Effects of disability-related limitations in daily living on unmet needs: a longitudinal-study1 | BMC Public Health

This study found that the risk of having unmet medical care needs increased with an increase in disability-related limitations in daily living, and this effect was more pronounced in men. Men with physical, brain lesion-related, or mild disabilities, and women with internal, facial, or severe disabilities were vulnerable to having unmet health needs due to limitations in daily life. In both men and women, pain due to leg and foot limitations increased the risk of having unmet health needs. Regarding causes of unmet needs, women were more likely to have the burden of medical expenses as a cause, while men were more likely to have factors other than this as causes.

We found that the risk of having unmet needs was higher when an individual’s disabilities severely affected their activities of daily living and limited their daily life. This is similar to prior findings that unmet needs increase due to limitations in daily life caused by old age or diseases such as cancer, dementia, asthma, and osteoarthritis in previous studies [16,17,18,19,20,21,22]. Our results and those of previous studies, both, confirm the relationship between unmet needs and chronic or incurable diseases, including disabilities. Additionally, this study is meaningful because it is generalizable by conducting a national survey and examines the impact of disability on unmet needs based on severity, both generally and in detail.

The study found that daily limitations owing to disabilities increase the risk of having unmet needs. Women were more vulnerable to having unmet needs when their limitations in daily life were moderate. However, men were more likely to have unmet needs if their daily life limitations were severe. In previous studies, women with disabilities were found to be at a higher risk of having unmet needs than men [6, 23, 24]. Nevertheless, when care is lacking, men with disabilities are more vulnerable to unmet needs than women [25]. However, the results may have been uncertain because the absolute number of women in this study who fell into the high daily-life limitation group was small.

To examine the effect of daily life limitations on unmet needs in detail, we used the subdivisions of disability type, severity, health aspect that limits daily life, and cause of unmet needs in this study. Regarding disability type, this effect differed by sex. Men with physical or brain lesion disabilities were 2.77 times more likely to have unmet needs when their daily life limitations were higher than those with no limitations. In South Korea, physical disabilities in men were due to (1) joint injuries (60.0%), (2) amputation (19.1%), (3) paralysis (16.2%), and (4) deformity (4.6%) in 2017 [26]. Among joint injuries, 25.7% involved the spinal discs and 12.4%, the knees [26]. Additionally, one in four people with physical disabilities did not have assistance in their daily life [27]. Physical disabilities may result in gait disturbances while accessing medical institutions thereby leading to unmet health needs.

Disabilities related to brain lesions are characterized by overlapping disorders. The main comorbidities in men with brain lesions were (1) language (45.7%), (2) intellectual (24.3%), (3) visual (21.9%), and (4) hearing (17.3%) in 2017 in South Korea [26]. Among people with brain lesions, nine out of ten had helpers to execute activities of daily life. However, 44.6% respondents said that they lacked assistance from others. The reasons were (1) limited help from family (54.9%), (2) lack of time from personal assistants (23.7%), and (3) severe disability (16.0%) [26]. Brain lesions can make it difficult to obtain independent medical care because of communication or intellectual impairments. People with brain lesions may also have unmet needs owing to insufficient help from others.

Meanwhile, women with internal or facial disabilities and severe daily life limitations were 7.45 times more likely to have unmet needs. Internal disabilities include renal, cardiac, respiratory, liver, stoma, urostomy, and epileptic disabilities. External physical disability typically results from the initial cessation of the pathology caused by an injury or disease, after which disability and impairment persist. However, internal organ disabilities require continuous medical attention, including treatment, diagnosis, and testing, because disabilities and diseases exist simultaneously, and usually worsen over time [28]. In South Korea, where national health insurance is available, the average additional monthly cost due to internal disabilities was higher than the average in 2017 (average: $144.8; liver: $405.4; kidney: $257.5; stoma or urostomy $205.9) [26].

Facial disabilities had the second-highest average monthly cost of disability (at $288.8, after autism at $533.7) [26]. Additionally, people with facial disabilities were the group that most often responded that they could not visit hospitals or clinics even if they wanted to due to economic reasons [26]. The economic burden of internal or facial disabilities can create a gap between the need for and use of medical services.

Regarding limiting factors in daily life due to disability, difficulties in using legs and feet had the greatest effect on the existence of unmet needs, regardless of sex. Mobility impairment is a major concern for adults with disabilities [29, 30]. With the exception of non-face-to-face treatment and home nursing, discomfort in the legs and feet is directly related to unmet needs as physical movement becomes difficult.

The primary cause of unmet needs in women was the burden of medical expenses. Women with disabilities face a dual barrier to the labor market: being a woman and a person with disabilities [31]. The employment rate of women with disabilities was only 49.8% of that of men [26]. Considering that difficulty performing work due to disability (34.0%) and health problems (20.5%) are the main reasons for non-employment for women with disabilities who do not work, it can be concluded that limitations due to disability and unmet needs due to household difficulties are closely related.

This study has certain limitations. First, the data used in this study excluded facility residents, individuals with unknown addresses, and the deceased. However, as this accounted for 2.6% of the registered disabled persons surveyed (residence in facilities: 0.6%, expungement or death: 2.0%) [32], this would not have had a significant impact on the overall results. Second, unmet needs based on time-series changes in the degree of limitation in daily life were not analyzed. However, we can consider that disability is chronic and has a relatively stable severity. Third, we adjusted for various covariates that could affect our hypothesis testing; however, some variables were not included in the study. Congenital presence or absence of disability, acceptance of disability, and support status due to disability were not considered to be covariates. Therefore, follow-up studies that consider these factors are warranted. Fourth, it was difficult to analyze each disability type individually because of the limited number of participants. However, we attempted to differentiate disability types by categorizing them in this study.

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