Measuring Disability-Related Health Disparities: Empirical and Normative Issues

Despite the significant body of research on health disparities in the United States, researchers have paid relatively little attention to disability-related health disparities. The complicated interaction between disability and health raises empirical and normative challenges for the measurement of disability-related health disparities. The three aims in this dissertation project all share the goals of improving the measurement of disability-related health disparities and closing the research gap. Aim 1 is a normative paper arguing that disabled people should be included among the minority groups targeted by the National Institute of Minority Health and Health Disparities’ research framework. Although the NIMHD framework has many strengths, including its emphasis on social disadvantage, it was modified to account for three challenges faced by research studies measuring health disparities between disabled and non-disabled populations: the extreme heterogeneity within disabled populations, the complicated relationship between disability and health, and disagreement over the need to medically treat disabling conditions. Aim 2 used the 2014-2018 IPUMS Health Surveys to compare the prevalence of eight self-reported chronic health conditions in populations defined by two different disability classification approaches and ran logistic regression to control for socioeconomic factors. The odds of reporting a work-activity limitation without reporting any of the standard six functional limitations were lower for individuals with four of the eight conditions examined. One condition exhibited a positive association with work-activity limitations. These findings support the conclusion that the choice of survey questions used by researchers to classify individuals by disability status can demarcate disabled populations with significantly different prevalence of some chronic health conditions. Aim 3 examined changes in rates of health insurance coverage, rates of experiencing financial barriers to health care, and rates of experiencing financial barriers to obtaining prescription medications in working-age disabled and non-disabled adults between a time period after full implementation of the Affordable Care Act (2014-2016) and the first two years of the Trump administration (2017-2018). The study found widening disparities in the experience of financial barriers to medical care between disabled working age adults and non-disabled working age adults