Department of Community Health, Tufts University, 574 Boston Ave., Suite 208, Medford, MA, 02155, USA.
Affiliated Research Faculty, Social Science Applied Research Center, University of North Carolina, Wilmington, NC, USA.
J Gen Intern Med. 2018 Dec;33(12):2147-2155. doi: 10.1007/s11606-018-4625-1. Epub 2018 Aug 24.
Persons with speech, language, and/or voice disabilities (collectively referred to as communication disabilities (CD)) represent 10% of the US population, yet their healthcare outcomes have not been described. Generally, research shows that persons with disabilities have poorer health and healthcare outcomes than their non-disabled peers.
To examine the health and healthcare outcomes of persons with CD compared to persons without CD.
Retrospective cohort study of the 2012 National Health Interview Survey, which contained the first supplemental questions on CD. We compared proportional differences in outcomes; logistic and ordered logistic regression assessed the outcome measures across CD categories, controlling for demographics, non-communication disabilities, and chronic conditions. Findings are weighted to permit national inferences.
Adults (≥ 18 years old) were divided into 4 mutually exclusive groups: people with voice disabilities only; speech/language disabilities only; speech/language and voice disabilities; and people without CD.
Chronic health conditions; self-rated health; access to care; unmet needs for care; healthcare utilization.
Adults with CD more frequently had ≥ 1 chronic condition (voice 67.9%, speech/language 68.6%, speech/language and voice 79.9%, no CD 50.1%, p < 0.001) and reported fair/poor health (voice 19.5%, speech/language 32.5%, speech/language and voice 48.3%, no CD 11.2%, p < 0.001) compared to those without CD. Adults with CD more frequently utilized healthcare compared to those without CD. However, persons with CD endorsed greater difficulties accessing care than those without CD, including identifying a usual source of care, trouble finding a physician, and delaying or foregoing care (e.g., delayed due to availability of care: voice 26.1%, speech/language 37.2%, speech/language and voice 30.8% no CD 16.1%, p < 0.001).
Persons with CD are medically complex and experience greater challenges accessing healthcare than persons without CD. Healthcare providers need support and tools to provide equitable care that addresses the medical needs of persons with CD.
患有言语、语言和/或声音障碍（统称为交流障碍 (CD)）的人占美国总人口的 10%，但他们的医疗保健结果尚未得到描述。一般来说，研究表明，残疾人士的健康状况和医疗保健结果不如非残疾同龄人。
检查患有 CD 的人与无 CD 的人相比的健康和医疗保健结果。
对 2012 年全国健康访谈调查的回顾性队列研究，该研究包含了关于 CD 的第一个补充问题。我们比较了结果的比例差异；逻辑和有序逻辑回归评估了 CD 类别中的结果衡量标准，同时控制了人口统计学、非沟通障碍和慢性疾病。结果经过加权处理，以允许进行全国性推断。
成年人（≥ 18 岁）分为 4 个相互排斥的组：只有声音障碍的人；只有言语/语言障碍的人；言语/语言和声音障碍的人；以及没有 CD 的人。
慢性健康状况；自我评估的健康状况；获得医疗保健的机会；未满足的医疗保健需求；医疗保健的使用。
患有 CD 的成年人更频繁地患有≥1 种慢性疾病（声音障碍 67.9%，言语/语言障碍 68.6%，言语/语言和声音障碍 79.9%，无 CD 50.1%，p<0.001），并且报告的健康状况不佳/较差（声音障碍 19.5%，言语/语言障碍 32.5%，言语/语言和声音障碍 48.3%，无 CD 11.2%，p<0.001）与没有 CD 的人相比。与没有 CD 的人相比，患有 CD 的成年人更频繁地使用医疗保健。然而，与没有 CD 的人相比，患有 CD 的人更难获得医疗保健，包括确定常规医疗服务提供者、寻找医生有困难，以及延迟或放弃医疗保健（例如，由于可获得的医疗保健而延迟：声音障碍 26.1%，言语/语言障碍 37.2%，言语/语言和声音障碍 30.8%，无 CD 16.1%，p<0.001）。
患有 CD 的人病情复杂，在获得医疗保健方面面临更大的挑战，与没有 CD 的人相比。医疗保健提供者需要支持和工具来提供公平的医疗保健，以满足患有 CD 的人的医疗需求。
