Disability Discrimination, Medical Rationing and COVID-19

Chen, Bo; McNamara, Donna

doi:10.1007/s41649-020-00147-x

Cited by 51 publications

(30 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During the first wave of the COVID-19 pandemic, many healthcare services (e.g., outpatient, day services, some in-patient rehabilitation services, assistive devices programs), essential for people with disabilities (e.g., to maintain or recover health and function, manage chronic conditions, prevent secondary conditions, benefit from psychosocial support), were either shutdown or operating at a reduced capacity due to lockdown restrictions. In other words, if they were open, they were operating without sufficient human resources, beds, or other healthcare resources that were diverted to fighting the pandemic [9,14,48,71,80,84,107].…”

Section: Disrupted Access To Healthcare (Other Than For Covid-19)mentioning

confidence: 99%

Lockdown-Related Disparities Experienced by People with Disabilities during the First Wave of the COVID-19 Pandemic: Scoping Review with Thematic Analysis

Jesus

Bhattacharjya

Papadimitriou

et al. 2021

IJERPH

133

View full text Add to dashboard Cite

People with disabilities may be disproportionally affected by the COVID-19 pandemic. We synthesize the literature on broader health and social impacts on people with disabilities arising from lockdown-related measures. Methods: Scoping review with thematic analysis. Up to mid-September 2020, seven scientific databases and three pre-print servers were searched to identify empirical or perspective papers addressing lockdown-related disparities experienced by people with disabilities. Snowballing searches and experts’ consultation also occurred. Two independent reviewers took eligibility decisions and performed data extractions. Results: Out of 1026 unique references, 85 addressed lockdown-related disparities experienced by people with disabilities. Ten primary and two central themes were identified: (1) Disrupted access to healthcare (other than for COVID-19); (2) Reduced physical activity leading to health and functional decline; (3) From physical distance and inactivity to social isolation and loneliness; (4) Disruption of personal assistance and community support networks; (5) Children with disabilities disproportionally affected by school closures; (6) Psychological consequences of disrupted routines, activities, and support; (7) Family and informal caregiver burden and stress; (8) Risks of maltreatment, violence, and self-harm; (9) Reduced employment and/or income exacerbating disparities; and (10) Digital divide in access to health, education, and support services. Lack of disability-inclusive response and emergency preparedness and structural, pre-pandemic disparities were the central themes. Conclusions: Lockdown-related measures to contain the COVID-19 pandemic can disproportionally affect people with disabilities with broader impact on their health and social grounds. Lack of disability-inclusive response and emergency preparedness and pre-pandemic disparities created structural disadvantages, exacerbated during the pandemic. Both structural disparities and their pandemic ramifications require the development and implementation of disability-inclusive public health and policy measures.

show abstract

Section: Disrupted Access To Healthcare (Other Than For Covid-19)mentioning

confidence: 99%

Lockdown-Related Disparities Experienced by People with Disabilities during the First Wave of the COVID-19 Pandemic: Scoping Review with Thematic Analysis

Jesus

Bhattacharjya

Papadimitriou

et al. 2021

IJERPH

133

View full text Add to dashboard Cite

show abstract

“…Medical rationing decisions based on markers such as ‘quality of life’ may lead healthcare providers to discriminate against disability due to preconceived (and often without awareness) ableist notions about people with disabilities’ quality of life [ 13 , 44 , 47 , 53 , 56 ]. Physicians and health care providers may well be influenced by implicit and explicit ableism [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

Health Risks and Consequences of a COVID-19 Infection for People with Disabilities: Scoping Review and Descriptive Thematic Analysis

Kamalakannan

Bhattacharjya

Bogdanova

et al. 2021

IJERPH

View full text Add to dashboard Cite

This study aims to synthesize the literature on any disproportionate health risks or consequences of a COVID-19 infection for people with disabilities. Scoping review with a descriptive thematic analysis was carried out. Up to mid-September 2020, seven scientific databases and three preprint servers were searched to identify empirical or perspective papers. Snowballing searches and expert’ consultations also took place. Two independent reviewers were used for the screenings and data extractions. Of 1027 references, 58 were included, 15 of which were empirical articles. The thematic analysis showed that: (1) People with disabilities living in residential or long-term care facilities were more likely to have greater infection rates; (2) Intersecting mediators of greater infection risks were multiple (e.g., lack of accessible information); (3) People with disabilities often face greater health problems when infected; and (4) Unethical disadvantages in the rationing of lifesaving and critical care can be experienced by people with disabilities. Conclusions: Beyond any health-related vulnerabilities (e.g., comorbidity rates), multiple yet modifiable environmental factors can provide disproportionate health risks and consequences of a COVID-19 infection for people with disabilities. Public health and policy measures must prevent or reduce modifiable environmental risks.

show abstract

“…31 Other contributing factors may be related to tolerability of interventions (particularly non-invasive ventilation) for people with ID, perceived treatment difficulties that may influence decision making, and inappropriate use of Do Not Resuscitate orders. 32 Complications of COVID-19 infection, mortality rates, and length of stay Having a diagnosis of ID was associated with a 56% increase in mortality risk, which was not associated with seizures or dementia, despite these conditions being more common in ID patients compared with the general population, particularly those with Down syndrome. 33 The increased mortality also does not appear to be related to other suggested COVID-19 comorbidities for adverse outcome, 9 11 13 although as in the general population, older age and severity of illness on admission did show significant associations with mortality in ID.…”

Section: Course Of Illness In Hospitalised Patients With Id and Access To Interventions And Icusmentioning

confidence: 99%

Understanding inequalities in COVID-19 outcomes following hospital admission for people with intellectual disability compared to the general population: a matched cohort study in the UK

et al. 2021

View full text Add to dashboard Cite

ObjectivesThis study explores the hospital journey of patients with intellectual disabilities (IDs) compared with the general population after admission for COVID-19 during the first wave of the pandemic (when demand on inpatient resources was high) to identify disparities in treatment and outcomes.DesignMatched cohort study; an ID cohort of 506 patients were matched based on age, sex and ethnicity with a control group using a 1:3 ratio to compare outcomes from the International Severe Acute Respiratory and emerging Infections Consortium WHO Clinical Characterisation Protocol UK.SettingAdmissions for COVID-19 from UK hospitals; data on symptoms, severity, access to interventions, complications, mortality and length of stay were extracted.InterventionsNon-invasive respiratory support, intubation, tracheostomy, ventilation and admission to intensive care units (ICU).ResultsSubjective presenting symptoms such as loss of taste/smell were less frequently reported in ID patients, whereas indicators of more severe disease such as altered consciousness and seizures were more common. Controls had higher rates of cardiovascular risk factors, asthma, rheumatological disorder and smoking. ID patients were admitted with higher respiratory rates (median=22, range=10–48) and were more likely to require oxygen therapy (35.1% vs 28.9%). Despite this, ID patients were 37% (95% CI 13% to 57%) less likely to receive non-invasive respiratory support, 40% (95% CI 7% to 63%) less likely to receive intubation and 50% (95% CI 30% to 66%) less likely to be admitted to the ICU while in hospital. They had a 56% (95% CI 17% to 102%) increased risk of dying from COVID-19 after they were hospitalised and were dying 1.44 times faster (95% CI 1.13 to 1.84) compared with controls.ConclusionsThere have been significant disparities in healthcare between people with ID and the general population during the COVID-19 pandemic, which may have contributed to excess mortality in this group.

show abstract

Disability Discrimination, Medical Rationing and COVID-19

Cited by 51 publications

References 13 publications

Lockdown-Related Disparities Experienced by People with Disabilities during the First Wave of the COVID-19 Pandemic: Scoping Review with Thematic Analysis

Lockdown-Related Disparities Experienced by People with Disabilities during the First Wave of the COVID-19 Pandemic: Scoping Review with Thematic Analysis

Health Risks and Consequences of a COVID-19 Infection for People with Disabilities: Scoping Review and Descriptive Thematic Analysis

Understanding inequalities in COVID-19 outcomes following hospital admission for people with intellectual disability compared to the general population: a matched cohort study in the UK

Contact Info

Product

Resources

About