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PubMed2006

Does multiple sclerosis-associated disability differ between races?

OBJECTIVE: To investigate differences in disability between African American and Caucasian patients with multiple sclerosis (MS) by comparing the relationship between current age and disability between races and by assessing the effect of adjustment for socioeconomic status (SES) on the associations. METHODS: The authors selected US participants from the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry with an age at symptom onset of 10 to 60 years, who reported their race as Caucasian or African American (n = 21,557). They classified participants as having mild, moderate, or severe disability in the domains of mobility, hand function, cognition, and vision using Patient Determined Disease Steps and Performance Scales and assessed the association of disability with race using polytomous logistic regression. RESULTS: Disability increased more rapidly with increasing disease duration in older patients, but there was no interaction between race and age. African Americans had increased odds of severe vs mild disability in all four domains (odds ratio [OR] [95% CI]: hand 1.35 [1.10 to 1.64]; vision 1.75 [1.37 to 2.27]; cognition 1.32 [1.04 to 1.67]; mobility 1.32 [1.11 to 1.56]). Adjustment for all covariates, including SES, attenuated these associations (OR [95% CI]: hand 1.27 [1.00 to 1.61]; vision 1.59 [1.19 to 2.08]; cognition 0.98 [0.74 to 1.30]; mobility 1.37 [1.11 to 1.67]). Lack of adjustment for SES produced stronger associations. After enrollment in NARCOMS, disability progression did not differ between the groups. CONCLUSIONS: African Americans experience greater multiple sclerosis-associated disability than Caucasians. Failure to account for socioeconomic status leads to overestimation of these differences. Disease progression is similar in African Americans and Caucasians after diagnosis.

Adolescent↗

PubMed2007

High prevalence of somatic symptoms and depression in women with disabling chronic headache.

OBJECTIVE: To better define, in women with headache, the relationship of depression and somatic symptoms to headache, characterized by diagnoses, frequency, and disability. METHODS: At six headache specialty clinics, women with headache were classified using ICHD-II criteria, and frequency was recorded. A questionnaire addressing demographics, age at onset of headache, headache-related disability, somatic symptom, and depression severity was completed. Logistic regression was performed to measure the associations of headache frequency and headache-related disability with somatic symptom and depression severity. RESULTS: A total of 1,032 women with headache completed the survey, 593 with episodic (96% with migraine) and 439 with chronic headache (87% with migraine). Low education and household income was more common in chronic headache sufferers and in persons with severe headache disability. Somatic symptom prevalence and severity was greater in persons with chronic headache and with severe headache-related disability. Significant correlation was observed between PHQ-9 and PHQ-15 scores (r = 0.62). Chronic headache, severe disability, and high somatic symptom severity were associated with major depressive disorder (OR = 25.1, 95% CI: 10.9 to 57.9), and this relationship was stronger in the subgroup with a diagnosis of migraine (OR = 31.8, 95% CI: 12.9 to 78.5). CONCLUSIONS: High somatic symptom severity is prevalent in women with chronic and severely disabling headaches. Synergistic relationship to major depression exists for high somatic symptom severity, chronic headache, and disabling headache, suggesting a psychobiological underpinning of these associations.

Activities of Daily Living↗

PubMed1997

Impact of interferon beta-1a on neurologic disability in relapsing multiple sclerosis. The Multiple Sclerosis Collaborative Research Group (MSCRG).

BACKGROUND AND OBJECTIVE: A phase III double-blind, placebo-controlled clinical trial demonstrated that interferon beta-1a (IFN beta-1a) (Avonex, Biogen) significantly delayed progression of disability in relapsing MS patients. The primary clinical outcome was time from study entry until disability progression, defined as > or = 1.0 point worsening from baseline Kurtzke Expanded Disability Status Scale (EDSS) score persisting for at least two consecutive scheduled visits separated by 6 months. The objective of this study was to examine the magnitude of benefit on EDSS and its clinical significance. METHODS: Post hoc analyses related to disability outcomes using data collected during the double-blind, placebo-controlled phase III clinical trial. RESULTS: (1) Clinical efficacy related to disability did not depend on the definition of disability progression. A significant benefit in favor of IFN beta-1a was observed when > or = 2.0 point worsening from baseline EDSS was required or when worsening was required to persist for > or = 1.0 year. (2) Placebo recipients who reached the primary clinical outcome worsened by a larger amount from baseline EDSS than did IFN beta-1a recipients who reached the primary study outcome. (3) Significantly fewer IFN beta-1a recipients progressed to EDSS milestones of 4.0 (relatively severe impairment) or 6.0 (unilateral assistance needed to walk). (4) Cox proportional hazards models demonstrated that the only baseline characteristic strongly correlated with longer time to disability progression was IFN beta-1a treatment. CONCLUSIONS: The primary clinical outcome for the IFN beta-1a clinical trial underestimated clinical benefits of treatment. Results in this report demonstrate that IFN beta-1a treatment is associated with robust, clinically important beneficial effects on disability progression in relapsing MS patients.

Adolescent↗

PubMed2005

Physical activity among adults >or=50 yr with and without disabilities, BRFSS 2001.

PURPOSE: Before 2001, the Behavioral Risk Factor Surveillance System (BRFSS), a national survey of health behaviors, assessed only leisure-time physical activity. In 2001, the BRFSS used newly developed physical activity items to evaluate combined leisure-time, household, and transportation activities. Using BRFSS 2001 data, this cross-sectional study describes the prevalence of inactivity and insufficient and recommended physical activity for older adults (i.e., aged >or=50 yr). METHODS: BRFSS 2001 data were analyzed using prevalence estimates and logistic regression to assess physical activity patterns among older adults (N=74,960) stratified by disability status, and select sociodemographic and health status characteristics. RESULTS: A total of 43.4, 39.1, and 17.5% of respondents without disabilities were active at a recommended level, insufficiently active, and inactive, respectively, taking into account nonoccupational physical activities. A total of 28.8% of older adults with disabilities were active at a recommended level, 35.7% insufficiently active, and 35.5% inactive. Among persons with and without disabilities, groups with the highest odds of inactivity and insufficient activity were women, persons aged >or=75 yr, blacks, persons with lower education levels and low incomes, and those who were obese. CONCLUSIONS: Not all persons with disabilities can be active at recommended levels, but it is possible for the vast majority to do some types of physical activity, even if at insufficient levels. Thus, it may be possible for the prevalence of inactivity among persons with and without disabilities to be similar. This was not found. At the start of the new millennium, almost 60% of older adults without disabilities and 70% with disabilities were not obtaining a recommended amount of combined leisure-time, transportation, and household physical activity.

Activities of Daily Living↗

PubMed1989

Gender differences in allied health students' knowledge of disabled women and men.

Disabled women experience greater handicaps than disabled men do. A survey of 907 students in six allied health professions indicated that the majority lacked knowledge of 13 sex differences in frequency of occurrence of physical disabilities and handicaps. Female students revealed greater unawareness. Students who recognized sex differences in frequency of disabilities were more likely to correctly identify predominantly male disabilities but tended to incorrectly attribute predominantly female disabilities to men. This trend was stronger among male subjects. Beliefs regarding sex differences in handicaps suggest that disabled men are perceived as coping more effectively with disability. Results are a matter of concern given that health practitioners' knowledge and expectations influence rehabilitation outcomes.

Chi-Square Distribution↗

PubMed2005

Disability and health care spending among medicare beneficiaries.

This paper forecasts the impact of changing disability rates on spending by Medicare beneficiaries. We adjust for differential changes in spending by the disabled because the composition of the disabled population and the intensity of their treatment are changing. Among community-dwelling elderly, spending growth among the least disabled grew more quickly than among the most disabled, which offsets some of the cost savings associated with declining disability rates. Using estimates of spending trends by disability category, we project that the cost savings associated with improved disability rates will not dramatically slow Medicare spending in the long run.

Aged↗

PubMed1993

Work disability among adults with asthma.

OBJECTIVE: To estimate the incidence of work disability among adults with asthma and to evaluate a clinically based illness severity score as a predictor of such disability. DESIGN: Baseline and follow-up telephone interviews and medical record review. SETTING: University-based outpatient pulmonary specialty practice. PATIENTS: Fifty-six patients interviewed at baseline; 42 reinterviewed 2 years later. MEASUREMENTS: Work disability ascertained by interview report and defined as change in job duties, reduction in pay, or change in job or employment status attributed to asthma. Severity of asthma score derived from medical records and based on respiratory symptom frequency, asthma history, and prescribed medications. Pulmonary function by routine testing. Logistic regression analysis of the 5-year incidence of work disability on severity score and forced expiratory volume in 1 s (FEV1). RESULTS: The 5-year work disability cumulative incidence was 19 percent for change in duties, 17 percent for reduction in pay, 20 percent for change in job or work status, and 36 percent for any of these measures. The median asthma score was 10 (range, 2 to 26). The mean FEV1 as a percent predicted (FEV1 percent) was 88 +/- 25 percent. Score and FEV1 percent were statistically correlated (r = -0.6, p < 0.0001). Severity of asthma score statistically predicted each measure of work disability (p < 0.01). Addition of FEV1 percent added little additional explanatory power to the logistic regression model (maximum chi 2 = 1.3, p > 0.2). CONCLUSIONS: Work disability is common among adults with asthma. A severity of asthma score based on clinical variables is statistically correlated with lung function but appears to be a stronger predictor of disability than airflow measured at one point in time.

Adolescent↗

PubMed2004

Stigma, community, ethnography: Joan Ablon's contribution to the anthropology of impairment-disability.

Joan Ablon has helped establish the anthropology of impairment-disability and significantly contributed to the role of anthropology in disability studies. In this article, we review the development of and situate Ablon's ethnographic research in the anthropology of impairment-disability. We then address various methodological issues in her work including her ethnographic approach, her grounding in action anthropology and her support for the development of the academic study of disability in anthropology and the careers of disabled anthropologists. The next section of the article examines Ablon's use of the notion of stigma, her understanding of community, and her engagement with disability rights. As examples of themes important to disability studies, we present her discussion of the implications of the ideal of the body beautiful, and gender differences in negotiating intimacy for people with physical differences. We close with a discussion of the future of an anthropology of impairment-disability.

Anthropology, Cultural↗

PubMed2004

Health services use and health care expenditures for children with disabilities.

OBJECTIVE: To examine health care utilization and expenditure patterns for children with disabilities. METHODS: Secondary data analysis was conducted of the 1999 and 2000 editions of the Medical Expenditure Panel Survey (MEPS), a nationally representative survey conducted in 5 rounds by household interview. Two years of MEPS data were combined in this analysis to improve the precision of estimates. Disability was defined by the presence of a limitation in age-appropriate social role activities, such as school or play, or receipt of specialized services through the early intervention or special education programs. The survey sample included 13,792 children younger than 18 years. The overall response rate was 65.5%. RESULTS: Our findings demonstrate that the 7.3% of US children with disabilities used many more services than their counterparts without disabilities in 1999-2000. The largest differences in utilization were for hospital days (464 vs 55 days per 1000), nonphysician professional visits (3.0 vs 0.6), and home health provider days (3.8 vs 0.04). As a result of their greater use, children with disabilities also had much higher health care expenditures (2669 dollars vs 676 dollars) and higher out-of-pocket expenditures (297 dollars vs 189 dollars). We also found that the distributions of total and out-of-pocket expenses were highly skewed, with a small fraction of the disabled population accounting for a large proportion of expenditures: the upper decile accounted for 65% of total health care expenses and 85% of all out-of-pocket expenses for the population with disabilities. Health insurance was found to convey significant protection against financially burdensome expenses. However, even after controlling for insurance status, low-income families experienced greater financial burdens than higher income families. CONCLUSIONS: The skewed distribution of out-of-pocket expenses found in this and earlier studies indicates that the financial burden of childhood disability continues to be shared unevenly by families. Low-income families are especially vulnerable to burdensome out-of-pocket expenses. Additional efforts are needed to protect these high-risk families.

Adolescent↗

PubMed2005

Persistent and growing socioeconomic disparities in disability among the elderly: 1982-2002.

OBJECTIVE: We sought to determine whether socioeconomic and racial/ethnic disparities in prevalence of disability over age 70 have widened or narrowed during the past 2 decades. METHODS: We used data from the 1982-2002 National Health Interview Surveys, which are nationally representative cross-sectional surveys of the noninstitutionalized population of the United States. Participants included 172227 people aged 70 years and older. The primary outcome measure was the average annual percentage change in the prevalence of 2 self-reported disability measures: the need for help with activities of daily living ("ADL disability") and need for help with either ADL or instrumental activities of daily living ("any disability"). RESULTS: All groups experienced declines in the age- and gender-adjusted prevalence of any disability during the 1982 to 2002 period. However, the average annual percent declines were smaller for the least advantaged socioeconomic groups. Differences in trends across racial/ethnic groups were not statistically significant. ADL disability prevalence decreased for the more advantaged groups but increased among the lowest income and education groups. Non-Hispanic Whites and minorities experienced similar average annual percent declines in ADL disability. CONCLUSIONS: Racial/ethnic disparities in old-age disability have persisted over the last 20 years, whereas socioeconomic disparities have increased.

Aged↗

PubMed2005

Incidence of disability among preretirement adults: the impact of depression.

OBJECTIVES: We evaluated the effect of depression on risk, on the basis of standardized assessment, for developing activities of daily living (ADL) disability. METHODS: Depression-related risk on 2-year ADL disability is estimated from 6871 participants in a population-based national sample aged 54-65 years and free of baseline ADL disability. We evaluated the effects of factors amenable to clinical and public health intervention that may explain the relationship between depression and incident disability. RESULTS: The odds of ADL disability were 4.3 times greater for depressed adults than their non-depressed peers (95% confidence interval=3.1, 6.0). Among depressed adults, 18.7% of African Americans, 8.0% of Whites, and 7.8% of His-panics developed disability within 2 years. The attributable population fraction because of depression is 17.3% (95% confidence interval=11%, 24%). Concurrent health factors moderated depression-associated risk. CONCLUSIONS: Elevated risk of ADL disability onset because of depression, in a cohort whose medical costs will imminently be covered via Medicare, is attenuated by factors amenable to public health intervention. Prevention and/or public health/policy programs that lead to more accessible and effective mental health and medical care could reduce the development of ADL disability among depressed adults.

Activities of Daily Living↗

PubMed2005

Disability and preventive cancer screening: results from the 2001 California Health Interview Survey.

OBJECTIVE: We sought to evaluate preventive cancer screening compliance among adults with disability in California. METHODS: We used data from the 2001 California Health Interview Survey to compare disabled and nondisabled adults for differences in preventive cancer screening behaviors. Compliance rates for cancer screening tests (mammography, Papanicolaou test, prostate-specific antigen, sigmoidoscopy/colonoscopy, and fecal occult blood test) between the 2 subpopulations were evaluated. RESULTS: Women with disabilities were 17% (Papanicolaou tests) and 13% (mammograms) more likely than women without disabilities to report noncompliance with cancer screening guidelines. Interactions between disability and reports of a doctor recommendation on cervical cancer screening were significant; women with disabilities had a lower likelihood of receiving a recommendation. Men with disabilities were 19% less likely than men without disabilities to report a prostate-specific antigen test within the last 3 years. CONCLUSIONS: secondary to structural and/or clinical factors underpinning the differences found.

California↗

PubMed1998

Prevalence and impact of disabling chronic conditions in childhood.

OBJECTIVES: This study provides a current national profile of the prevalence and impact of chronic conditions causing childhood disability. Disability is defined as a long-term reduction in ability to conduct social role activities, such as school or play, because of a chronic physical or mental condition. METHODS: A cross-sectional descriptive analysis was performed on data from 99513 children younger than 18 years who were included in the 1992-1994 National Health Interview Survey. The response rate exceeded 93% during each year. RESULTS: A significant proportion of children, estimated at 6.5% of all US children, experienced some degree of disability. The most common causes of childhood disability were respiratory diseases and mental impairments. Prevalence of disability was higher for older children, boys, and children from low-income and single-parent families. Childhood disability is estimated to result in 66 million restricted activity days annually, including 24 million days lost from school. Furthermore, disability in childhood results in an added 26 million physician contacts and 5 million hospital days annually. CONCLUSIONS: Childhood disability has profound impacts on children, the education system, and the health care system.

Absenteeism↗

PubMed2003

Occupational disability after hospitalization for the treatment of an injury of the anterior cruciate ligament.

BACKGROUND: To date, no large population-based studies have focused on permanent occupational disability after injury of the anterior cruciate ligament as far as we know. The purpose of our study was to determine the risk factors for occupational disability after an injury of the anterior cruciate ligament. METHODS: We identified a cohort of 2192 active-duty personnel in the Army who had been hospitalized between 1989 and 1997 because of an injury of the anterior cruciate ligament and had completed a health risk-assessment survey. With use of the Total Army Injury and Health Outcomes Database, we retrospectively followed these individuals for up to nine years and collected clinical, demographic, occupational, and psychosocial data. These data were then evaluated with bivariate and proportional-hazards regression analyses to identify risk factors for receiving a disability discharge related to an injury of the anterior cruciate ligament. RESULTS: Overall, 209 (9.5%) of 2192 initial anterior cruciate ligament injuries resulted in a permanent disability discharge. In bivariate analyses, the following factors were related to a disability discharge: lower job satisfaction (p < 0.0001), lower education level (p < 0.0001), shorter length of service (p < 0.0001), lower pay grade or rank (p < 0.0001), occupational classification (p < 0.0001), older age (p < 0.01), cigarette-smoking (p = 0.01), and greater mental stress at work (p = 0.02). Associated cartilage injury (p = 0.07) and occupational physical demands (p = 0.08) approached significance; however, with the numbers available, other variables that were hypothesized to contribute to the development of disability, such as gender (p = 0.85), reconstruction of the anterior cruciate ligament (p = 0.52), and other secondary comorbidities of the knee, demonstrated no significant association. Proportional-hazards regression analysis confirmed that pay grade or rank, occupational classification, job satisfaction, age, and length of service were independent predictors of disability discharge. CONCLUSIONS: In keeping with risk profiles of several other musculoskeletal disorders, such as low-back pain and carpal tunnel syndrome, the results revealed a multifactorial risk profile in which psychosocial factors were strongly associated with disability discharge from active military duty after injury of the anterior cruciate ligament.

Adolescent↗

PubMed2005

Childhood trauma and employment disability.

INTRODUCTION: While the relationship between childhood trauma and employment disability has undergone very limited study, existing data suggest a possible correlation. METHOD: In this study of 91 outpatients in an internal medicine setting, we surveyed participants and inquired about their childhood histories of sexual, physical, and emotional abuse, of physical neglect, and of witnessing violence. We also asked whether participants had ever been on employment disability, either psychiatric or non-psychiatric, and the length of that disability. RESULTS: Being or having been on disability was significantly related to childhood histories of emotional abuse, physical neglect, and witnessing violence. Being or having been on psychiatric disability was significantly related to childhood emotional abuse and physical neglect while being on non-psychiatric medical disability was significantly related to witnessing violence. The percent of one's lifetime on disability was significantly related to physical and emotional abuse as well as witnessing violence. CONCLUSIONS: Maltreatment in childhood appears to have a relationship to employment disability in adulthood. The authors discuss the implications of these findings.

Adolescent↗

PubMed1987

Injury and disability effects of motor car accidents.

The results of a field experiment into the relations between injuries and disability are presented. In this study the effect of the variables age, sex, injury severity, and injury location on the disability rate was investigated. Injury location appears to have the greatest effect on the chance of disability. Injuries located in the locomotive system cause much disability and injuries of the internal organs cause little disability. The variables age (greater than or equal to 15 years), sex, and injury severity--MAIS greater than or equal to 2--have little influence on disability occurring. It is therefore clear that MAIS is not a good predictor of disability. Among children, injuries cause much less disability, approximately 50% of that among the adults.

Accidents, Traffic↗

PubMedDate not supplied

Researching disability: the way forward.

This paper critically examines the individualistic and medicalized assumptions underlying much research on disability. The OPCS surveys of disability, in particular, are examined. Based on the perceptions of disabled people and their organizations, and drawing on a series of seminars on disability research which took place in 1991, an alternative social view of disability is presented and applied to research. It is concluded that the assumptions underlying much disability research, especially when they are translated into practice, are oppressive to disabled people, and that participatory and emancipatory research needs to be developed in order to assist disabled people in their struggle for empowerment.

Persons with Disabilities↗

PubMedDate not supplied

Disability in late adolescence. II: Follow-up of perceived limitation.

The disabilities experienced by a large cohort of 18-year-olds have been reported in the previous paper of this series. In this paper, we present the results of a detailed examination of the extent to which the disabilities caused limitation in the everyday activities of this group of young people. The results showed that nearly three-quarters of the members of the sample reported having one or more difficulties in performing activities in their daily lives, though the extent of limitation on their activities was low for most adolescents. Of this group who reported any type of disablement, 23% indicated it imposed very little general limitation on their lives (on a five point scale) and 6% rated it at the highest degree of limitation. Approximately half those with a disability felt the condition was improving, but 28% required an aid or help from another person. From 8% to 11% of those with a disability rated it as serious in relation to aspects of their daily living (education, leisure, social and work) and about half of those with a serious degree of limitation had sought help. The most common disabilities related to behaviour, communication and situations, for example environmental factors. As part of an ongoing study, the results provide a base from which to examine the extent and severity of disability among young people and change in disability as a result of the ageing process.

Activities of Daily Living↗