Mortality inequalities for people with disability in New Zealand: Census-mortality linked cohort study — The Association Specialists
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  3. Mortality inequalities for people with disability in New Zealand: Census-mortality linked cohort study

Mortality inequalities for people with disability in New Zealand: Census-mortality linked cohort study (23874)

Ruth Cunningham 1 , Anne Kavanagh 2 , George Disney 2 , Tristram Ingham 1 , Esther Woodbury 3 , Shanthi Ameratunga 4
  1. University of Otago, Wellington, NEW ZEALAND, New Zealand
  2. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  3. independent disability researcher and advocate, Wellington, New Zealand
  4. University of Auckland, Auckland, New Zealand

Background
Disabled people have a right to the highest attainable standard of health, enshrined in international treaties and local laws. Health equity for disabled people is an increasing focus of policy attention. Mortality differences provide crucial information for understanding health inequities and opportunities for intervention. This study examines cause-specific mortality differences between disabled people and non-disabled people, further broken down by disability type.

Methods
The 2013 NZ Census cohort was linked to mortality records over five years in the Integrated Data Infrastructure. We estimated total and cause-specific mortality risks for 15–74-year-olds. Activity-limitation groups were defined using the 2013 Census question, grouped into sensory, physical, learning, and communication limitations. Absolute and relative inequalities were estimated for people with activity limitations, in comparison to people without limitations.

Results
Overall, disabled people had a higher age-standardised mortality risk than non-disabled people. This finding was consistent across each cause of death and disability type investigated, with variations in the magnitude of increased risk. People with learning and communication limitations had the highest mortality rates. The highest relative differences between disabled and non-disabled people were for nervous system, respiratory and diabetes causes. The highest absolute differences were for cardiovascular, respiratory and non-lung cancer causes.

Conclusions
The markedly elevated mortality risks observed for disabled people indicate significant and preventable health inequities. These reflect combined pathways involving underlying conditions, disabling social and economic environments, and persistent barriers to accessible, effective health care. Reducing these disparities will require coordinated cross-sector action and health-system transformation.

  1. Note: We use the term “disabled people” rather than “people with disabilities” as it aligns with the terminology used in the New Zealand Disability Strategy, the social model of disability, and the preferences expressed by many Disabled People’s Organisations in Aotearoa NZ. This wording emphasises that disability arises from the interaction between individuals and disabling societal and environmental barriers.