Age at disability onset and self-reported health status
Abstract. This study analyzes the impact of early onset of disability (at birth through young adulthood) on educational and employment outcomes and examines. This study analyzes the impact of early onset of disability (at birth through young adulthood) on educational and employment outcomes and. Department of Educational Psychology and Learning Systems .. quality of life or adaptation disability between older adults with early-onset physical determine if age of disability onset continues to affect employment outcomes later in life.
At the same time, Danish workplaces are among the most accommodating in the world, with municipalities covering necessary adaptations, wage subsidy programs for employers or disabled workers, and opportunities for sick-listed workers for partial return to work without risk of benefit loss [ 6 ]. Thus, the effects of socioeconomic background on disability coping found in a Danish setting most likely represent a lower bound of what could be expected in other settings.
Our focus will be on identifying a potential causal effect of education on disability coping, and on uncovering the precise channels through which educated individuals with a disability better cope with their disability. For example, the educated could be more efficient at combining inputs or they could have greater health knowledge.
The study further finds that elderly disabled who are educated tend to use more assistive technologies and more paid help. However, these factors do not explain why they can better cope with their disability [ 7 ].
In this study, we use representative Danish survey data sampling the working-age population. After estimating our models using quasi-experimental econometric methodology exploiting a major school reform that exogenously increased the level of education only for certain groups, we consider several pathways or mechanisms through which any potential causal effects arise.
Instead of examining the use of assistive technology at home which the previous literature found played only a limited role, we consider whether educated persons with a disability may more easily be granted workplace adaptations. We add to the literature by empirically examining whether educated individuals with a disability may have an informational advantage in terms of working the system i.
Finally, we also control for the potential effect of educated individuals with a disability individuals having higher levels of intrinsic motivation. The rich survey data at our disposal has information on the degree to which individuals with a disability use each of these resources.
Note, individuals in our sample with a mental disability reporting having a slight cognitive impairment and not a severe intellectual disability or a learning disability.
ADLs Activities of Daily Living and IADLs Instrumental Activities of Daily Living are standard measures of functioning and capture how well the individual manages the basic activities of daily living such as eating and dressing and a more expanded set of activities such as shopping, housework, financial and administrative tasks etc.
Although the measure for selecting individuals to participate in the sample is based on a self-report of a long-standing condition, the detailed nature of the questions in the sample i.
Furthermore, self-reported health has been shown to be an excellent predictor of objective health, for instance, global self-rated health is an important and independent predictor of mortality found consistently across 27 different studies from the US and other settings [ 8 ]. We investigate not only whether educated individuals with a disability have a higher probability of being employed, but also whether they are better off according to an alternative measure of well-being, i. Gannon and Nolan [ 9 ] find that the onset of a disability is associated with a decline in the probability of employment and, especially in the case of a severe disability, also hampers social participation.
The previous literature finds ample evidence of an education gradient in the presence of disability. Crimmins and Saito [ 10 ] examine healthy life expectancy and thereby indirectly examine acquired disability in the U.
They find that these educational differences have been increasing over time. They find no difference, however, between educational groups in the chances of recovery or in the risk of death once disabled.
The relationship between early disability onset and education and employment
Economic means are important for acquiring and coping with a disability, see e. Zimmer and House [ 13 ]. In the Scandinavian setting, however, the public sector freely provides the needed assistive technology, paid help, and home modifications.
Thus, other mechanisms are likely to be more relevant for the educational gradient. We add to this literature by examining whether an educational gradient exists for disability coping, whether the effect is potentially causal, and what the likely mechanisms behind such an effect are. In terms of a theoretical basis, the theory of social inclusion is a fundamental concept in sociology literature on inequality.
CiteSeerX — 1 THE RELATIONSHIP BETWEEN EARLY DISABILITY ONSET AND EDUCATION AND EMPLOYMENT
Social inclusion is seen as essential for living a meaningful life, including having self-reliance and motivation to live and stay healthy.
Social inclusion takes the form of social contacts, leisure activities, participation in employment, and participation in other informal social contexts. Various social models of coping behaviour have been proposed, ranging from individualist coping personal agency theories, factors such as individual age, gender, and personality to social support as a means of coping [ 15 ].
Another view proposes a conservation of resources approach, such that compensating actions will be undertaken to try to minimize the effects of any loss [ 16 ].
Age at disability onset and self-reported health status
Furthermore, we include age, gender, cohabitation status, health endowment i. Considering health stock and health-promoting differences, and equating marginal benefit to marginal cost, it explains why educated individuals, in general, are likely to be healthier than uneducated individuals.
Within the framework of this model as well, obtaining and using knowledge of support systems and seeking out accommodation at the workplace are ways in which educated people would invest more in their health, because their expected returns to healthy days exceed those of uneducated people. Whereas, intrinsic motivation may capture a selection effect, i. A few studies employing robust identification methods have uncovered a potentially causal negative relationship between education and disability, meaning that education does indeed reduce disability and is not simply a proxy for unobserved traits.
Compared with younger onset, the adjusted odds ratios OR were ages 22— Conclusion This cross-sectional study provides population-level, generalizable evidence of increased fair or poor health in people with later onset disability compared to those with disability onset prior to the age of 21 years. This finding suggests that examining the general health of people with and those without disabilities might mask differences associated with onset, potentially relating to differences in experience and self-perception.
Future research relating to global health status and disability should consider incorporating age at disability onset. In addition, research should examine possible differences in the relationship between age at onset and self-reported health within specific impairment groups.
Background "Disability is an issue that affects every individual, community, neighborhood, and family Of critical importance is the ability to develop or maintain a high quality of life after the acquisition of a disability [ 2 ]. Health related quality of life HRQOL is included as an overarching aspect of the American health strategic plan, Healthy Peoplewhich is a set of national health objectives that encourages the use of self-rated health as a measure to evaluate health status in the population.
Population-based surveillance of general health status monitors progress of two overall goals from Healthy People Surveillance questions on HRQOL can be used to examine different outcomes for people with and without disabilities and detect possible disparities [ 4 ].
However, even within specific impairments and diagnoses, people with disabilities report a broad range of self-reported health on commonly-used measures [ 5 ].
Factors that may impact self-reported health status include severity of disability or health condition, type of activity limitation, and age of the person with the disability [ 26 ]. Further, in what has been referred to as the "disability paradox", people with serious and persistent disabilities often report experiencing a good or excellent quality of life when to others it would appear that their health is poor [ 7 ].
This seeming paradox may be related to adoption of a positive disability minority group identity [ 8 ] or to a tendency on the part of outside observers to equate poor health with disability while people with disabilities may view them as separate constructs [ 9 ].
Age at onset of a disability, as well as the duration of the disability, can also impact health status [ 10 ].
Individuals who acquire a disability later in life may be more likely to rate their global health status in relation to their perceived health prior to the disability and have greater difficulty adjusting to the disability [ 11 ].
In contrast, early disability onset and longer duration of disability may allow greater adjustment to the disability both in terms of psychosocial identity development and adoption of coping strategies, leading to higher reported general health [ 1213 ].
Evaluation of general health itself also may be adjusted to reflect changing standards and values in response to disability [ 121415 ]. Empirical evidence supports the view that self-reported health status is related to age at onset and duration of disability. For example, people with congenital deafness have reported better health status than people with later onset deafness [ 1617 ]. In people with spinal cord injury SCIboth increasing age with SCI and more advanced age at injury onset have been associated with higher depression levels and poorer self-perceived health [ 18 ].
Other disease specific studies suggest earlier age onset is associated with better reported health status, even accounting for advancing age [ 1019 ]. However, the overall relationship between age at onset and health status in broad population-based disability groups e. If the age that disability is acquired is associated with perceived general health, this knowledge might assist in more sensitive measurement of health, as well as in developing tailored interventions and interpreting heterogeneous age-related effects on general health status.
Specifically, we asked if general health status differs for people with different ages of disability onset, while controlling for possible confounders. The BRFSS uses a Disproportionate Stratified Sample DSS method, where phone numbers are randomly selected throughout the state, business and nonworking numbers are omitted, and individuals aged 18 years and older are randomly selected from each household called.
Data are subsequently weighted to reflect the complex sampling methods and nonresponse bias of the final sample [ 23 ]. This survey provides annual population-based cross-sectional data that can be used to analyze self-reported risks and health conditions.
The BRFSS includes national "core" questions and modules, and state-added modules on special topics of interest to specific states.