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Rudra S, McManus S, Hassiotis A, Ali A. Mental health and service use of parents with and without borderline intellectual functioning. Psychol Med 2024; 54:1294-1308. [PMID: 37877259 DOI: 10.1017/s0033291723003136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Abstract
BACKGROUND People with borderline intellectual functioning (BIF) encounter greater social adversities than the general population and have an increased prevalence of mental illness. However, little is known about the socio-demographic characteristics and mental health of parents with BIF. METHODS A secondary data analysis of the Adult Psychiatric Morbidity Survey 2014 was conducted. Logistic regression models were fitted to compare differences in socio-demographic, mental health and service-use characteristics between parents and non-parents with and without BIF, and to investigate if the relationship between parent status and mental health outcomes was modified by BIF status, sex, and employment. RESULTS Data from 6872 participants was analyzed; 69.1% were parents. BIF parents had higher odds of common mental disorder, severe mental illness, post-traumatic stress disorder, self-harm/suicide and were more likely to see their General Practitioner (GP) and to receive mental health treatment than non-BIF parents. BIF parents did not have a higher prevalence of mental health problems than BIF non-parents. Being a parent, after adjusting for BIF status and other confounders, was associated with increased odds of having a common mental disorder, visits to see a GP and treatment for mental health. Female parents had higher odds of treatment for mental health problems. CONCLUSIONS Being a parent is associated with elevated rates of common mental disorders. There is a higher burden of mental health problems and service use in people with BIF. A greater provision of specialist support services including ascertainment is indicated for this group.
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Affiliation(s)
| | - Sally McManus
- City University and NatCen Associate; NatCen Social Research, London, UK
| | | | - Afia Ali
- Queen Mary University of London, Wolfson Institute of Population Health, London, UK
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McKee MM, Zhang J, Akobirshoev I, McKee K, Mitra M. Antenatal Hospital Use among Deaf and Hard of Hearing Women. Am J Perinatol 2024; 41:e1560-e1569. [PMID: 36918163 DOI: 10.1055/a-2053-7439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Hearing loss is increasingly prevalent among younger adults, impacting health and health care use. Deaf and hard of hearing (DHH) women have a higher risk of chronic diseases, pregnancy complications, and adverse birth outcomes compared with hearing women. Health care utilization patterns during the perinatal period remain not well understood. The objective of this study was to examine differences in antenatal emergency department and inpatient utilization among DHH and non-DHH women. STUDY DESIGN We conducted a retrospective cohort study design to analyze 2002 to 2013 Massachusetts Pregnancy to Early Life Longitudinal data to compare antenatal inpatient and emergency department use between DHH (N = 925) and hearing (N = 2,895) women with singleton deliveries. Matching was done based on delivery year, age at delivery, and birth parity in 1:3 case-control ratio. Demographic, socioeconomic, clinical, and hospital characteristics were first compared for DHH mothers and the matched control group using chi-squared tests and t-tests. Multivariable models were adjusted for sociodemographic and clinical characteristics. RESULTS Among DHH women (N = 925), 49% had at least one emergency department visit, 19% had an observational stay, and 14% had a nondelivery hospital stay compared with 26, 14, and 6%, respectively, among hearing women (N = 28,95) during the antenatal period (all ps < 0.001). The risk of nondelivery emergency department visits (risk ratio [RR] 1.58; p < 0.001) and inpatient stays (RR = 1.89; p < 0.001) remained higher among DHH women compared with hearing women even after adjustment. Having four or more antenatal emergency department visits (7 vs. 2%) and two or more nondelivery hospital stays (4 vs. 0.4%) were more common among pregnant DHH women compared with their controls (all p-values < 0.001). CONCLUSION The findings demonstrate that DHH women use emergency departments and inpatient services at a significantly higher rate than their hearing controls during the antenatal period. A systematic investigation of the mechanisms for these findings are needed. KEY POINTS · Antenatal emergency department use is significantly higher among deaf and hard of hearing women.. · Antenatal hospitalizations are significantly higher among deaf and hard of hearing women.. · Hearing loss screening may identify those at risk for adverse pregnancy and birth outcomes..
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Affiliation(s)
- Michael M McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jianying Zhang
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - Kimberly McKee
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
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3
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Powell RM, Albert SM, Nthenge S, Mitra M. Family Caregivers' Attitudes and Perspectives About the Sexual and Reproductive Health of Women With Intellectual and Developmental Disabilities: An Online Survey. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2024; 129:135-150. [PMID: 38411243 DOI: 10.1352/1944-7558-129.2.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/11/2023] [Indexed: 02/28/2024]
Abstract
Although sexual and reproductive health is critically important for women with intellectual and developmental disabilities (IDD), there is limited research elucidating the role of family caregivers in assisting women with IDD access sexual and reproductive health services and information. Understanding the family caregivers' attitudes and perspectives is essential to improving access to sexual and reproductive health services and information for women with IDD. A cross-sectional online survey of family caregivers of women with IDD was administered between June and October 2018. Quantitative analysis was conducted for closed-ended responses, and qualitative analysis was conducted for open-ended responses. The analytic sample included 132 family caregivers. Most participants were parents and reported being closely involved in their family member's access to sexual and reproductive health services and information. Although most participants expressed that sexual and reproductive health services and information are essential for women with IDD, qualitative analysis of participants' open-ended responses revealed both supportive and restrictive attitudes and perspectives on sexual and reproductive health services and information for women with IDD. Supportive attitudes and perspectives included (1) "knowledge is power;" (2) supported decision-making; and (3) protection against sexual abuse. Restrictive attitudes and perspectives included (1) dependent on the individual; (2) lack of autonomy; and (3) placing responsibility on disability. Greater attention from policymakers and practitioners to systems-level changes, including universal and accessible sexual education for women with IDD, supported decision-making, and sexual abuse prevention measures, are urgently needed.
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Affiliation(s)
- Robyn M Powell
- Robyn M. Powell, University of Oklahoma College of Law and The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University
| | - Sasha M Albert
- Sasha M. Albert, The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University
| | | | - Monika Mitra
- Monika Mitra, The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University
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Pérez-Curiel P, Vicente E, Morán ML, Gómez LE. The Right to Sexuality, Reproductive Health, and Found a Family for People with Intellectual Disability: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1587. [PMID: 36674341 PMCID: PMC9864803 DOI: 10.3390/ijerph20021587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/08/2023] [Accepted: 01/12/2023] [Indexed: 05/31/2023]
Abstract
Although sexuality, reproductive health, and starting a family are human rights that should be guaranteed for all citizens, they are still taboo issues for people with intellectual disability (ID), and even more so for women with ID. This paper systematically reviews the current qualitative and quantitative evidence on the rights of people with ID in regard to Articles 23 (right to home and family) and 25 (health, specifically sexual and reproductive health) of the Convention on the Rights of Persons with Disabilities (CRPD). A systematic review of the current literature, following PRISMA 2020, was carried out in ERIC, PsychInfo, Scopus, PubMed, ProQuest, and Web of Science. In all, 151 articles were included for review. The studies were categorized into six themes: attitudes, intimate relationships, sexual and reproductive health, sexuality and sex education, pregnancy, and parenthood. There are still many barriers that prevent people with ID from fully exercising their right to sexuality, reproductive health, and parenthood, most notably communicative and attitudinal barriers. These findings underline the need to continue advancing the rights of people with ID, relying on Schalock and Verdurgo's eight-dimensional quality of life model as the ideal conceptual framework for translating such abstract concepts into practice and policy.
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Affiliation(s)
- Patricia Pérez-Curiel
- Department of Psychology and Sociology, University of Zaragoza, C./Pedro Cerbuna, 12, 50009 Zaragoza, Spain
| | - Eva Vicente
- Department of Psychology and Sociology, University of Zaragoza, C./Pedro Cerbuna, 12, 50009 Zaragoza, Spain
| | - M. Lucía Morán
- Department of Education, University of Cantabria, Av./de los Castros, 52, 39005 Santander, Spain
| | - Laura E. Gómez
- Department of Psychology, University of Oviedo, 33003 Oviedo, Spain
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Horner-Johnson W, Garg B, Darney BG, Biel FM, Caughey AB. Severe maternal morbidity and other perinatal complications among women with physical, sensory, or intellectual and developmental disabilities. Paediatr Perinat Epidemiol 2022; 36:759-768. [PMID: 35437812 PMCID: PMC9398919 DOI: 10.1111/ppe.12873] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 12/28/2022]
Abstract
BACKGROUND Little is known about severe maternal morbidity (SMM) among women with disabilities. OBJECTIVE We assessed differences in SMM and other perinatal complications by presence and type of disability. We hypothesised that SMM and other complications would be more common in births to women with disabilities than to women without disabilities. METHODS We conducted a retrospective cohort study of California births from 2000 to 2012, using birth and death certificate data linked with hospital discharge data. We included singleton deliveries with gestational age of 23-42 weeks. We classified women as having any disability or not and identified disability type (physical, hearing, vision, intellectual/developmental disabilities [IDD]). Our primary outcome was a composite indicator of SMM. Secondary outcomes included additional perinatal complications: gestational hypertension, preeclampsia, gestational diabetes, venous thromboembolism, chorioamnionitis, puerperal endometritis and mental health disorders complicating pregnancy, childbirth or the puerperium. We used modified Poisson regression to obtain covariate-adjusted relative risks (RR) and 95% confidence intervals (CI) for the association of disability status and type with SMM and secondary outcomes. RESULTS Of 5,787,090 deliveries, 33,044 (0.6%) were to women with disabilities. Of these, 311 per 10,000 were complicated by SMM, compared with 84 per 10,000 deliveries to women without disabilities. In multivariable analyses, risk of SMM for births to women with disabilities was nearly three times that for women without disabilities (RR 2.84, 95% CI 2.67, 3.02). Proportion and risk of SMM were greatest for vision disability (793 per 10,000; RR 4.04, 95% CI 3.41, 4.78). Secondary outcomes were also more common among women with disabilities. In particular, more than a third of births to women with IDD (37.4%) were complicated by mental health disorders (versus 2.2% for women without disabilities). CONCLUSION As hypothesised, SMM and other perinatal complications were more common among women with disabilities than among women without disabilities.
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Affiliation(s)
- Willi Horner-Johnson
- Institute on Development and Disability, Oregon Health & Science University, Portland, OR
- OHSU-PSU School of Public Health, Portland, OR
| | - Bharti Garg
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Blair G. Darney
- OHSU-PSU School of Public Health, Portland, OR
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | - Frances M. Biel
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
- Present affiliation: OCHIN, Inc., Portland, OR
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
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York J, Wechuli Y, Karbach U. Emergency Medical Care of People with Intellectual Disabilities: A Scoping Review. Open Access Emerg Med 2022; 14:441-456. [PMID: 35983306 PMCID: PMC9381009 DOI: 10.2147/oaem.s361676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/13/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose The paper intends to do a scoping review of people with intellectual disabilities in emergency care where this group seems to face access barriers and discrimination. It analyses the conceptual and methodological framework for studies examining the former. Methods A scoping review is conducted. The studies' quality is assessed via a checklist developed by the authors drawing on a compilation of common assessment tools for study quality. Results Fourteen quantitative studies fulfil the inclusion criteria for further analysis. Summary measures are extracted. Results are synthesized with Andersen's Behavioral Model of Health Service Use. Studies employ a combination of variables attributable to different aspects of population characteristics and health behavior. Conclusion Most studies seek to quantify or predict emergency care overuse by people with intellectual disabilities. Future studies should also take patients' poor health or treatment outcomes and their perspectives into account.
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Affiliation(s)
- Jana York
- Faculty of Rehabilitation Sciences, TU Dortmund University, Dortmund, Germany
| | - Yvonne Wechuli
- Faculty of Human Sciences, University of Kassel, Kassel, Germany
| | - Ute Karbach
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
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Rosenthal E, Parish SL, Ransom C, Smith LD, Mitra M. Formal and Informal Supports for Women With Intellectual and Developmental Disabilities During Pregnancy. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 60:261-272. [PMID: 35868299 DOI: 10.1352/1934-9556-60.4.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 01/18/2022] [Indexed: 06/15/2023]
Abstract
This article explores the role of formal and informal supports for women with intellectual and developmental disabilities (IDD) throughout their pregnancy, childbirth, and postpartum experiences. Data from qualitative interviews with women with IDD (n = 16) were analyzed. Results showed that formal supports aided in planning, transportation, advocacy, and providing emotional support throughout pregnancy. Informal supports helped with errands, comfort, and emotional encouragement. The community surrounding these women facilitated communication with providers, self-empowerment regarding health choices, and increased preparedness for parenthood. Findings indicate the importance of encouraging and sustaining both formal and informal supports during pregnancy, childbirth, and postpartum to improve pregnancy and parenting experiences for women with IDD.
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Affiliation(s)
| | | | | | | | - Monika Mitra
- Lauren D. Smith and Monika Mitra, Brandeis University
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8
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Smith LD, Valentine A, Moore Simas TA, Parish SL, Levy A, Mitra M. Clinician-reported barriers to providing perinatal care to women with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2022; 48:12-22. [PMID: 36969147 PMCID: PMC10036077 DOI: 10.3109/13668250.2022.2086110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Research suggests that women with intellectual and developmental disabilities are at increased risk for adverse pregnancy outcomes. Further, they report unmet perinatal care needs. This qualitative study examined clinician perspectives on barriers to providing perinatal care to women with intellectual and developmental disabilities. Method We conducted semi-structured interviews and one focus group with US obstetric care clinicians (n=17). We used a content analysis approach to code data and analyse them for larger themes and relationships. Results The majority of participants were white, non-Hispanic, and female. Participants reported barriers providing care to pregnant women with intellectual and developmental disabilities across individual (e.g., communication challenges), practice (e.g., identification of disability status), and system levels (e.g., lack of clinician training). Conclusions Clinician training and evidence-based guidelines for perinatal care of women with intellectual and developmental disabilities as well as services and supports during pregnancy are needed.
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Affiliation(s)
- Lauren D. Smith
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester , MA, USA
| | - Susan L. Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Alanna Levy
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
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Ransohoff JI, Kumar PS, Flynn D, Rubenstein E. Reproductive and pregnancy health care for women with intellectual and developmental disabilities: A scoping review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:655-674. [PMID: 35064736 PMCID: PMC10119781 DOI: 10.1111/jar.12977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/22/2021] [Accepted: 01/09/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities face poorer reproductive and pregnancy outcomes partially due to health care inequity. Our objective was to conduct a scoping review of reproductive and pregnancy related health care among women with intellectual and developmental disabilities. METHODS We systematically reviewed three databases for keywords pertaining to pregnancy, reproductive health, and intellectual and developmental disabilities. Two reviewers screened abstracts and extracted full text. We synthesised included papers, identifying common themes. RESULTS Thirty-six papers met review criteria. Women with intellectual and developmental disabilities had lower fertility rates and were less likely to receive adequate sexual education compared to peers. While most women received prenatal care, uptake was lower and received later than women without intellectual and developmental disabilities. CONCLUSIONS Pregnancy-related health care is often lacking for women with intellectual and developmental disabilities. There are gaps inhibiting our understanding which prevents action to reduce health disparities.
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Affiliation(s)
- Jade I. Ransohoff
- School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Prisha Sujin Kumar
- School of Public Health, Boston University, Boston, Massachusetts, USA
- Boston University Medical Campus, Boston University, Boston, Massachusetts, USA
| | - David Flynn
- Boston University Medical Campus, Boston University, Boston, Massachusetts, USA
| | - Eric Rubenstein
- School of Public Health, Boston University, Boston, Massachusetts, USA
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Mitra M, Akobirshoev I, Valentine A, Brown HK, Moore Simas TA. Severe Maternal Morbidity and Maternal Mortality in Women With Intellectual and Developmental Disabilities. Am J Prev Med 2021; 61:872-881. [PMID: 34579985 PMCID: PMC8608722 DOI: 10.1016/j.amepre.2021.05.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 05/01/2021] [Accepted: 05/24/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Despite increased attention on severe maternal morbidity and maternal mortality, scant research exists on adverse maternal outcomes in women with disabilities. This study compares the rates of severe maternal morbidity and maternal mortality in women with and without intellectual and developmental disabilities. METHODS This study used 2004-2017 Healthcare Cost and Utilization Project Nationwide Inpatient Sample data. Analyses were conducted in 2019‒2020. The risk of severe maternal morbidity with and without blood transfusion and maternal mortality during delivery among women with and without intellectual and developmental disabilities were compared using modified Poisson regression analysis. RESULTS This study identified 32,324 deliveries to women with intellectual and developmental disabilities. Per 10,000 deliveries, 566 deliveries with severe maternal morbidity occurred in women with intellectual and developmental disabilities compared with 239 in women without intellectual and developmental disabilities. Women with intellectual and developmental disabilities had greater risk of both severe maternal morbidity (risk ratio=2.36, 95% CI=2.06, 2.69) and nontransfusion severe maternal morbidity (risk ratio=2.95, 95% CI=2.42, 3.61) in unadjusted analyses, which was mitigated in adjusted analyses for sociodemographic characteristics (risk ratio=1.74, 95% CI=1.47, 2.06; risk ratio=1.85, 95% CI=1.42, 2.41) and the expanded obstetric comorbidity index (risk ratio=1.23, 95% CI=1.04, 1.44; risk ratio=1.31, 95% CI=1.02, 1.68). The unadjusted incidence of maternal mortality in women with intellectual and developmental disabilities was 284 per 100,000 deliveries, nearly 4-fold higher than in women without intellectual and developmental disabilities (69 per 100,000 deliveries; risk ratio=4.07, 95% CI=2.04, 8.12), and the risk remained almost 3-fold higher after adjustment for sociodemographic characteristics (risk ratio=2.86, 95% CI=1.30, 6.29) and the expanded obstetric comorbidity index (risk ratio=2.30, 95% CI=1.05, 5.29). CONCLUSIONS Women with intellectual and developmental disabilities are at increased risk of severe maternal morbidity and maternal mortality. These findings underscore the need for enhanced monitoring of the needs and maternal outcomes of women with intellectual and developmental disabilities in efforts to improve maternal health.
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Affiliation(s)
- Monika Mitra
- The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts.
| | - Ilhom Akobirshoev
- The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Anne Valentine
- The Lurie Institute for Disability Policy, Brandeis University, Waltham, Massachusetts
| | - Hilary K Brown
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, Worcester, Massachusetts
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Bensken WP, Navale SM, Andrew AS, Jobst BC, Sajatovic M, Koroukian SM. Markers of Quality Care for Newly Diagnosed People With Epilepsy on Medicaid. Med Care 2021; 59:588-596. [PMID: 33797505 PMCID: PMC8187271 DOI: 10.1097/mlr.0000000000001541] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND For newly diagnosed people with epilepsy (PWE), proper treatment is important to improve outcomes, yet limited data exist on markers of quality care. OBJECTIVE Examine markers of quality care for newly diagnosed PWE. METHODS Using Medicaid claims data (2010-2014) for 15 states we identified adults 18-64 years of age diagnosed with incident epilepsy in 2012 or 2013. We built 5 sequential logistic regression models to evaluate: (1) seeing a neurologist; (2) diagnostic evaluation; (3) antiepileptic medication adherence; (4) serum drug levels checked; and (5) being in the top quartile of number of negative health events (NHEs). We adjusted for demographics, comorbidities, county-level factors, and the outcomes from all prior models. RESULTS Of 25,663 PWE, 37.3% saw a neurologist, with decreased odds for those of older age, those residing in counties with low-density of neurologists, and certain race/ethnicities; about 57% of PWE received at least 1 diagnostic test; and nearly 62% of PWE were adherent to their medication. The most common comorbidities were hypertension (37.1%) and psychoses (26.9%). PWE with comorbidities had higher odds of seeing a neurologist and to have NHEs. Substance use disorders were negatively associated with medication adherence and positively associated with high NHEs. CONCLUSIONS There are notable differences in demographics among people with incident epilepsy who do or do not see a neurologist. Differences in NHEs persist, even after controlling for neurologist care and diagnostic evaluation. Continued attention to these disparities and comorbidities is needed in the evaluation of newly diagnosed PWE.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Suparna M Navale
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Angeline S Andrew
- Department of Neurology, Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Barbara C Jobst
- Department of Neurology, Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Martha Sajatovic
- Departments of Neurology and Psychiatry, University Hospitals Cleveland Medical Center and School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH
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Rubenstein E, Ehrenthal DB, Mallinson DC, Bishop L, Kuo HH, Durkin M. Pregnancy complications and maternal birth outcomes in women with intellectual and developmental disabilities in Wisconsin Medicaid. PLoS One 2020; 15:e0241298. [PMID: 33108397 PMCID: PMC7591078 DOI: 10.1371/journal.pone.0241298] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDD) may face greater risk for poor pregnancy outcomes. Our objective was to examine risk of maternal pregnancy complications and birth outcomes in women with IDD compared to women without IDD in Wisconsin Medicaid, from 2007-2016. METHODS Data were from the Big Data for Little Kids project, a data linkage that creates an administrative data based cohort of mothers and children in Wisconsin. Women with ≥1 IDD claim the year before delivery were classified as having IDD. Common pregnancy complications and maternal birth outcomes were identified from the birth record. We calculated risk ratios (RR) using log-linear regression clustered by mother. We examined outcomes grouped by IDD-type and explored interaction by race. RESULTS Of 177,691 women with live births, 1,032 (0.58%) had an IDD claim. Of 274,865 deliveries, 1,757 were to mothers with IDD (0.64%). Women with IDD were at greater risk for gestational diabetes (RR: 1.28, 95% CI: 1.0, 1.6), gestational hypertension (RR: 1.22, 95% CI: 1.0, 1.5), and caesarean delivery (RR 1.32, 95% CI: 1.2, 1.4) compared to other women. Adjustment for demographic covariates did not change estimates. Women with intellectual disability were at highest risk of gestational hypertension. Black women with IDD were at higher risk of gestational hypertension than expected under a multiplicative model. CONCLUSIONS Women with IDD have increased risk of pregnancy complications and adverse outcomes in Wisconsin Medicaid. Results were robust to adjustment. Unique patterns by IDD types and Black race warrant further exploration.
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Affiliation(s)
- Eric Rubenstein
- Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States of America
| | - Deborah B. Ehrenthal
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - David C. Mallinson
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
- Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Lauren Bishop
- Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America
- Sandra Rosesnbaum School of Social Work, University of Wisconsin-Madison, Madison, WI, United States of America
| | - Hsiang-Huo Kuo
- Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Maureen Durkin
- Waisman Center, University of Wisconsin Madison, Madison, WI, United States of America
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
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Casebolt MT. Barriers to reproductive health services for women with disability in low- and middle-income countries: A review of the literature. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 24:100485. [DOI: 10.1016/j.srhc.2020.100485] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 12/28/2019] [Accepted: 01/07/2020] [Indexed: 12/18/2022]
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Powell RM, Parish SL, Mitra M, Rosenthal E. Role of family caregivers regarding sexual and reproductive health for women and girls with intellectual disability: A scoping review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:131-157. [PMID: 31808223 PMCID: PMC9016753 DOI: 10.1111/jir.12706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 10/10/2019] [Accepted: 11/15/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND While people with intellectual disability (ID) face disparities relating to sexual and reproductive health (SRH) services, little is known about the role of family caregivers who assist women and girls with ID access SRH services. This scoping review examined the findings of studies to elucidate the role of family caregivers with regard to SRH for women and girls with ID. METHOD We used Arksey and O'Malley's six-stage scoping framework, with Levac, Colquhoun and O'Brien's revisions, to evaluate identified sources. We searched three electronic databases, six ID journals and reference lists in full-text articles. Inclusion criteria included (1) primary and secondary source research studies in peer-reviewed journals; (2) published in English; (3) all research methodologies (i.e. qualitative, quantitative, mixed methods and systematic reviews or commentaries); (4) published between 2000 and 2016; and (5) studies from any country. RESULTS The search yielded 2062 studies; 57 articles met inclusion criteria. Most studies employed purposive, convenience or criterion sampling. Participants included people with ID, family caregivers, paid caregivers and health-care professionals. Findings were summarised thematically: (1) menstruation and menopause; (2) vaccinations and preventive screenings; (3) supporting sexuality and healthy relationships; (4) coordinating with health-care providers and (5) contraception and sterilisation. CONCLUSIONS Findings from this scoping review underscore the need for more and better-quality research, including how family caregivers assist women and girls with ID access perinatal and preventive SRH services and sexual abuse education. Family caregivers, women and girls with ID and health-care providers need increased access to information about SRH.
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Affiliation(s)
- R M Powell
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - S L Parish
- The College of Health Professions, Virginia Commonwealth University, Richmond, Virginia
| | - M Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
| | - E Rosenthal
- School Psychology, College of Education, Lehigh University Bethlehem, Pennsylvania
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Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 222:27.e1-27.e32. [PMID: 31306650 DOI: 10.1016/j.ajog.2019.07.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/29/2019] [Accepted: 07/09/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Women with disabilities are increasingly becoming pregnant, and growing evidence suggests maternal disability may be associated with increased risk for perinatal complications. OBJECTIVE A systematic review and meta-analysis were undertaken to examine the association between maternal disabilities and risk for perinatal complications. STUDY DESIGN Medline, CINAHL, EMBASE, and PsycINFO were searched from inception to July 2018 for full-text publications in English on pregnancy, delivery, and postpartum complications in women with any disability and those with physical, sensory, and intellectual and developmental disabilities specifically. Searches were limited to quantitative studies with a comparison group of women without disabilities. Reviewers used standardized instruments to extract data from and assess the quality of included studies. Pooled odds ratios and 95% confidence intervals were generated using DerSimonian and Laird random effects models for outcomes with data available from ≥3 studies. RESULTS The review included 23 studies, representing 8,514,356 women in 19 cohorts. Women with sensory (pooled unadjusted odds ratio, 2.85, 95% confidence interval, 0.79-10.31) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.10, 95% confidence interval, 0.76-1.58) had elevated but not statistically significant risk for gestational diabetes. Women with any disability (pooled unadjusted odds ratio, 1.45, 95% confidence interval, 1.16-1.82) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.77, 95% confidence interval, 1.21-2.60) had increased risk for hypertensive disorders of pregnancy; risk was elevated but not statistically significant for women with sensory disabilities (pooled unadjusted odds ratio, 2.84, 95% confidence interval, 0.85-9.43). Women with any (pooled unadjusted odds ratio, 1.31, 95% confidence interval, 1.02-1.68), physical (pooled unadjusted odds ratio, 1.60, 95% confidence interval, 1.21-2.13), and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.29, 95% confidence interval, 1.02-1.63) had increased risk for cesarean delivery; risk among women with sensory disabilities was elevated but not statistically significant (pooled unadjusted odds ratio, 1.28, 95% confidence interval, 0.84-1.93). There was heterogeneity in all analyses, and 13 studies had weak-quality ratings, with lack of control for confounding being the most common limitation. CONCLUSION Evidence that maternal disability is associated with increased risk for perinatal complications demonstrates that more high-quality research is needed to examine the reasons for this risk and to determine what interventions could be implemented to support women with disabilities during the perinatal period.
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Akobirshoev I, Parish SL, Mitra M, Rosenthal E. Birth outcomes among US women with intellectual and developmental disabilities. Disabil Health J 2017; 10:406-412. [PMID: 28404230 DOI: 10.1016/j.dhjo.2017.02.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/02/2017] [Accepted: 02/19/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women with intellectual and developmental disabilities (IDD) are bearing children at increasing rates. However, there is very little research about pregnancy experiences and birth outcomes among women with IDD. No studies to date have examined birth outcomes with a US population-based sample. OBJECTIVE The main objective was to estimate the national occurrence of deliveries in women with IDD and to compare their birth outcomes to women without IDD. METHODS We examined the 2007-2011 Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project to compare birth outcomes in women with and without IDD. Birth outcomes included preterm birth, low birth weight, and stillbirth. Multivariable regression analyses compared birth outcomes between women with and without IDD controlling for race/ethnicity, maternal age, household income, health insurance status and type, comorbidity, region and hospital location, teaching status, ownership, and year. RESULTS Of an estimated 20.6 million deliveries identified through the HCUP 2007-2011 data 10,275 occurred in women with IDD. In adjusted regression analyses, women with IDD compared to those without IDD were significantly more likely to have preterm birth (OR = 1.46; 95%CI: 1.26-1.69, p < 0.001), low birth weight (OR = 1.61, 95%CI: 1.27-2.05, p < 0.001), and stillbirth (OR = 2.40, 95% CI: 1.70-3.40, p < 0.001). CONCLUSION This study provides a first examination of the birth outcomes among women with IDD in the United States using a largest population-based sample. There are significant differences in birth outcomes between women with and without IDD. Understanding the causes of these differences and addressing these causes are critical to improving pregnancy outcomes among women with IDD.
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Affiliation(s)
- Ilhom Akobirshoev
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA.
| | - Susan L Parish
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
| | - Eliana Rosenthal
- Lurie Institute for Disability Policy, Brandeis University, Waltham, MA, USA
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