Health Care Access
Attitudinal Barriers - Participants in a town hall meeting on health care access for people with disabilities discussed specific attitudinal issues, such as:
•
"When I take someone with me, they talk to the person who is with me, not to me. I’m the one who’s gone through this and I keep detailed information."•
"Being shifted among clinicians in the practice and they don’t know about me."•
"Doctors who can’t get past the mental illness diagnosis—don’t look at the other things (hypertension, diabetes, etc)—and refer you back to the mental health care provider."•
"Too many offices are unaware of rights of persons and their use of service animals."According to a national online survey on health care access for people with disabilities:
45% percent of women with disabilities said there was a time in the last 12 months when they needed health care but did not get it. The top three reasons given for not receiving needed health care were:
Cost and insurance issues (e.g. it cost too much; my insurance didn’t cover it)
Inability to get an appointment
Inability to find a health care provider who understood or was willing to treat my disabilityWomen with disabilities said the following health care issues were very important to them:
Health insurance concerns -- for example, finding a doctor who accepts Medicaid (94%)
Health care provider’s attitude (92%)
Health care provider’s knowledge of my disability (80%) Health DisparitiesGeneral Health - In Oregon, 38% of women with disabilities describe their health as fair or poor, compared to 6% of women without disabilities. Health Behaviors and Health Promotion Compared to adults without disabilities, men and women with disabilities in Oregon are:
Less likely to have had a dental cleaning in the past year (63% vs. 70%)
More likely to have had permanent teeth removed (60% vs. 35%)
Compared to nondisabled women, Oregon women with disabilities are:
More likely to smoke (19% vs. 14%)
More likely to be obese (36% vs. 19%)
Less likely to receive information from health professionals on how to get appropriate physical activity (81% vs. 88%)
Domestic Violence/Abuse
Among women with developmental disabilities, 83% (Sobsey and Doe, 1991) experienced sexual assault.
Among women with physical disabilities found 62% experienced abuse of some type (Nosek, et al., 2001).
Women with disabilities were 4 times likely to report sexual assault in the past year compared to women without disabilities (Martin et al., 2006).
Breast and Cervical Cancer Screenings
Studies show significant health disparities between women with disabilities compared to women with disabilities. For example, women with disabilities diagnosed with cancer are more likely to be diagnosed at later stages. [1] This matters because cancer diagnosed at a later, less treatable stage results is likely to mean worse outcomes for women with disabilities. Women with disabilities are also less likely to receive the breast and cervical cancer screening tests compared to women without disabilities. [2]Clinical Breast Exams (CBE) -
Women with disabilities (age 50+) are significantly less likely to have had a CBE. [3]Mammograms -
Women with disabilities (age 50+) are significantly less likely to receive a mammogram.[3-5] Some additional information:Women with
cognitive disabilities are more than twice as likely to NOT receive a mammogram as women without cognitive disabilities. [6]Almost two-thirds of women with
severe disabilities1 are less likely to ever have a mammogram (age 65+). [5]Nondisabled women are about three times more likely to have had a mammogram in the last year than are disabled women (all aged 45 and up. [7]
In Oregon, women with
cognitive disabilities are less likely than women without cognitive disabilities to have had a mammogram within the last 2 years. [8]1 Severe disabilities in this case is defined as having 3 or more functional limitations
Pap tests - Women with disabilities are significantly less likely to receive a Pap test. [3, 4, 9] Some additional information:
Women with
severe disabilities are less likely to have had a Pap test than women with less severe disabilities; in turn, women with less severe disabilities are less likely than nondisabled women to have had a Pap test (65.5% vs. 72.8% vs. 78.9%, respectively). [9]Women with
cognitive disabilities are 5.3 times more likely to not have had a Pap test compared to those without cognitive disabilities. [6]Women with
moderate (64.8%) and severe (60.6%) disabilities were less likely to have had a recent Pap compared to women without disabilities (76.1 %.). [5]In Oregon, women with cognitive disabilities are less likely to have had a
Pap test within the last 3 years compared to those without cognitive disabilities. [8]Lung Cancer
Smoking tobacco products in any form is the major cause of lung cancer. In Oregon:Women with disabilities are more likely to smoke (19% vs. 14%) than non-disabled women.
10People with disabilities (women and men) are more likely to have smoking-related cancers than people without disabilities.
11Contact Information:
For more information about these health disparities or about WowDHEC, please contact Marjorie McGee, Director of WowDHEC: mcgeem@ohsu.edu or 503.494.2685. See below for references for these facts about health disparities.Resources/ References for Health Care Access:
The survey and town hall meeting were conducted by the RRTC on Health and Wellness at OHSU. Visit www.healthwellness.org or call 503-494-3533 for more information.
Resources/ References for Health Disparities:
Oregon data from the Behavioral Risk Factor Surveillance System, analyzed by the Oregon Office on Disability and Health.
Cardinal, B.J. & Spaziani, M.D. (2003). ADA compliance and the accessibility of physical activity facilities in western Oregon. American Journal of Health Promotion. 17(3), 197-201.
Moore, D. & Li, L. (1998). Prevalence and risk factors of illicit drug use by people with disabilities. The American Journal on Addictions, 7(2), 93-102.
Krahn, G.L., Deck, D.D., Gabriel, R.M., & Bersani, H.L. (2000). Examining access and success of drug & alcohol treatment for persons with disabilities. American Public Health Association Annual Meeting. Boston, Massachusetts.
Sobsey, D., & Doe, T. (1991). Patterns of sexual abuse and assault. Sexuality & Disability, 9(3), 243-259.
Nosek, M. A., Howland, C., Rintala, D. H., Young, M. E., & Chanpong, G. F. (2001). National study of women with physical disabilities: Final report. Sexuality & Disability, 19(1), 5.
Martin, S. L., Ray, N., Sotres-Alvarez, D., Kupper, L. L., Moracco, K.E., Dickens, P. A., et al. (2006). Physical and sexual assault of women with disabilities. Violence Against Women, 12(9), 823-837.References for Breast and Cervical Cancer Statistics: 1. Roetzheim, R.G. and T.N. Chirikos, Breast cancer detection and outcomes in a disability beneficiary population. Journal of Health Care For The Poor And Underserved, 2002. 13(4): p. 461-476. 2. Wisdom J. P., et al., Health Disparities between Women with and without Disabilities: A Review of the Research. Journal of Health and Social Policy, in press. 3. Diab, M.E. and M.V. Johnston, Relationships between level of disability and receipt of preventive health services. Archives of Physical Medicine And Rehabilitation, 2004. 85(5): p. 749-757. 4. Iezzoni, L.I., et al., Mobility impairments and use of screening and preventive services. American Journal of Public Health, 2000. 90(6): p. 955-961. 5. Nosek, M.A. and C.J. Gill, Use of cervical and breast cancer screening among women with and without functional limitations--United States, 1994-1995. MMWR: Morbidity & Mortality Weekly Report, 1998. 47(40): p. 853. 6. Havercamp, S.M., D. Scandlin, and M. Roth, Health disparities among adults with developmental disabilities, adults with other disabilities, and adults not reporting disability in North Carolina. Public Health Reports, 2004. 119(4): p. 418-426. 7. Chan, L., et al., Do Medicare patients with disabilities receive preventive services? A population-based study. Archives of Physical Medicine And Rehabilitation, 1999. 80(6): p. 642-646. 8. Horner-Johnson, W., et al., Breast and cervical cancer screening among Oregon women with and without disabilities. 2006, Oregon Office on Disability and Health, OHSU: Portland.
9. Schootman, M. and L.J. Fuortes, Breast and cervical carcinoma: the correlation of activity limitations and rurality with screening, disease incidence, and mortality. Cancer, 1999. 86(6): p. 1087-1094.
References for Lung Cancer: 10 Non-institutionalized Oregonians aged 18 years and older. [Data from the Oregon Behavioral Risk Factor Surveillance System analyzed by the Oregon Office on Disability and Health] 11 Oregon Medicaid recipients. [Austin, D. (2003). Disabilities are risk factors for late stage or poor prognosis cancers. In RRTC Health and Wellness Consortium (Ed.), Changing concepts of health and disability: State of the science conference & policy forum (p.52-55). Portland, OR: Oregon Health & Science University.] This publication was supported in part by the Oregon Office on Disability and Health, Grant/Cooperative Agreement Number U59/CCU1093509 from the Centers for Disease Control and Prevention (CDC) to the Oregon Department of Human Services; the Rehabilitation Research and Training Center on Health and Wellness, Grant Number H133B040034 from the U.S. Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR) to Oregon Health & Science University; and the Women with Disabilities Health Equity Coalition, a grant from Johnson & Johnson to the Center of Excellence in Women’s Health and Oregon Health & Science University. The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC, NIDRR, or Johnson & Johnson.