disability and cognitive functioning through pathway a (Disability-Depressive Symptoms) [B = 0.190; 95% CI: (0.020, 0.036)], path b (depressive symptoms-cognitive impairment) [B = 0.029; 95% CI: (0.015, 0.042)], and path c' (incapacitation-cognitive impairment) [B = 0.492; 95% CI: (0.298, 0.685)] to modulate the effect of incapacitation on cognitive impairment. In addition, social activities and social networks moderated the mediation model directly or indirectly, whereas social support moderated only the direct effect.
CONCLUSION
This study explains the intrinsic link between incapacitation and cognitive impairment in Chinese older adults, and that social relationships and depressive symptoms can directly or indirectly modulate the effects between them. This provides a basis for healthcare professionals to be able to better develop interventions that can be used to improve the level of cognitive functioning and mental health of older adults.
Topics: Humans; Male; Female; Aged; China; Cross-Sectional Studies; Depression; Disabled Persons; Cognitive Dysfunction; Aged, 80 and over; Longitudinal Studies; Cognition; Interpersonal Relations; Middle Aged; East Asian People
PubMed: 38689766
DOI: 10.3389/fpubh.2024.1354877 -
BMJ Open May 2024Around the world, the disability rights movements and the social model of disability have placed emphasis on the importance of social participation for people with... (Review)
Review
INTRODUCTION
Around the world, the disability rights movements and the social model of disability have placed emphasis on the importance of social participation for people with disability. People with physical disability who have high and complex support needs often need support to access their communities, however, very little is known about the interaction between support and social participation for this population of people. Therefore, the aim of this scoping review is to explore the literature related to the interaction between support and social participation for adults with disability and understand any existing gaps in the literature where further research may be required in order to maximise quality support and social participation.
METHODS AND ANALYSIS
This scoping review will be conducted and reported according to scoping review guidelines outlined by Arksey and O'Malley and later modified by Levac , as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analysis: Extension for Scoping Reviews. Thorough database searches will be conducted across MEDLINE, PsycINFO, CINAHL and Scopus. The search will be limited to papers published in English from 2013 onwards. Citations will be uploaded into Covidence and screened by two independent reviewers. Data extraction will extract data regarding participants, housing, support and study characteristics, as well as qualitative and quantitative data relevant to the research question. A narrative synthesis will be used to summarise findings. A minimum of three consultants with lived experience of disability will be engaged to review and contribute to the final scoping review paper.
ETHICS AND DISSEMINATION
It is anticipated that the findings of this scoping review will be made available in peer-reviewed publications and also in plain language formats to ensure accessibility to a wide range of audiences. Ethics will not be required for this scoping review.
Topics: Humans; Disabled Persons; Social Participation; Social Support; Research Design; Review Literature as Topic
PubMed: 38816056
DOI: 10.1136/bmjopen-2023-083102 -
Disability and Health Journal Apr 2024
Topics: Humans; Disabled Persons; Human Rights; Intellectual Disability
PubMed: 38402004
DOI: 10.1016/j.dhjo.2024.101592 -
JAMA Network Open May 2024
Topics: Humans; Burnout, Professional; Male; Female; Disabled Persons; Physicians; Middle Aged; Adult; Cross-Sectional Studies; Surveys and Questionnaires
PubMed: 38722631
DOI: 10.1001/jamanetworkopen.2024.10701 -
Psychiatria Danubina Dec 2023Disabled people, and particularly people with intellectual disability and autism spectrum disorder, experience significant health disparities compared to nondisabled...
Disabled people, and particularly people with intellectual disability and autism spectrum disorder, experience significant health disparities compared to nondisabled people. These disparities are not explained by the underlying disabling condition but, rather, by unfair and avoidable conditions. One prevailing condition, implicit bias and discrimination against disabled patients in the healthcare sector, limits quality of care and health outcomes for this population. Most healthcare professionals have strong implicit bias against disabled people, which negatively impact clinical decision-making and the behavior of healthcare professionals toward disabled patients. For example, most healthcare providers believe that disability confers poor quality of life. According to quality of life research with disabled people, this belief is false and damaging. Because training programs fail to challenge implicit biases and damaging beliefs about disability, healthcare providers are not prepared to provide quality health care to disabled patients. Including disabled people in didactic and clinical training as instructors, members of panels, and as healthcare students is the first essential step to preparing a disability competent healthcare workforce.
Topics: Humans; Autism Spectrum Disorder; Quality of Life; Disabled Persons; Health Personnel; Delivery of Health Care
PubMed: 37994069
DOI: No ID Found -
The Primary Care Companion For CNS... Jul 2023To examine the prevalence and sociodemographic, medical, and psychiatric correlates of disability in activities of daily living (ADLs) and instrumental ADLs (IADLs) in...
To examine the prevalence and sociodemographic, medical, and psychiatric correlates of disability in activities of daily living (ADLs) and instrumental ADLs (IADLs) in the US veteran population. Data were analyzed from 4,069 US veterans who participated in the 2019-2020 National Health and Resilience in Veterans Study (NHRVS). Multivariable and relative importance analyses (RIAs) were conducted to identify independent and strongest correlates of ADL and IADL disability. A total of 5.2% (95% CI, 4.4%-6.2%) and 14.2% (95% CI, 12.8%-15.7%) of veterans reported ADL and IADL disability, respectively. Older age, male sex, Black race, lower income, and deployment-related injuries were associated with ADL and IADL disabilities, as were certain medical and cognitive conditions. Results of RIAs revealed that sleep disorders, diabetes, posttraumatic stress disorder (PTSD), older age, and cognitive disorders were most strongly associated with ADL disability, while chronic pain, PTSD, lower income, and sleep and cognitive disorders were most strongly associated with IADL disability. Results of this study provide an up-to-date estimate of the prevalence and sociodemographic, military, and health correlates of functional disability in US veterans. Improved identification and integrated clinical management of these risk factors may help mitigate disability risk and promote the maintenance of functional capacity in this population. .
Topics: Humans; Male; Activities of Daily Living; Veterans; Disabled Persons; Cognition Disorders; Cognitive Dysfunction
PubMed: 37419488
DOI: 10.4088/PCC.22m03461 -
The Journal of Social Psychology Jul 2023Using the stereotype content model and behavior from intergroup affect and stereotypes map model, we examined whether stereotype content directed toward specific...
Using the stereotype content model and behavior from intergroup affect and stereotypes map model, we examined whether stereotype content directed toward specific disabilities conforms to the high warmth/low competence stereotype associated with "disabled people" or whether individual disabilities, or clusters, would elicit different stereotypes. Participants from the USA rated 12 disabilities on perceived warmth, competence, courage, emotions and behavioral tendencies. All disabilities, except schizophrenia and disability, were rated higher in warmth than competence. Four clusters emerged, varying on relative warmth, competence and courage. Pity was the highest rated emotion, and negative behavioral intentions were generally low. Perceived warmth predicted positive behavioral intentions, but mean ratings suggest actual help might be minimal. Results suggest some uniformity in stereotypes of different disabilities, but some variation in stereotypes indicates the need for targeted interventions to reduce prejudice and discrimination against disabled people.
Topics: Humans; Stereotyping; Prejudice; Emotions; Disabled Persons; Surveys and Questionnaires
PubMed: 35037596
DOI: 10.1080/00224545.2021.2017253 -
Social Work Sep 2023According to the Centers for Disease Control and Prevention, over 61 million Americans have a disability, which translates to about 26 percent of the national...
According to the Centers for Disease Control and Prevention, over 61 million Americans have a disability, which translates to about 26 percent of the national population. The most common types of disability are physical (13.7 percent), or those that impact mobility, and intellectual (10.8 percent), or those related to cognitive processing. The Bureau of Justice Statistics has reported that 32 percent of people in state prisons and 40 percent of people in county jails have at least one disability, rates that demonstrate alarming disproportionality. Yet the history of the disability rights movement, the impact of the Americans with Disabilities Act for people with disabilities who are involved with the criminal justice system, and the implications of disability justice and critical disability theory for the field of social work are not well understood. The purpose of this article is to review these under-recognized topics and offer recommendations for addressing this neglected area of social work education, research, policy, and practice.
Topics: Humans; United States; Social Work; Disabled Persons; Prisons; Intellectual Disability; Social Justice
PubMed: 37537135
DOI: 10.1093/sw/swad034