New Analysis: More U.S. Adults Identify as Disabled; Ethnic and Socioeconomic Disparities Persist

A new analysis led by Johns Hopkins Medicine researchers finds that the number of U.S. adults who report they have a disability is 27%, representing 67 million adults, an increase of 1% since the data were last analyzed in 2016. In this new study, which used data collected in 2019, before the COVID-19 pandemic, the researchers found a wide array of disparities between socioeconomic and demographic factors that persists among those who identify as disabled and those who do not.

“To reduce ableism and create more inclusive communities, our country must be equipped with data on the prevalence of disabilities and who is most impacted by them,” says Bonnielin Swenor, Ph.D., M.P.H., director of the Johns Hopkins Disability Health Research Center and associate professor of ophthalmology at the Johns Hopkins University School of Medicine and Wilmer Eye Institute.

Swenor and her research team analyzed survey data from the Centers for Disease Control and Prevention’s 2019 Behavioral Risk Factor Surveillance System, a collection of health and behavior information from annual telephone surveys of more than 400,000 U.S. adults.

Results of the analysis were published Oct. 21 in JAMA Network Open.

Approximately 27% of American adults reported a disability. When compared with the U.S. adult population, this represents 67 million adults. An additional 6 million people reported a disability since data on disability prevalence were analyzed and reported in 2016.

In the current study, approximately 12% of American adults reported more than one disability. Mobility was the most often reported disability type, followed by cognitive/mental, independent living (requiring help for daily tasks and outings), hearing, vision, and self-care (needing help with bathing, dressing and other personal care tasks).

In addition, the researchers analyzed socioeconomic and demographic data to better understand the prevalence of disability across intersecting groups.

“Developing effective measures and policies to include people with disabilities in all aspects of life needs to account for the variability in how people among different ethnic, socioeconomic, demographic and geographic groups experience disability,” says Swenor. “With robust data, we can strengthen the foundation of our knowledge about disability and develop tangible solutions.”

The survey data showed that, compared with adults without a disability, disabled adults were more likely to be older, female, Hispanic, have less than a high school education, have low income, be unemployed, and be bisexual, transgender or gender nonconforming. Digging deeper, the team found differences in disability prevalence based on sociodemographic groups. For example, Black females had a higher prevalence of disability than females of other races, and Black adults identifying as gay or bisexual had a lower prevalence of disability compared with gay or bisexual adults of other races.

Swenor and the research team note that an aging population and other factors may contribute to the increase in reported disability. The data include information from before the COVID-19 pandemic, and Swenor says there may be an increase in people reporting a disability resulting from long-term symptoms of COVID-19.

The research team aims to use these data to continue studying the experiences of disabled populations, including identifying and finding support and resources for people with disabilities and ascertaining the capabilities of schools and employers in supporting disabled communities.

In addition to Swenor, researchers who contributed to the report include Jessica Campanile, Jennifer Deal, Ph.D., Nicholas Reed, Au.D., and Varshini Varadaraj, M.D., M.P.H.

What Drives Racial and Ethnic Disparities in Prenatal Care for Expectant Mothers?

Prenatal care — health care for pregnant mothers — is one of the most commonly used forms of preventive health care among women of reproductive age. Prenatal care represents an important opportunity to detect, monitor, and address risky health conditions and behaviors among expectant mothers that can impact birth outcomes.

Both delayed prenatal care (i.e., care initiated after the first trimester of pregnancy) and inadequate prenatal care are associated with poor infant health outcomes such as low birth weight. Although researchers continue to debate precise causal effects, studies suggest that prenatal care brings important benefits — including reductions in maternal smoking, lower rates of preventable pregnancy complications like high blood pressure, and better management of the mother’s weight after giving birth. Furthermore, mothers who initiate care earlier are more likely to take their infants to well-baby visits after their babies are born.

As with other forms of healthcare, we see significant racial/ethnic disparities in access to and use of prenatal care. Although researchers have explored overall disparities in health outcomes rooted in differences in health insurance coverage, education, family income, and county-level poverty, more remains to be learned about how such factors affect various racial/ethnic inequalities.

Such knowledge is critical for achieving national public health goals and for addressing gaps in health outcomes for pregnant women. My research explores this area and can point to solutions that can improve and equalize health care for various groups of women and their children.

Disparities in First Trimester Initiation and Adequacy of Prenatal Care

My research quantifies how various factors contribute to gaps in prenatal care among non-Hispanic white, non-Hispanic black, and Hispanic women. By combining county-level U.S. Census data with rich data on children born in 2001 from the Early Childhood Longitudinal Study, I am able to pinpoint factors that typically cannot be considered simultaneously. For example, I can explore the effects of both maternal access to transportation and the availability of physicians in various counties.

My results reveal significant disparities among black, Hispanic, and white mothers in terms of the start of prenatal care in the first trimester of pregnancy. Although approximately 89 percent of whites initiate care during the first trimester, only 75 percent of black mothers and 79 percent of Hispanic mothers do so. Mothers from these groups also experience disparities in the adequacy of prenatal care they receive. Approximately 79 percent of non-Hispanic whites experience at least adequate prenatal care, while only 68 percent of Hispanic mothers and 69 percent of black mothers receive adequate care. What explains these differences? Here are the key findings from my research:

  • Socioeconomic characteristics like education, family income, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children explain far more of the racial/ethnic gaps in prenatal care than any other factors. These factors explain over half of black–white disparities and nearly half of Hispanic–white disparities in first trimester prenatal care initiation. Socioeconomic characteristics also explain far more of the racial/ethnic gaps in prenatal care adequacy than any other group of factors (although these factors account for considerably more of the black-white gap than the Hispanic-white gap).

  • Maternal health and characteristics of pregnancies (such as maternal age and number of previous pregnancies) explain 8.8 percent of black-white differences and 8.7 – 9.7 percent of Hispanic–white differences in the timing of the start of care in the first trimester. But differences in the adequacy of care are not related to maternal health or pregnancy characteristics.

  • Types of insurance coverage – whether women are covered by Medicaid, private insurance, or have no coverage — explain similar small percentages of differences in the timing of first trimester care, but again do not account for gaps in the adequacy of care.

  • The location of prenatal care facilities – in physicians’ offices and public health clinics — explained 4.7-6 percent of black–white gaps in timing of the start of care and 2.9-4.9 percent of Hispanic–white disparities. Location of care explained about 8.3 percent of black–white gaps in the adequacy of care but did not explain Hispanic-white gaps.

  • Maternal behaviors like smoking and state of residence and count-level conditions did not significantly contribute to racial and ethnic disparities in the initiation of prenatal care. But the availability of local gynecologists and state of residence did help to narrow black–white gaps in the adequacy of prenatal care, although these factors did not influence gaps in the adequacy of care between Hispanics and whites.

Addressing Socioeconomic Factors to Improve Prenatal Health

My research suggests that large and persistent socioeconomic disparities are primary contributors to racial/ethnic gaps in the timing and adequacy of prenatal care. This finding is not surprising — pregnant women with lower incomes and levels of formal education often do not have the resources necessary to obtain care early and often. However, participation in the Special Supplemental Nutrition Program for Women, Infants, and Children made a difference for pregnant women, suggesting that this public program can help meet the financial needs that remain an important barrier to timely and adequate prenatal care.

My findings suggest that policymakers should endeavor to help disadvantaged populations gain expanded access to healthcare. Medicaid expansions through the 2010 Affordable Care Act provide one promising intervention. Although such expansions target childless poor and near-poor adults, women who receive coverage prior to pregnancy can end up enrolling earlier in prenatal care; and they can obtain continuing help with the management of chronic health problems, potentially improving outcomes when their babies are born.

Ultimately, as my research shows, reducing economic inequality may help to close racial and ethnic disparities in prenatal care. Read more in Tiffany L. Green, “Unpacking Racial/Ethnic Disparities in Prenatal Care Use: The Role of Individual-, Household-, and Area-Level Characteristics,” Journal of Women’s Health 27, no.9 (2018).

Zero Tolerance Policies Hurt Minorities and Students with Disabilities in Pennsylvania’s Public Schools

There has been many heated discussions throughout the country regarding the disparities of zero tolerance policies implemented in our nation’s public schools.  Last week, the American Civil Liberties Union (ACLU) of Pennsylvania released a report that outlined startling statistics regarding the number of African-American, and Latino students, and students with disabilities who were disproportionately affected by zero tolerance policies within Pennsylvania’s public schools.

The report, titled “Beyond Zero Tolerance:  Discipline and Policing Pennsylvania’s Public Schools” disclosed the high numbers of minorities and students with disabilities being suspended at greater rates than their white and able-bodied peers.  During the 2011-2012 academic year, there were over 166,000 out-of-school suspensions issued by school districts.  To give you a better understanding of this figure, 10 out of 100 students in Pennsylvania’s public schools were suspended during this particular academic term.

Zero Tolerance 1The disparities in race and disability are taken into account when one reviews the number of minority and students with disabilities that attend Pennsylvania’s public schools, and how these students comprised the high percentages of students who received disciplinary action that resulted in suspension, expulsions, and arrests.  African American students made up only 13.6% of the population that attended Pennsylvania schools, but they accounted for close to half of the out-of-school suspensions reported by school districts.  One out of every 10 Latino students were suspended at least once during the 2011-2012 school year; this is the highest figure reported concerning Latino students and suspension in the country, according to the ACLU.  Students with disabilities did not fair much better; students with disabilities were suspended at a 11.1% rate.  In comparison to their peers, students with disabilities faced the fate of being twice as likely to experience suspension.

In the ACLU’s report, the organization noted the probable cause for these disparities revolved around the fact that zero tolerance policies cast out a very wide net that catches “undesirable,” or disruptive behaviors and actions.  These behaviors and actions were deemed unacceptable by school districts, and are judged as grounds for punishment.

The ACLU proposed several suggestions for school districts to consider when it comes to the disparities surrounding zero tolerance policies.  Full-scale review of current suspension policies, utilize intensive disciplinary actions only when there is a imminent danger to safety of the offending student and/or others, and fully evaluating the true effectiveness of law enforcement officials within the schools were a few of the recommendations issued by the ACLU.

Reading the striking findings of this report hopefully enlightens us about the covert inequities of blanket polices like zero tolerance in our public schools.  Such blanket policies are detrimental to the students who are more likely to be disproportionately represented and unfairly labeled as “troublemakers.”  These policies also prove to be inflexible in appropriately discerning between behaviors that are indeed disruptive to the school environment and/or place students and staff in danger versus behaviors conducted that may be due to cultural differences, problems experienced by students within the home environment, cognitive limitations, etc.  Without taking these possible reasons for the occurrence of these behaviors into consideration, we end up mislabeling these students as recalcitrant and fail to look deeper into the actual cause(s) of their misconduct.

To the educators, parents, and students out there, what issues have your school districts encountered with zero tolerance policies?  Have your school district reported similar trends in high percentages of suspensions, expulsions, and arrest among minority students and students with disabilities?  If so, what steps have been taken to ameliorate these disparities?  Do you believe zero tolerance policies work effectively at extinguishing all forms of misconduct in schools, no matter how minor or severe the behavior?  Tell me your thoughts and experiences by sending an email to Vilissa@rampyourvoice.com, or by visiting my website, Ramp Your Voice!

(Featured headline image:  Courtesy of WTAE.) 

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