Inequitable distribution of mortality between persons with and without disabilities

BACKGROUND: People with disabilities (PWD) experience avoidable health inequalities throughout their lives, which can lead to disparities in end-of-the-line health outcomes, such as death. We compared the trends in mortality between PWD and those without disabilities (PWOD) over the past decade and assessed the mortality gap for PWD based on health determinants. METHODS: We linked the National Health Insurance Database, which includes the entire Korean population, with National Disability Registration Database and Cause of Death Database. Crude mortality rate (CMR) and age- and sex-standardized mortality rate (SMR) for PWD and PWOD were calculated using data from over 50 million individuals per year from 2008 to 2017. Sociodemographic and health variables including age, sex, income, place of residence, and Charlson comorbidity index (CCI) were considered. RESULTS: All-cause CMR increased for both PWD and PWOD from 2008 to 2017, but the upsurge was greater among PWD (+11.2% vs. +7.3%). PWD continuously had higher CMRs (2668.3 vs. 412.9 per 100,000 in 2017) and SMRs (768.0 vs. 252.9 per 100,000 in 2017) than PWOD. However, the ratio of the mortality rate for PWD to PWOD intensified among less vulnerable groups in the population, including those who were younger, had higher incomes, or had no comorbidities. Compared to PWOD, the odds of death for PWD increased by 1.40-fold (95% CI = 1.38-1.41). The association between disability and death was stronger in the young age group (OR = 8.34, 95% CI = 7.20-9.65 for <20 years) than in the older age group (OR = 1.10, 95% CI = 1.08-1.11 for ≥80 years). Greater disparities were also observed in groups with higher income or no comorbidities. CONCLUSIONS: These findings suggest that macro-level social barriers, such as institutional discrimination against PWD in health care and inaccessible public health interventions, may contribute to the mortality disparities for PWD in a broader and more profound manner. KEY MESSAGES: • Disability was associated with an increased risk of mortality, and a larger mortality gap compared to the general population was observed, particularly among less vulnerable groups in the population. • Fundamental policies are required to mitigate inequalities in mortality among persons with disabilities.