Socioeconomic Factors at the Intersection of Race and Ethnicity Influencing Health Risks for People with Disabilities

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d6355204e143">Objectives</h5> <p id="P2">People with disabilities are known to experience disparities in behavioral health risk factors including smoking and obesity. What is unknown is how disability, race/ethnicity, and socioeconomic status combine to affect prevalence of these health behaviors. We assessed the association between race/ethnicity, socio-economic factors (income and education), and disability on two behavioral health risk factors. </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d6355204e148">Methods</h5> <p id="P3">Data from the 2007–2010 Behavioral Risk Factor Surveillance System were used to determine prevalence of cigarette smoking and obesity by disability status, further stratified by race and ethnicity as well as income and education. Logistic regression was used to determine associations of income and education with the two behavioral health risk factors, stratified by race and ethnicity. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d6355204e153">Results</h5> <p id="P4">Prevalence of disability by race and ethnicity ranged from 10.1 % of Asian adults to 31.0 % of American Indian/ Alaska Native (AIAN) adults. Smoking prevalence increased with decreasing levels of income and education for most racial and ethnic groups, with over half of white (52.4 %) and AIAN adults (59.3 %) with less than a high school education reporting current smoking. Education was inversely associated with obesity among white, black, and Hispanic adults with a disability. </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d6355204e158">Conclusion</h5> <p id="P5">Smoking and obesity varied by race and ethnicity and socioeconomic factors (income and education) among people with disabilities. Our findings suggest that disparities experienced by adults with disabilities may be compounded by disparities associated with race, ethnicity, and socioeconomic factors. This knowledge may help programs in formulating health promotion strategies targeting people at increased risk for smoking and obesity, inclusive of those with disabilities. </p> </div>

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Paula Braveman, Catherine Cubbin, Susan Egerter … (2010)

We aimed to describe socioeconomic disparities in the United States across multiple health indicators and socioeconomic groups. Using recent national data on 5 child (infant mortality, health status, activity limitation, healthy eating, sedentary adolescents) and 6 adult (life expectancy, health status, activity limitation, heart disease, diabetes, obesity) health indicators, we examined indicator rates across multiple income or education categories, overall and within racial/ethnic groups. Those with the lowest income and who were least educated were consistently least healthy, but for most indicators, even groups with intermediate income and education levels were less healthy than the wealthiest and most educated. Gradient patterns were seen often among non-Hispanic Blacks and Whites but less consistently among Hispanics. Health in the United States is often, though not invariably, patterned strongly along both socioeconomic and racial/ethnic lines, suggesting links between hierarchies of social advantage and health. Worse health among the most socially disadvantaged argues for policies prioritizing those groups, but pervasive gradient patterns also indicate a need to address a wider socioeconomic spectrum-which may help garner political support. Routine health reporting should examine socioeconomic and racial/ethnic disparity patterns, jointly and separately.

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G. Pappas, S Queen, W. Hadden … (1993)

There is an inverse relation between socioeconomic status and mortality. Over the past several decades death rates in the United States have declined, but it is unclear whether all socioeconomic groups have benefited equally. Using records from the 1986 National Mortality Followback Survey (n = 13,491) and the 1986 National Health Interview Survey (n = 30,725), we replicated the analysis by Kitagawa and Hauser of differential mortality in 1960. We calculated direct standardized mortality rates and indirect standardized mortality ratios for persons 25 to 64 years of age according to race, sex, income, and family status. The inverse relation between mortality and socioeconomic status persisted in 1986 and was stronger than in 1960. The disparity in mortality rates according to income and education increased for men and women, whites and blacks, and family members and unrelated persons. Over the 26-year period, the inequalities according to educational level increased for whites and blacks by over 20 percent in women and by over 100 percent in men. In whites, absolute death rates declined in persons of all educational levels, but the reduction was greater for men and women with more education than for those with less. Despite an overall decline in death rates in the United States since 1960, poor and poorly educated people still die at higher rates than those with higher incomes or better educations, and this disparity increased between 1960 and 1986.

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Physical activity participation among persons with disabilities: barriers and facilitators.

James H. Rimmer, Barth B Riley, Edward Wang … (2004)

The purpose of this study was to identify various barriers and facilitators associated with participation in fitness and recreation programs/facilities among persons with disabilities. Focus groups were conducted in ten regions across the United States in 2001 to 2002 with four types of participants: (1) consumers with disabilities, (2) architects, (3) fitness and recreation professionals, and (4) city planners and park district managers. Sessions were tape-recorded and content analyzed; focus group facilitators took notes of identified barriers and facilitators to access. Content analysis of tape recordings revealed 178 barriers and 130 facilitators. The following themes were identified: (1) barriers and facilitators related to the built and natural environment; (2) economic issues; (3) emotional and psychological barriers; (4) equipment barriers; (5) barriers related to the use and interpretation of guidelines, codes, regulations, and laws; (6) information-related barriers; (7) professional knowledge, education, and training issues; (8) perceptions and attitudes of persons who are not disabled, including professionals; (9) policies and procedures both at the facility and community level; and (10) availability of resources. The degree of participation in physical activity among people with disabilities is affected by a multifactorial set of barriers and facilitators that are unique to this population. Future research should utilize this information to develop intervention strategies that have a greater likelihood of success.