Research in Developmental Disabilities 35 (2014) 591–596

Contents lists available at ScienceDirect

Research in Developmental Disabilities

The self-rated health of British adults with intellectual disability Eric Emerson a,b, Janet Robertson a,*, Susannah Baines a, Chris Hatton a a b

Centre for Disability Research, Lancaster University, UK Centre for Disability Research and Policy, University of Sydney, Australia

A R T I C L E I N F O

A B S T R A C T

Article history: Received 21 November 2013 Accepted 3 January 2014 Available online 27 January 2014

People with intellectual disability have significantly higher age-adjusted rates of mortality and morbidity than their non-disabled peers. While self-rated health status is commonly used as an indicator of the health status of populations of interest, few studies have explored the self-rated health of adults with intellectual disability. We undertook secondary analysis of de-identified cross-sectional data from the first waves of two contemporary UK surveys: the Life Opportunities Survey (n = 37,513) and Understanding Society (n = 50,976). In the Life Opportunities Survey we identified 316 participants age 16– 49 (1.7% of the age-restricted sample) as having intellectual disability. In Understanding Society we identified 415 participants age 16–49 (1.5% of the age-restricted sample) as having intellectual disability. Participants with intellectual disability were significantly more likely to report having fair or worse health than their peers (Life Opportunities Survey OR = 8.86 (6.54–12.01), p < 0.001; Understanding Society OR = 13.14 (10.65–16.21), p < 0.001). However the strength of this association was significantly attenuated when risk estimates were adjusted to take account of the increased rates of exposure of participants with intellectual disability to socio-economic disadvantage and (in the Life Opportunities Survey) exposure to discrimination and violence. ß 2014 Elsevier Ltd. All rights reserved.

Keywords: Self-rated health Health Health disparities Socio-economic disadvantage Discrimination

1. Introduction People with intellectual disability have significantly higher age-adjusted rates of mortality and morbidity than their nondisabled peers (Emerson & Hatton, 2014; Heslop et al., 2013; Krahn & Fox, in press). This evidence, when combined with expose´s of failings in healthcare systems (Heslop et al., 2013; Mencap, 2007, 2012; Michael, 2008) and increased attention to the human rights of disabled people (United Nations, 2006), has led regulatory bodies and governments to stress the importance of reducing the health inequalities experienced by people with intellectual disability (Department of Health, 2007; Disability Rights Commission, 2006; Krahn, Fox, Campbell, Ramon, & Jesien, 2010; Parliamentary and Health Service Ombudsman and Local Government Ombudsman, 2009; US Department of Health and Human Services, 2002). While self-rated health status is commonly used as an indicator of the health status of populations of interest (DeSalvo, Bloser, Reynolds, He, & Muntner, 2006; Idler & Benyamini, 1997, 1999; Jylha, 2009), few studies have explored the self-rated health of adults with intellectual disability (Emerson & Hatton, 2014; Fujiura, 2012). Of these, only three have employed relatively robust population-based sampling frames (Emerson & Hatton, 2008; Haider, Ansari, Vaughan, Matters, & Emerson,

* Corresponding author. E-mail addresses: [email protected] (E. Emerson), [email protected] (J. Robertson), [email protected] (S. Baines), [email protected] (C. Hatton). 0891-4222/$ – see front matter ß 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ridd.2014.01.005

592

E. Emerson et al. / Research in Developmental Disabilities 35 (2014) 591–596

2013; Larson, Lakin, Anderson, & Kwak, 2001) and only two of these collected information on the self-rated health of participants with and without intellectual disability (Haider et al., 2013; Larson, Lakin, Anderson, & Kwak, 2001). Larson and colleagues identified 3076 respondents with predominantly mild intellectual disability in the disability supplements to the 1994–95 US National Health Interview Survey (NHIS) (Larson, Lakin, & Anderson, 2003; Larson, Lakin, Anderson, & Kwak, 2001; Larson, Lakin, Anderson, Lee, et al., 2001). They reported that adults with intellectual disability were markedly more likely to rate their health as fair or poor (24%) than their peers without intellectual disability (10%). More recently, Haider and colleagues undertook a telephone survey of the health of 897 adults with intellectual disability in the State of Victoria, Australia (Haider et al., 2013). They reported that adults with intellectual disability were markedly more likely to rate their health (or have their health rated by a proxy) as fair or poor (24%) than their peers without intellectual disability (18%). Current knowledge indicates that the reasons for the poorer health of people with intellectual disability primarily fall within two broad spheres (Emerson & Hatton, 2014). First, a range of secondary health conditions is associated with some specific causes of intellectual disability (e.g., higher rates of congenital heart defects in children with Down syndrome). Second, people with intellectual disability are much more likely than their non-disabled peers to be exposed to a range of well-established social determinants of poorer health (e.g., poverty, social exclusion, discrimination, reduced access to timely and effective healthcare). To date no study has examined the extent to which the poorer self-rated health of adults with intellectual disability may reflect their increased rates of exposure to common social determinants of poorer health. However, previous research has demonstrated that: (1) poorer self-rated health among adults with intellectual disability is related to increased rates of exposure to indicators of socio-economic disadvantage and discrimination (Emerson, 2010; Emerson & Hatton, 2008); and (2) the poorer maternal-rated health of children with intellectual disability can be partially accounted for by their increased rates of exposure to indicators of socio-economic disadvantage (Emerson & Hatton, 2007a, 2007b). The aims of the present paper are: (1) to describe the self-rated general health status of British adults with intellectual disability; and (2) to examine the extent to which any between-group differences in health status may reflect betweengroup differences in rates of exposure to socio-economic disadvantage and discrimination.

2. Methods We undertook secondary analysis of de-identified cross-sectional data from the first waves of two contemporary UK surveys; the Life Opportunities Survey (LOS)(Office for National Statistics, 2011) and Understanding Society (McFall & Garrington, 2011). Data were downloaded from the UK Data Archive (http://www.data-archive.ac.uk/). Full details of the surveys’ development and methodology are available in a series of reports (Boreham, Boldysevaite, & Killpack, 2012; Buck & McFall, 2012; Dawe, 2011; Howe, 2010; McFall, 2012; McFall & Garrington, 2011; Office for Disability Issues, 2011), key aspects of which are summarised below. 2.1. Samples LOS is a new longitudinal study focusing on the life experiences of disabled people in Great Britain (Dawe, 2011; Howe, 2010; Office for Disability Issues, 2011). In the first wave of data collection (undertaken between June 2009 and March 2011), random unclustered sampling from the small users Postcode Address File identified 34,004 eligible households. Interviews were completed with 37,513 individuals aged 16 or older from 19,951 households, giving a household response rate of 59% (Cuddeford, Duncan, Howe, & Glen, 2008; Dawe, 2011; Howe, 2010; Office for Disability Issues, 2011). Understanding Society is a new longitudinal study focusing on the life experiences of UK citizens. In the first wave of data collection (undertaken between January 2009 and December 2011), random sampling from the Postcode Address File in Great Britain and the Land and Property Services Agency list of domestic properties in Northern Ireland identified 55,684 eligible households. Interviews were completed with 50,976 individuals aged 16 or older from 30,117 households, giving a household response rate of 54% (Boreham et al., 2012; Buck & McFall, 2012; McFall, 2012; McFall & Garrington, 2011). 2.2. Procedures Data collection was primarily undertaken using Computer Assisted Personal Interviewing. 2.3. Measures 2.3.1. Intellectual disability Neither survey included information on the formal diagnosis of intellectual disability. As a result, we identified adults with intellectual disability on the basis of self-reported difficulties in learning or understanding coexisting with low selfreported educational attainment. Low self-reported educational attainment was used as a selection criterion for two reasons: (1) to exclude from the intellectual disability group respondents with specific learning disabilities such as dyslexia; and (2) as evidence that the person’s self-reported difficulty may have originated in childhood. Due to historical changes in educational qualifications and attainment in the UK, we further restricted our analysis to the age range 16–49.

E. Emerson et al. / Research in Developmental Disabilities 35 (2014) 591–596

593

Three inclusion criteria were used to identify LOS participants with intellectual disability: (1) a positive response to one of two impairment screening questions asked of all participants (Do you have a difficulty learning for example at school, college, work or in other places? Do you have an intellectual difficulty or developmental delay? This may not have a name but include things like Down’s syndrome, autism and other conditions); (2) they met the criteria for being considered disabled under existing UK legislation (defined in the LOS data set by the extent of activity limitations/participation restrictions reported by respondents as a result of their impairment); and (3) their highest educational attainment was lower than a General Certificate of Secondary Education at Grade C or equivalent (24.3% of all LOS participants reported lower this level of attainment). This process identified 316 participants age 16–49 (1.7% of the unweighted age-restricted sample) as having intellectual disability. Men were significantly more likely to be identified as having intellectual disability than women (2.1% vs. 1.3%, OR = 1.59 (95%CI 1.17–2.16), p < 0.01). Understanding Society uses a two-stage process for identifying participants with impairments or disability. First all participants are asked ‘Do you have any long-standing physical or mental impairment, illness or disability? By ‘longstanding’ I mean anything that has troubled you over a period of at least 12 months or that is likely to trouble you over a period of at least 12 months.’ If participants respond in the affirmative they are then asked ‘Does this/Do these health problem(s) or disability(ies) mean that you have substantial difficulties with any of these areas of your life? Please read out the numbers from the card next to the ones which apply to you.’ One response option is ‘Memory or ability to concentrate, learn or understand’. We initially identified adults in US with potential intellectual disability on the basis of their positive response to this routed question. We then excluded from this group participants who did not meet the additional criteria of having a highest level of educational attainment lower than a General Certificate of Secondary Education or equivalent. Overall 22.5% of US participants reported lower than this level of attainment. This process identified 415 participants age 16– 49 (1.5% of the unweighted age-restricted sample) as having intellectual disability. Men were more likely to be identified as having intellectual disability than women (1.6% vs. 1.4%, OR = 1.10 (95%CI 0.90–1.33), n.s.). 2.3.2. Self-rated health Self-rated health was evaluated in both surveys by a single question incorporating five possible response options: LOS ‘How is your health in general; would you say it was. . . (1) very good, (2) good, (3) fair, (4) bad, (5) or very bad?’; Understanding Society: ‘In general, would you say your health is. . . (1) excellent, (2) very good, (3) good, (4) fair, (5) poor’. A binary measure of excellent/very good to good verses fair to very bad/poor self-rated health was derived for each participant (responses 1–2 vs. 3–5 in LOS, responses 1–3 vs. 4–5 in US). 2.3.3. Socio-economic disadvantage In both LOS and Understanding Society household socio-economic disadvantage was measured by a hardship scale. In LOS four items were included; ‘Looking at this card, can I just check whether your household could afford the following? (1) To pay for a week’s annual holiday away from home; (2) To eat meat, chicken or fish (or vegetarian equivalent) every second day; (3) Pay an unexpected, but necessary, expense of £500; (4) To keep your home adequately warm.’ A socioeconomic disadvantage score (0–4) based on the number of items that could not be afforded was derived for each participant. In Understanding Society eight items were included; ‘Next we have some questions about the sorts of things that some families/people have but which many people have difficulty finding the money for. For each of the following things please tell me the number from the showcard which best explains whether you (and your family/partner) have it or not. Do you (and your family partner) have. . . (1) A holiday away from home for at least one week a year, whilst not staying with relatives at their home? (2) Friends or family around for a drink or meal at least once a month? (3) Two pairs of all weather shoes for all adult members of the family? (4) Enough money to keep your house in a decent state of repair? (5) Household contents insurance? (6) Enough money to make regular savings of £10 a month or more for rainy days or retirement? (7) Enough money to replace any worn out furniture? (8) Enough money to replace or repair major electrical goods such as a refrigerator or a washing machine, when broken?’ The response options for each item were ‘1 I/We have this, 2 I/We would like to have this but cannot afford this at the moment, 3 I/We do not want/need this at the moment, 4 Does not apply’. A socio-economic disadvantage score (0–8) based on the number of items that could not be afforded was derived for each participant. 2.3.4. Discrimination and violence In LOS exposure to discrimination was measured by the following question; ‘In the last 12 months, do you feel that you have been treated unfairly by others for any of the reasons on this card? (1) age (2) sex (3) a health condition, illness or impairment, (4) disability related reasons, (5) ethnicity, (6) religion, (7) sexual orientation’. Exposure to violent crime in the last 12 months was measured by the following questions, with simple yes/no response options; ‘I would now like to ask you about crime. In the last 12 months, have you personally experienced any of the following. . . Violence or force used or threatened against you.’ Exposure to hate crime in the last 12 months was measured by the following two questions, each having simple yes/no response options. ‘A hate crime is one committed against you or your property on the grounds of your personal characteristics, for example religion, ethnic origin, disability or sexual orientation. Do you feel you have ever been a victim of a hate crime? Was this in the last 12 months?’ Information on discrimination and exposure to violence was not available in Understanding Society.

594

E. Emerson et al. / Research in Developmental Disabilities 35 (2014) 591–596

Table 1 Self-rated health, socio-economic disadvantage and exposure over the preceding 12 months to discrimination, harassment and hate crime among participants aged 16–49 with and without intellectual disability. Study/variable Self-rated health Life Opportunities Survey Very good Good Fair Bad Very bad Fair-very bad Understanding Society Excellent Very good Good Fair Poor Fair-poor Socio-economic disadvantage Life Opportunities Survey Mean number of items cannot afford (range 0–4) Understanding Society Mean number of items cannot afford (range 0–8)

With intellectual disability

Without intellectual disability

Test statistics

19.5% 29.9% 32.2% 14.4% 4.0% 50.6%

53.4% 36.2% 7.7% 2.1% 0.5% 10.4%

Mann–Whitney U = 546,165, Z =

2.5% 8.0% 23.5% 34.0% 32.0% 66.0%

22.3% 36.7% 28.1% 9.8% 3.1% 12.9%

Mann–Whitney U = 1,476,432, Z =

1.7

0.8

Mann–Whitney U = 583,859, Z =

3.6

1.6

Mann–Whitney U = 2,328,729, Z =

Exposure over the preceding 12 months to discrimination and violence Life Opportunities Survey Treated unfairly 36.4% 12.3% Threatened or actual violence 13.2% 5.8% Victim of hate crime 8.3% 2.4%

13.15, p < 0.001

OR = 8.86 (6.54–12.01), p < 0.001 23.73, p < 0.001

OR = 13.14 (10.65–16.21), p < 0.001

12.09, p < 0.001 17.64, p < 0.001

OR = 4.06 (2.83–5.82), p < 0.001 OR = 2.47 (1.58–3.87), p < 0.001 OR = 3.71 (1.97–6.99), p < 0.001

3. Results Simple descriptive statistics on the self-rated health, socio-economic disadvantage and exposure over the preceding 12 months to discrimination, harassment and hate crime of participants with and without intellectual disability are presented in Table 1. As can be seen, in both data sets participants with intellectual disability had significantly poorer self-rated health and were significantly more likely to be exposed to socio-economic disadvantage than participants without intellectual disability. In LOS they were also significantly more likely to have been exposed over the past 12 months to discrimination and violence. In order to examine the extent to which any between-group differences in health status may reflect between-group differences in rates of exposure to socio-economic disadvantage and discrimination we first created binary variables in each data set denoting fair or poorer health. We then examined the strength of association between intellectual disability and fair or poorer health while sequentially adjusting for between-group differences in: (1) age and sex; (2) socio-economic disadvantage; and for LOS (3) exposure to discrimination and violence. The resulting analyses are presented in Table 2. As can be seen, in both data sets controlling for between-group differences in exposure to socio-economic disadvantage significantly reduced but did not eliminate the association between intellectual disability and fair or poorer self-rated health. Estimating the magnitude of the reduction by 100*(model 1 idOR model 2 idOR)/(model 1 idOR 1) gives a 41% reduction in association in LOS and 34% reduction in US. Controlling for between-group differences in exposure to discrimination and violence in LOS led to a modest (21%) further reduction in the strength of the association between intellectual disability and fair or poorer self-rated health. 4. Discussion Our results indicate that: (1) British adults with intellectual disability have markedly poorer self-rated health than their non-disabled peers; and (2) that a significant proportion of their risk of poorer self-rated health may be attributable to their poorer living conditions (rather than their intellectual disability per se). These results add to existing knowledge about the health inequalities faced by people with intellectual disability in five important ways. First, they add to the very sparse literature on the self-rated health of adults with intellectual disability (Emerson & Hatton, 2014; Fujiura, 2012). Second, they present the first data on the extent to which risk of poorer self-rated health may be attenuated by taking into account between-group differences in living circumstances. Third, they add to the very sparse literature on the relationship between exposure to violence and discrimination and the health of adults with intellectual disability (Emerson, 2010). Fourth, they are based on the analysis of contemporary population-based sampling frames, a relative rarity in this field of study (Emerson & Hatton, 2014). Finally, by being based on samples drawn from

E. Emerson et al. / Research in Developmental Disabilities 35 (2014) 591–596

595

Table 2 Strength of association (odds ratio with 95% confidence intervals) between intellectual disability, socio-economic disadvantage, exposure to discrimination and violence and fair or poorer self-rated health. Life Opportunities Survey

Model 1 ***

Intellectual disability Socio-economic disadvantage Discrimination Violent crime Hate crime

10.45 (7.25–15.08)

Understanding Society Intellectual disability Socio-economic disadvantage

Model 1 12.28 (9.94–15.18)***

Model 2 (adjusted for socio-economic disadvantage) 6.59 (4.47–9.70)*** 1.76 (1.67–1.86)***

Model 3 (adjusted for socio-economic disadvantage, discrimination and victimisation) 5.41 (3.63–8.05)*** 1.68 (1.59–1.78)*** 3.05 (2.56–3.64)*** 1.78 (1.39–2.27)*** 1.11 (0.77–1.61)

Model 2 8.41 (6.75–10.49)*** 1.28 (1.26–1.30)***

Notes: All analyses adjusted for age and sex. *** p < 0.001.

general households participants are likely to include adults with less severe intellectual disability who may not be in receipt of specialised disability services. Given that most intellectual disability research is based on convenience samples drawn from the users of specialised disability services, very little is currently known about the health or well-being of this group that has been termed the ‘hidden majority’ of adults with intellectual disability (Emerson, 2011; Emerson & Brigham, 2013; Tymchuk, Lakin, & Luckasson, 2001). However, there are four limitations to the study that should be kept in mind when considering the salience and implications of these results. First, it is not possible to estimate the sensitivity or specificity of the method used to identify participants with intellectual disability in either survey. It should be noted, however, that: (1) the overall prevalence rates lies within the expected boundaries for intellectual disability (Maulik, Mascarenhas, Mathers, Dua, & Saxena, 2011) (2) the prevalence of intellectual disability varied with gender and indicators of socio-economic position in a manner consistent with previous epidemiological research (Maulik et al., 2011). Second, the use of general household sampling frames in both LOS and Understanding Society excludes people with (primarily more severe) intellectual disability living in more institutional forms of supported accommodation. Third, the consent and interview procedures used in LOS and Understanding Society are also likely to exclude people with more severe intellectual disability from participating. Consequently, the results are likely to be particularly relevant to understand the self-rated health of British adults with less severe intellectual disability. Finally, while the cross-sectional analyses presented in this paper are consistent with the hypothesis that the poorer self-rated health of adults with intellectual disability may be partially attributable to their poorer living conditions, it is not possible to rule out other explanations (e.g., people with intellectual disability are more susceptible to downward social mobility if they have poor health than their non-disabled peers). However, there is overwhelming evidence from the wider literature that the association between living conditions and health status is primarily driven by the causal influence of living conditions on health (Marmot, 2005; Marmot & Wilkinson, 2006; World Health Organization, 2008; World Health Organization Regional Office for Europe, 2012). The primary implication of these results are that research, policy and practice in intellectual disability needs to take account of social context in understanding and ameliorating the health inequalities experienced by people with intellectual disability (Emerson, 2013; Emerson & Hatton, 2014; Emerson et al., in press). Key aspects of social context include exposure the range of environmental adversities associated with low socio-economic position (Emerson, 2013) and exposure to overt or personal and institutional discrimination (Emerson, 2010; Emerson & Roulstone, in press; Krieger, 1999). A secondary implication is that population health approaches to reducing health inequalities need to recognise people with intellectual disabilities (and people with disabilities more generally) as constituting a particularly ‘vulnerable’ group for poor health and ensure that generic programs and interventions are tailored to their specific needs and context (World Health Organization, 2011). Future research is required to test the validity of components of the procedure used to identify adults with intellectual disability in generic health and social surveys. Longitudinal research is required to untangle the causal pathways linking the health of people with intellectual disabilities with socio-economic position and discrimination. References Boreham, R., Boldysevaite, D., & Killpack, C. (2012). UKHLS: Wave 1 technical report. London: NatCen. Buck, N., & McFall, S. L. (2012). Understanding Society: Design overview. Longitudinal and Life Course Studies, 3, 5–17. Cuddeford, J., Duncan, D., Howe, T., & Glen, F. (2008). Life Opportunities Survey: Development findings. London: Office for National Statistics. Dawe, F. (2011). Life Opportunities Survey – Wave one technical report, 2009/11. Newport: Office for National Statistics. Department of Health. (2007). Promoting equality: Response from department of health to the disability rights commission report, ‘‘Equal Treatment: Closing the Gap’’. London: Department of Health. DeSalvo, K. B., Bloser, N., Reynolds, K., He, J., & Muntner, P. (2006). Mortality prediction with a single general self-rated health question: A meta-analysis. Journal of General Internal Medicine, 21, 267–275. Disability Rights Commission. (2006). Equal treatment – Closing the gap. London: Disability Rights Commission. Emerson, E. (2010). Self-reported exposure to disablism is associated with poorer self-reported health and well-being among adults with intellectual disabilities in England: Cross sectional survey. Public Health, 124, 682–689.

596

E. Emerson et al. / Research in Developmental Disabilities 35 (2014) 591–596

Emerson, E. (2011). Health status and health risks of the ‘hidden majority’ of adults with intellectual disability. Intellectual & Developmental Disabilities, 49, 155– 165. Emerson, E. (2013). Commentary: Childhood exposure to environmental adversity and the well-being of people with intellectual disabilities. Journal of Intellectual Disabilities Research, 57, 589–600. http://dx.doi.org/10.1111/j.1365-2788.2012.01577.x Emerson, E., & Brigham, P. (2013). Health behaviours and mental health status of parents with intellectual disabilities. Public Health, 127, 1111–1116. Emerson, E., & Hatton, C. (2007a). The contribution of socio-economic position to the health inequalities faced by children and adolescents with intellectual disabilities in Britain. American Journal on Mental Retardation, 112, 140–150. Emerson, E., & Hatton, C. (2007b). Poverty, socio-economic position, social capital and the health of children and adolescents with intellectual disabilities in Britain: A replication. Journal of Intellectual Disability Research, 51, 866–874. Emerson, E., & Hatton, C. (2008). Socioeconomic disadvantage, social participation and networks and the self-rated health of English men and women with mild and moderate intellectual disabilities: Cross sectional survey. European Journal of Public Health, 18, 31–37. Emerson, E., & Hatton, C. (2014). Health inequalities and people with intellectual disabilities. Cambridge: Cambridge University Press. Emerson, E., & Roulstone, A. (in press). Developing an evidence base for violent and disablist hate crime in the Britain: Findings from the Life Opportunities Survey. Journal of Interpersonal Violence. (in press). Emerson, E., Vick, B., Rechel, B., Mun˜oz, I., Sørensen, J., & Fa¨rm, I. (2014). Health inequalities and people with disabilities in Europe. Copenhagen: European Regional Office of the World Health Organization. (in press). Fujiura, G. T. (2012). Self-reported health of people with intellectual disability. Intellectual and Developmental Disabilities, 50, 352–369. Haider, S. I., Ansari, Z., Vaughan, L., Matters, H., & Emerson, E. (2013). Health and wellbeing of Victorian adults with and without an intellectual disability. Research in Developmental Disabilities, 34, 4034–4042. Heslop, P., Blair, P., Fleming, P., Hoghton, M., Marriott, A., & Russ, L. (2013). Confidential inquiry into premature deaths of people with learning disabilities. Bristol: Norah Fry Research Centre. Howe, T. (2010). Life Opportunities Survey: User guide to coding and defining disability. Newport: Office for National Statistics. Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21–37. Idler, E. L., & Benyamini, Y. (1999). Community studies reporting association between self-rated health and mortality: Additional studies, 1995 to 1998. Research on Aging, 21, 392–401. Jylha, M. (2009). What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social Science & Medicine, 69, 307–316. Krahn, G., & Fox, M. H. (in press). Health disparities of adults with intellectual disabilities: What do we know? What do we do?. Journal of Applied Research in Intellectual Disability. (in press). Krahn, G., Fox, M. H., Campbell, V. A., Ramon, I., & Jesien, G. (Writers). (2010). Developing a health surveillance system for people with intellectual disabilities in the United States. Journal of Policy & Practice in Intellectual Disabilities, 7, 155–166. Krieger, N. (1999). Embodying inequality: A review of concepts, measures, and methods for studying health consequences of discrimination. International Journal of Health Services, 29, 295–352. Larson, S., Lakin, K. C., & Anderson, L. L. (2003). Definitions and findings on intellectual and developmental disabilities within the NHIS-D. In B. M. Altman, S. N. Barnartt, G. E. Hendershot, & S. A. Larson (Eds.), Using survey data to study disability: Results from the National Health Interview Survey on Disability (pp. 229– 255). Boston: Elsevier. Larson, S., Lakin, C., Anderson, L., & Kwak, N. (2001). Characteristics of and service use by persons with MR/DD living in their own homes or with family members: NHIS-D analysis. Minneapolis, MN: Research and Training Center on Community Living, Institute on Community Integration, University of Minnesota. Larson, S., Lakin, K. C., Anderson, L., Kwak, N., Lee, J. H., & Anderson, D. (2001). Prevalence of mental retardation and developmental disabilities: Estimates from the 1994/1995 National Health Interview Survey Disability Supplements. American Journal on Mental Retardation, 106, 231–252. Marmot, M. (2005). Social determinants of health inequalities. Lancet, 365, 1099–1104. Marmot, M., & Wilkinson, R. G. (Eds.). (2006). Social determinants of health (2nd ed.). Oxford: Oxford University Press. Maulik, P. K., Mascarenhas, M. N., Mathers, C. D., Dua, T., & Saxena, S. (2011). Prevalence of intellectual disability: A meta-analysis of population-based studies. Research in Developmental Disabilities, 32, 419–436. McFall, S. L. (Ed.). (2012). Understanding Society: Findings. Colchester: Institute for Social and Economic Research, University of Essex. McFall, S. L., & Garrington, C. (Eds.). (2011). Early findings from the first wave of the UK’s household longitudinal study. Colchester: Institute for Social and Economic Research, University of Essex. Mencap. (2007). Death by indifference. London: Mencap. Mencap. (2012). Death by indifference: 74 deaths and counting. A progress report 5 years on. London: Mencap. Michael, J. (2008). Healthcare for all: Report of the independent inquiry into access to healthcare for people with learning disabilities. London: Independent Inquiry into Access to Healthcare for People with Learning Disabilities. Office for Disability Issues. (2011). Life Opportunities Survey: Wave one results, 2009/11. London: Office for Disability Issues. Office for National Statistics. (2011). Life Opportunities Survey. Colchester: UK Data Archive. Parliamentary and Health Service Ombudsman and Local Government Ombudsman. (2009). Six lives: The provision of public services to people with learning disabilities. London: Parliamentary and Health Service Ombudsman and Local Government Ombudsman. Tymchuk, A. J., Lakin, K. C., & Luckasson, R. (Eds.). (2001). The forgotten generation: The status and challenges of adults with mild cognitive limitations. Baltimore: Brookes. United Nations. (2006). Convention on the rights of persons with disabilities. New York: United Nations. US Department of Health and Human Services. (2002). Closing the gap: A national blueprint to improve the health of persons with mental retardation. Rockville, MD: US Department of Health and Human Services. World Health Organization (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final report of the Commission on the Social Determinants of Health. Geneva: World Health Organization. World Health Organization. (2011). Rio political declaration on social determinants of health. Geneva: World Health Organization. http://www.who.int/ sdhconference/declaration/en/. World Health Organization Regional Office for Europe. (2012). Report on social determinants of health and the health divide in the WHO European Region: Executive summary. Copenhagen: World Health Organization Regional Office for Europe.

The self-rated health of British adults with intellectual disability.

People with intellectual disability have significantly higher age-adjusted rates of mortality and morbidity than their non-disabled peers. While self-...
302KB Sizes 3 Downloads 0 Views

Recommend Documents


The physical health of British adults with intellectual disability: cross sectional study.
Adults with intellectual disability have poorer health than their non-disabled peers. However, little is known about the health of the 'hidden majority' of adults with primarily mild intellectual disability who do not use intellectual disability serv

Obesity and health behaviours of British adults with self-reported intellectual impairments: cross sectional survey.
People with intellectual disability have significantly higher age-adjusted rates of mortality and morbidity (including obesity) than their non-disabled peers. They are also significantly less likely to be physically active.

Perceptions of neighbourhood quality, social and civic participation and the self rated health of British adults with intellectual disability: cross sectional study.
There is extensive evidence from research undertaken on general population samples that people who have more extensive and closer social networks and people who report feeling connected to their local community tend to have better health. However, re

Hospitalizations of adults with intellectual disability in academic medical centers.
Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions an

Predictors of specialized inpatient admissions for adults with intellectual disability.
Individuals with intellectual disability (ID) have complex mental health needs and may seek specialized ID psychiatric services. This study reports on predictors of specialized inpatient admissions for 234 individuals with ID who received outpatient

Central nervous system medication use in older adults with intellectual disability: Results from the successful ageing in intellectual disability study.
Information on the rates and predictors of polypharmacy of central nervous system medication in older people with intellectual disability is limited, despite the increased life expectancy of this group. This study examined central nervous system medi

Sedentary and Physical Activity Patterns in Adults with Intellectual Disability.
Little is known about the patterns of sedentary time (ST) and physical activity (PA) levels throughout the week among adults and older adults with Intellectual Disability (ID). We analyzed ST and PA patterns of adults and older adults with ID. Forty-

Obesity and associated factors in adults with intellectual disability.
We examined the prevalence of obesity in adults with intellectual disabilities (ID) compared with the general population, and the factors associated with obesity and weight management status, comparing individuals with ID who were overweight or obese

Obesity in British children with and without intellectual disability: cohort study.
Reducing the prevalence of and inequities in the distribution of child obesity will require developing interventions that are sensitive to the situation of 'high risk' groups of children. Children with intellectual disability appear to be one such gr

Ambulatory mental health data demonstrates the high needs of people with an intellectual disability: results from the New South Wales intellectual disability and mental health data linkage project.
To investigate the ambulatory mental health service profile of persons with intellectual disability (ID) in a representative sample of New South Wales (NSW).