Health-related lifestyles and obesity among adults with and without disability in Australia: Implication for mental health care

Tobacco use among adults with disabilities in nine countries-Demographic and Health Survey, 2016-2021

Few studies have investigated tobacco use among people with disabilities living in low- and middle-income countries (LMICs). We aimed to examine current tobacco use among men and women with disabilities using Demographic and Health Survey (DHS) data from 9 LMICs. We considered a respondent currently use tobacco products if they reported current use of any combustible/smoked tobacco products or smokeless tobacco products. We performed secondary analyses of DHS data from 2016-2021 collected in Haiti, Mali, Mauritania, Nigeria, Pakistan, Rwanda, South Africa, Timor-Leste, and Uganda. We examined marginal effects in logistic regression to calculate the adjusted prevalence and adjusted prevalence differences of tobacco use by disability status, controlling for selected sociodemographic characteristics. The adjusted prevalence of current use of tobacco products among women with a moderate/severe disability, mild disability, and no disability varied across countries, with medians of 1.9% (range = 0.1% [Mali] to 11.3% [Pakistan]), 3.2% (range = 0.9% [Nigeria] to 13.3% [South Africa]), and 2.3% (range = 0.5% [Nigeria] to 8.9% [South Africa]), respectively. For men with moderate/severe disability, the median adjusted prevalence for current use of tobacco products was 18.8% (range = 8.9% [Rwanda] to 55.0% [Timor-Leste]). The median prevalences of current use of tobacco products for men with mild disability and no disability were similar to those with moderate/severe disability, at 16.5% and 15.9%, respectively. Current tobacco product use among people with disabilities varied for countries included in our study; however, with few exceptions, current tobacco product use was similar across disability status groups. Additional research is warranted to determine whether our findings extend beyond the nine countries assessed here. It is important to consider the needs of people with disabilities in tobacco prevention, control, and cessation efforts so that this substantial population can benefit equitably from such programs, interventions, or policies.

Health insurance and subjective well-being: evidence from integrating medical insurance across urban and rural areas in China

Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban-rural health insurance integration on the SWB of the Chinese population. Analysing 2011-18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts.

Impairments, health conditions and health risk behaviors: occurrence and associations, in the National Health Survey, Brazil, 2019

OBJECTIVE

To analyze association of visual, hearing, mental/intellectual, physical and multiple impairments with health conditions and health risk behaviors in Brazil.

METHODS

This was a cross-sectional study, using data from the 2019 National Health Survey; associations between impairments and presence of cardiovascular disease (CVD), hypertension, diabetes mellitus (DM), high cholesterol, alcohol abuse and smoking were estimated using logistic regression, thus obtaining the odds ratios (OR).

RESULTS

Impairment was reported by 7.6% of the 90,846 participants. Having a impairment was associated with greater odds of reporting chronic conditions, especially CVD (OR = 2.11; 95%CI 1.76;2.54) and DM (OR = 1.78; 95%CI 1.56;2.02 ); visual impairment was associated with greater odds of smoking (OR = 1.52; 95%CI 1.28;1.81); mental/intellectual impairment was inversely related to smoking (OR = 0.45; 95%CI 0.30;0.67) and alcohol abuse (OR = 0.13; 95%CI 0.06;0.26).

CONCLUSION

Having any of the impairments studied may be associated with greater odds of having chronic health conditions.

MAIN RESULTS

Positive association was identified between having one or more impairments, and health conditions and health risk behaviors. The higher the prevalence of mental/intellectual, physical and multiple impairments, the lower alcohol abuse and smoking.

IMPLICATIONS FOR SERVICES

As this population is vulnerable to chronic health conditions, health services need strategies to reduce barriers to access, as well as health promotion actions, such as health education, adapted for people with impairments.

PERSPECTIVES

Topics for future studies, examining the inverse relationship between impairments and alcohol abuse and smoking, in addition to acting on the causal chain, so as to prevent health conditions and health risk behaviors.

Association of demographics, cardiovascular indicators and disability characteristics with 7-year coronary heart disease incident in persons with disabilities

OBJECTIVE

Previous studies had demonstrated that disability increases mortality in patients with coronary heart disease (CHD). However, for people who had been disabled but do not have baseline cardiovascular disease, there is still limited data on how they might develop CHD. This study aimed to investigate the incidence and predictors of CHD in people with disabilities.

METHODS

We conducted a 7-year retrospective study utilizing data from the Shanghai Comprehensive Information Platform for Persons with Disabilities Rehabilitation. Subjects aged over 18 years with at least four annual complete electronic health records were included. The primary outcome was CHD, defined as ischemic heart disease or myocardial infarction. Kaplan-Meier analysis and log-rank tests were used to compare cumulative CHD for sub-populations, stratified by age, gender, and the classification of disabilities. Cox regression was used to identify the potentially important factors.

RESULTS

Out of 6419 persons with disabilities, 688 CHD cases (mean age 52.95 ± 7.17 years, male 52.2%) were identified, with a cumulative incidence of 10.72% and an incidence density of 15.15/1000 person-years. The incidence density of CHD is higher in the male gender, people over 45 years, and those with physical disabilities. Male (HR = 1.294, 95% CI, 1.111-1.506), hypertension (HR = 1.683, 95% CI, 1.405-2.009), diabetes mellitus (HR = 1.488, 95% CI, 1.140-1.934), total cholesterol (HR = 1.110, 95% CI, 1.023-1.204), and physical disabilities (HR = 1.122, 95% CI, 1.019-1.414) were independently associated with CHD.

CONCLUSION

The findings indicate that the incidence of CHD differs across disability categories rather than the severity of disability. People with physical disabilities had significantly higher risks for the development of CHD. The underlying physiological and pathological factors need to be further studied.

A scoping review on how physical fitness is evaluated in sitting volleyball players

INTRODUCTION

Sitting volleyball is a widely practiced paralympic sport. A correct and standardized physical evaluation helps coaches to plan and manage the training. It is also important to evaluate physical fitness accurately and adopt standardized protocols to compare and normalize the data. The aim of the study was to evaluate physical fitness evaluation methods adopted in sitting volleyball and to eventually propose standard operating procedures.

EVIDENCE ACQUISITION

English-written and peer-reviewed original articles were included in this review. The population studied was composed only of athletes practicing sitting volleyball. Articles were searched on the electronic databases PubMed, Web of Science, and Scopus using keywords matched with Boolean operators. Two independent investigators collected and screened the studies against the eligibility criteria. Data were analyzed narratively.

EVIDENCE SYNTHESIS

Only 7 studies were eligible and included in this review, but a wide testing methodology exists. There are some tests commonly adopted in the studies included and these are the handgrip test, the agility t-test, the speed, and endurance test. These tests with the 2-site skinfold thickness evaluation, the modified push-ups, the shoulder-stretch test, the chest throw test and the simple reaction time task were included in the standard operating procedure.

CONCLUSIONS

The literature on the topic is poor and standardization of the testing procedure to evaluate the physical fitness of people practicing SV has been provided.

Urgent Need of Integrated Health and Social Care to Alleviate High Psychological Distress in People with Disabilities: A Cross-Sectional National Representative Survey in Australia

OBJECTIVE

To investigate factors in association with high psychological distress in people with disabilities.

METHODS

We used the 2015 national survey on disability in Australia to derive the representative study population of 7936 people with disabilities aged 18+ years. The Kessler Psychological Distress Scale (K10) was used to define high psychological distress (scores ≥22). The explanatory variables included socioeconomic status, physical health, social relationships and environment factors. Adjusted Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were evaluated using weighted Logistic regression models with lasso techniques.

RESULTS

Approximately 21 in 100 study participants experienced high psychological distress. The risk of high psychological distress decreased with age and high educational attainment. Having non-English speaking background (2.31; 1.87-2.85) and need for assistance in cognitive or emotional tasks (3.25; 2.65-3.98) were independently significantly associated with high psychological distress in people with disabilities. Delay seeing a GP was associated with a 2-fold risk increase.

CONCLUSION

Integrated healthcare and social support are warranted with appropriate targeting to improve mental health outcomes in people with disabilities.

Psychiatric disorders and suicide risk among adults with disabilities: A nationwide retrospective cohort study

BACKGROUND

Adults with disabilities demonstrate a higher suicide risk than the general population; however, the association between mental illness and death by suicide among disabled adults remains relatively unknown. We aimed to explore the relationship between psychiatric disorders and suicide risk in adults with disabilities.

METHODS

We used nationally representative cohort data and included adults who registered as having a disability from 2004 to 2012, following up with them throughout 2013. We used the clinical diagnoses of all psychiatric disorders as an independent variable and death by suicide as a dependent variable to estimate the adjusted hazard ratio (AHR) of suicide risk using a Cox proportional hazards model.

RESULTS

Among adults with disabilities (n = 30,386), those who had any psychiatric disorder were at an increased risk of death by suicide compared to those without mental illness (AHR 1.42; 95% confidence interval [CI] 1.02-1.99). Adults with mild disabilities who had psychiatric or mood disorders were more likely to commit suicide than the comparison group (AHR 1.67, 3.00; 95% CI 1.13-2.46, 1.95-4.61, respectively).

LIMITATIONS

The actual time of disability onset could differ from the time of disability registration.

CONCLUSIONS

Adults with disabilities who have psychiatric disorders are at increased risk of suicide compared to those without mental illness. During rehabilitation treatment after disability diagnosis, mental health support should be provided to those who have psychiatric illnesses to potentially reduce the risk of death by suicide.