Health Care Access for Adults With Intellectual and Developmental Disabilities: A Scoping Review

People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID. (c) 2006 Wiley-Liss, Inc.

National survey data indicate the number of individuals reporting a disability is rising. Those with disabilities experience a large number of barriers to health promotion and disease prevention programming. However, only a limited number of studies have used nationally representative data to examine the health status of individuals with disabilities in comparison to those without disabilities. We used the Medical Expenditures Panel Survey (MEPS) to examine whether disability is associated with higher prevalence rates for common chronic diseases, lower use of preventive care and higher health care expenditures. Our research hypothesis was that nationally, adults with either physical disability or cognitive limitations experience significant health disparities in comparison to those with no disability. We conducted a retrospective analysis comparing the health of adults (18 and over) with physical disabilities or cognitive limitations to individuals with no disability using data from the 2006 full year consolidated data file from the Medical Expenditures Panel Survey (MEPS). We used chi-squared tests, t-tests, and logistic regression to evaluate the association. Individuals with physical disabilities or cognitive limitations had significantly higher prevalence rates for 7 chronic diseases than persons with no disabilities. The disability groups were also significantly less likely than the no disability group to receive 3 types of preventive care. These data suggest that adults with disabilities and chronic conditions receive significantly fewer preventive services and have poorer health status than individuals without disabilities who have the same health conditions. This indicates a need for public health interventions that address the unique characteristics of adults with disabilities, many of whom are at risk for high cost, debilitating conditions that may not have as severe an effect on other population segments. Published by Elsevier Inc.

People with disabilities experience worse health and poorer access to health care compared to people without disability. Large-scale health surveillance efforts have largely excluded adults with intellectual and developmental disability. This study expands knowledge of health status, health risks and preventative health care in a representative US sample comparing the health of adults with no disability to adults with intellectual and developmental disability and to adults with other types of disability.