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Special Issue "Disability and Healthcare Disparities"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Disabilities".

Deadline for manuscript submissions: closed (30 September 2021).

Special Issue Editors

Dr. Dikaios Sakellariou
E-Mail Website
Guest Editor
School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK
Interests: disability; access to health; health disparities; intersectionality
Special Issues, Collections and Topics in MDPI journals
Dr. Hisayo Katsui
E-Mail Website
Guest Editor
Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland
Interests: disability rights; inequality reduction; international cooperation; disability movement

Special Issue Information

Dear Colleagues,

The United Nations’ Convention on the Rights of Persons with Disabilities enshrines the right to health for all persons with disabilities. All people have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability and to have access to high-quality services that can help to prevent illness, maintain or restore health, and rehabilitate function.

Often, however, persons with disabilities face health disparities both in terms of access to services and in terms of health outcomes. Disparities in accessing healthcare services refer to compromised access to healthcare linked to service availability, affordability, relevance, physical accessibility, acceptability or other factors, and intertwine with health policy and service delivery, reflecting broader issues of disability inclusion. Persons with disabilities often report problems accessing services, whether these are specialised services linked to their impairment, or services unrelated to it, such as, for example, vaccinations, maternal care, sexual health, preventive care or cancer services.

Disparities in health outcomes refer to worse health indicators for people with disabilities. Such disparities may reflect existing structural issues associated with disability (for example, higher rates of poverty), which may contribute to healthcare disparities between persons with and without disabilities.

In this Special Issue, we invite contributions which will explore any aspect of health disparities for persons with disabilities, including interventions that can reduce such disparities. This Special Issue is open to all research designs (including systematic reviews), levels of healthcare, and all contexts. We welcome contributions from around the world, and we particularly encourage contributions from or about low- and middle-income countries and about under-represented populations.

We look forward to receiving your submissions.

Dr. Dikaios Sakellariou
Dr. Hisayo Katsui
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • health disparities
  • disability
  • access
  • health services
  • social determinants of health
  • convention on the rights of persons with disabilities

Published Papers (8 papers)

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Research

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Article
A Study on the Installation of Facilities for People with Disabilities in Dental Institutions of Chungbuk, South Korea
Int. J. Environ. Res. Public Health 2021, 18(19), 10425; https://doi.org/10.3390/ijerph181910425 - 03 Oct 2021
Viewed by 457
Abstract
To maintain the oral health and ability to smoothly receive dental treatment of people with disabilities, their accessibility to dental institutions must be enforced. Hence, this study aimed to assess the status of installation of convenience facilities for people with disabilities in dental [...] Read more.
To maintain the oral health and ability to smoothly receive dental treatment of people with disabilities, their accessibility to dental institutions must be enforced. Hence, this study aimed to assess the status of installation of convenience facilities for people with disabilities in dental institutions in Chungbuk Province, South Korea. According to the checklist based on installation items for convenience facilities for people with disabilities, 245 dental institutions in Chungbuk Province were visited and investigated to examine whether they had installed internal, intermediary, sanitary, and information-related facilities for people with disabilities. Inputs were analyzed using SPSS 25.0 (IBM, Armonk, NY, USA). Frequency analysis by item was conducted to determine the rate of installation, and Fisher’s exact test was performed to analyze the actual state of installation according to the type of institution. The results revealed a relatively higher rate of appropriate installation and access routes to the main entrance and parking spaces for people with disabilities in terms of intermediary and internal facilities, but at times they were installed at inappropriate locations or lacked proper signboards. The state of installation of convenience facilities by institution type was 0–1.3% per item at the clinic level but 75–87.5% per item in general and dental hospitals (p < 0.001). Insufficient government management and supervision at clinic-level dental institutions lead to limited scope for regulating the installation of convenience facilities. Better laws, with continued support and supervision of central and local governments, are needed to resolve this issue. Full article
(This article belongs to the Special Issue Disability and Healthcare Disparities)
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Article
Ten-Year Trend Analysis of Mortality Due to External Causes of Injury in People with Disabilities, South Korea, 2008–2017
Int. J. Environ. Res. Public Health 2021, 18(7), 3672; https://doi.org/10.3390/ijerph18073672 - 01 Apr 2021
Viewed by 588
Abstract
External causes of injury are major contributors to mortality among people with disabilities. We analyzed the 10-year trend (2008–2017) of mortality attributed to external causes of injury among people with disabilities. We conducted an observational, population-based, retrospective, cross-sectional study among people with disabilities [...] Read more.
External causes of injury are major contributors to mortality among people with disabilities. We analyzed the 10-year trend (2008–2017) of mortality attributed to external causes of injury among people with disabilities. We conducted an observational, population-based, retrospective, cross-sectional study among people with disabilities in South Korea. The database was compiled by merging two data sets: registered people with disabilities during 2008–2017 from the Ministry of Health and Welfare, and the data published by the Korea National Statistical Office. Between 2008 and 2017, the all-cause mortality among people with disabilities showed a rising trend and increased from 2641 per 100,000 in 2008 to 2751 per 100,000 in 2017. During this 10-year period, 6.5–9.2% of the total number of deaths were caused by injuries. Disabilities that were associated with a high crude mortality rate shared the same three most frequent causes of death: suicide, motor vehicle crashes, and falling. Mortality due to external causes of injury increased among older people with disabilities. Thus, effective strategies are required to decrease preventable deaths caused by unintentional injuries among people with disabilities. Full article
(This article belongs to the Special Issue Disability and Healthcare Disparities)
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Article
Diseases Costs and Impact of the Caring Role on Informal Carers of Children with Neuromuscular Disease
Int. J. Environ. Res. Public Health 2021, 18(6), 2991; https://doi.org/10.3390/ijerph18062991 - 15 Mar 2021
Viewed by 781
Abstract
This study aims to evaluate the costs of informal care for children with neuromuscular disease and evaluate how physical and psychological health is associated with socio-demographic variables. A cross sectional design was used with a convenience sample of 110 carers that participated in [...] Read more.
This study aims to evaluate the costs of informal care for children with neuromuscular disease and evaluate how physical and psychological health is associated with socio-demographic variables. A cross sectional design was used with a convenience sample of 110 carers that participated in this study. Participants were recruited from Spanish hospitals and rare diseases organizations. Economic costs and sociodemographic aspects were assessed using the economic costs questionnaire and the sociodemographic questionnaire. Physical and psychological health was evaluated using the CarerQol-7D, PHQ-15, Barthel Index, Zarit Overload Scale and Satisfaction with Life Scale. Carers of children with neuromuscular disease spent a large percentage of their annual income in physical therapy, psychological care and speech therapy. Informal costs differed according to the degree of dependency of the child. These were higher in those caregivers whose child under their care presented low functional independence. The loss of work productivity was related to marital status, use of professional services and the child’s dependency. Finally, carers who were female, single or separated and without a job showed worse physical and psychological health. The results highlighted that carers have to face a number of high costs because of the non-existence of social protection and due to the child’s diagnosis. Full article
(This article belongs to the Special Issue Disability and Healthcare Disparities)
Article
Disparities in Accessing Sexual and Reproductive Health Services at the Intersection of Disability and Female Adolescence in Tanzania
Int. J. Environ. Res. Public Health 2021, 18(4), 1657; https://doi.org/10.3390/ijerph18041657 - 09 Feb 2021
Cited by 1 | Viewed by 1387
Abstract
Despite at times having greater needs for sexual and reproductive health (SRH) services, adolescents with disabilities often face challenges when trying to access them. This inaccessibility is further exacerbated during female adolescence. The qualitative study examines how SRH services respond to the characteristics [...] Read more.
Despite at times having greater needs for sexual and reproductive health (SRH) services, adolescents with disabilities often face challenges when trying to access them. This inaccessibility is further exacerbated during female adolescence. The qualitative study examines how SRH services respond to the characteristics of Tanzanian adolescent females with disabilities. We used the method of empathy-based stories to investigate the perceptions of 136 adolescent females with disabilities of their access to SRH services in Tanzania. The study used thematic content analysis and the Levesque model of health care access was applied as an analytical framework. The results demonstrate that discrimination affects access at different phases of care-seeking, that affectionate behaviour of providers is a central enabler of access, and that for this population access relies on a collective effort. We propose that affection, as an enabler of access, is as an additional provider dimension of access to SRH services for adolescents with disabilities, serving as a “reasonable accommodation” to the health care systems in southern contexts and beyond. Full article
(This article belongs to the Special Issue Disability and Healthcare Disparities)
Article
Cross-Cultural Measurement Invariance of a Measure of Disability for White, Black, Hispanic and Asian Older Adults
Int. J. Environ. Res. Public Health 2021, 18(4), 1401; https://doi.org/10.3390/ijerph18041401 - 03 Feb 2021
Viewed by 1140
Abstract
Introduction: This study aims to determine the cross-cultural measurement equivalence of the Washington Group General Measure of Disability for older adults. Materials and Methods: This study used the 2012 California Health Interview Survey. The sample included 14,115 non-Hispanic White, Black, Hispanic and Asian [...] Read more.
Introduction: This study aims to determine the cross-cultural measurement equivalence of the Washington Group General Measure of Disability for older adults. Materials and Methods: This study used the 2012 California Health Interview Survey. The sample included 14,115 non-Hispanic White, Black, Hispanic and Asian adults aged 65 and older. Analysis was conducted using multi-group confirmatory factor analysis (CFA), parallel and Tau-equivalent tests. Results: The results indicated that the measure was valid for use with older adults (Satorra Bentler χ2 = 13.27, df = 3, p = 0.005, GFI = 0.996). Multi-group CFA indicated comparisons were valid between Whites with Blacks, and Hispanics with Asians. Cognitive disability was associated with independent living disability for Whites and Blacks, and with sensory disability for Hispanics and Asians. Conclusions: Findings indicated the measure is valid for cross-cultural comparison for certain racial/ethnic groups. Further research is needed to understand differences in associations of cognitive decline with other areas of disability for older adults. Full article
(This article belongs to the Special Issue Disability and Healthcare Disparities)
Article
‘I Waited for It until Forever’: Community Barriers to Accessing Intellectual Disability Services for Children and Their Families in Cape Town, South Africa
Int. J. Environ. Res. Public Health 2020, 17(22), 8504; https://doi.org/10.3390/ijerph17228504 - 17 Nov 2020
Cited by 2 | Viewed by 767
Abstract
Background: Intellectual disability is more common in low- and middle-income countries than in high-income countries. Stigma and discrimination have contributed to barriers to people with intellectual disability accessing healthcare. As part of a larger study on caregiving of children with intellectual disability in [...] Read more.
Background: Intellectual disability is more common in low- and middle-income countries than in high-income countries. Stigma and discrimination have contributed to barriers to people with intellectual disability accessing healthcare. As part of a larger study on caregiving of children with intellectual disability in urban Cape Town, South Africa, we interviewed a sub-group of families who had never used the intellectual disability services available to them, or who had stopped using them. Methods: We employed a qualitative research design and conducted semi-structured interviews to explore the views and perspectives of parents and caregivers of children with intellectual disability who are not using specialised hospital services. We developed an interview guide to help explore caregivers’ and parents’ views. Results: Results revealed that caregivers and parents of children with intellectual disability did not use the intellectual disability service due to financial difficulties, fragile care networks and opportunity costs, community stigma and lack of safety, lack of faith in services and powerlessness at effecting changes and self-stigmatisation. Conclusion: Current findings highlight a need for increased intervention at community level and collaboration with community-based projects to facilitate access to services, and engagement with broader issues of social exclusion. Full article
(This article belongs to the Special Issue Disability and Healthcare Disparities)

Review

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Review
Lockdown-Related Disparities Experienced by People with Disabilities during the First Wave of the COVID-19 Pandemic: Scoping Review with Thematic Analysis
Int. J. Environ. Res. Public Health 2021, 18(12), 6178; https://doi.org/10.3390/ijerph18126178 - 08 Jun 2021
Cited by 3 | Viewed by 1745
Abstract
People with disabilities may be disproportionally affected by the COVID-19 pandemic. We synthesize the literature on broader health and social impacts on people with disabilities arising from lockdown-related measures. Methods: Scoping review with thematic analysis. Up to mid-September 2020, seven scientific databases and [...] Read more.
People with disabilities may be disproportionally affected by the COVID-19 pandemic. We synthesize the literature on broader health and social impacts on people with disabilities arising from lockdown-related measures. Methods: Scoping review with thematic analysis. Up to mid-September 2020, seven scientific databases and three pre-print servers were searched to identify empirical or perspective papers addressing lockdown-related disparities experienced by people with disabilities. Snowballing searches and experts’ consultation also occurred. Two independent reviewers took eligibility decisions and performed data extractions. Results: Out of 1026 unique references, 85 addressed lockdown-related disparities experienced by people with disabilities. Ten primary and two central themes were identified: (1) Disrupted access to healthcare (other than for COVID-19); (2) Reduced physical activity leading to health and functional decline; (3) From physical distance and inactivity to social isolation and loneliness; (4) Disruption of personal assistance and community support networks; (5) Children with disabilities disproportionally affected by school closures; (6) Psychological consequences of disrupted routines, activities, and support; (7) Family and informal caregiver burden and stress; (8) Risks of maltreatment, violence, and self-harm; (9) Reduced employment and/or income exacerbating disparities; and (10) Digital divide in access to health, education, and support services. Lack of disability-inclusive response and emergency preparedness and structural, pre-pandemic disparities were the central themes. Conclusions: Lockdown-related measures to contain the COVID-19 pandemic can disproportionally affect people with disabilities with broader impact on their health and social grounds. Lack of disability-inclusive response and emergency preparedness and pre-pandemic disparities created structural disadvantages, exacerbated during the pandemic. Both structural disparities and their pandemic ramifications require the development and implementation of disability-inclusive public health and policy measures. Full article
(This article belongs to the Special Issue Disability and Healthcare Disparities)
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Review
Health Risks and Consequences of a COVID-19 Infection for People with Disabilities: Scoping Review and Descriptive Thematic Analysis
Int. J. Environ. Res. Public Health 2021, 18(8), 4348; https://doi.org/10.3390/ijerph18084348 - 20 Apr 2021
Cited by 6 | Viewed by 2100
Abstract
This study aims to synthesize the literature on any disproportionate health risks or consequences of a COVID-19 infection for people with disabilities. Scoping review with a descriptive thematic analysis was carried out. Up to mid-September 2020, seven scientific databases and three preprint servers [...] Read more.
This study aims to synthesize the literature on any disproportionate health risks or consequences of a COVID-19 infection for people with disabilities. Scoping review with a descriptive thematic analysis was carried out. Up to mid-September 2020, seven scientific databases and three preprint servers were searched to identify empirical or perspective papers. Snowballing searches and expert’ consultations also took place. Two independent reviewers were used for the screenings and data extractions. Of 1027 references, 58 were included, 15 of which were empirical articles. The thematic analysis showed that: (1) People with disabilities living in residential or long-term care facilities were more likely to have greater infection rates; (2) Intersecting mediators of greater infection risks were multiple (e.g., lack of accessible information); (3) People with disabilities often face greater health problems when infected; and (4) Unethical disadvantages in the rationing of lifesaving and critical care can be experienced by people with disabilities. Conclusions: Beyond any health-related vulnerabilities (e.g., comorbidity rates), multiple yet modifiable environmental factors can provide disproportionate health risks and consequences of a COVID-19 infection for people with disabilities. Public health and policy measures must prevent or reduce modifiable environmental risks. Full article
(This article belongs to the Special Issue Disability and Healthcare Disparities)
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