IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v315y2022ics0277953622008061.html

Disability-related inequalities in health and well-being are mediated by barriers to participation faced by people with disability. A causal mediation analysis

Author

Listed:
  • Aitken, Zoe
  • Bishop, Glenda M
  • Disney, George
  • Emerson, Eric
  • Kavanagh, Anne M

Abstract

Large inequalities in health and well-being exist between people with and without disability, in part due to poor socio-economic circumstances, and potentially also related to societal factors including issues associated with accessibility and participation. To better understand the contribution of societal factors, we used a unique longitudinal survey of disability in Great Britain to quantify the extent to which barriers to participation contribute to poorer health and well-being. We used data from 2354 individuals who participated in three waves of the Life Opportunities Survey between 2009 and 2014 and compared five health and well-being outcomes (self-rated health, anxiousness, life satisfaction, life worth, happiness) between adults who acquired an impairment and those who remained disability-free. Causal mediation analysis was conducted to quantify how much of the effect of disability acquisition on each outcome was explained by barriers to participation in employment, economic life, transport, community, leisure and civic activities, social contact, and accessibility. People who recently acquired a disability had poorer health and well-being compared to people with no disability. Barriers to participation explained 15% of inequalities in self-rated health, 28% for anxiousness, 32% for life satisfaction, 37% for life worth, and 70% for happiness. A substantial proportion of the inequalities in health and well-being experienced by people with recently acquired disability were socially produced, driven by barriers to participation in different life domains. Furthermore, there was evidence that barriers to participation mediated the effect of well-being measured to a greater extent than the more clinically aligned measures, self-reported health and anxiousness. These findings highlight modifiable factors amenable to public health interventions that could lead to substantial improvements in health and well-being for people with disability.

Suggested Citation

  • Aitken, Zoe & Bishop, Glenda M & Disney, George & Emerson, Eric & Kavanagh, Anne M, 2022. "Disability-related inequalities in health and well-being are mediated by barriers to participation faced by people with disability. A causal mediation analysis," Social Science & Medicine, Elsevier, vol. 315(C).
    • Handle: RePEc:eee:socmed:v:315:y:2022:i:c:s0277953622008061
    DOI: 10.1016/j.socscimed.2022.115500
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953622008061
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2022.115500?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. Oswald, Andrew J. & Powdthavee, Nattavudh, 2008. "Does happiness adapt? A longitudinal study of disability with implications for economists and judges," Journal of Public Economics, Elsevier, vol. 92(5-6), pages 1061-1077, June.
    2. Mithen, Johanna & Aitken, Zoe & Ziersch, Anne & Kavanagh, Anne M., 2015. "Inequalities in social capital and health between people with and without disabilities," Social Science & Medicine, Elsevier, vol. 126(C), pages 26-35.
    3. Krahn, G.L. & Walker, D.K. & Correa-De-Araujo, R., 2015. "Persons with disabilities as an unrecognized health disparity population," American Journal of Public Health, American Public Health Association, vol. 105, pages 198-206.
    4. Kavanagh, Anne M. & Aitken, Zoe & Baker, Emma & LaMontagne, Anthony D. & Milner, Allison & Bentley, Rebecca, 2016. "Housing tenure and affordability and mental health following disability acquisition in adulthood," Social Science & Medicine, Elsevier, vol. 151(C), pages 225-232.
    5. Anne Marie Kavanagh & Zoe Aitken & Lauren Krnjacki & Anthony Daniel LaMontagne & Rebecca Bentley & Allison Milner, 2015. "Mental Health Following Acquisition of Disability in Adulthood—The Impact of Wealth," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-13, October.
    6. Nicola Fortune & Rosamond H. Madden & Shane Clifton, 2021. "Health and Access to Health Services for People with Disability in Australia: Data and Data Gaps," IJERPH, MDPI, vol. 18(21), pages 1-15, November.
    7. Powdthavee, Nattavudh, 2009. "What happens to people before and after disability? Focusing effects, lead effects, and adaptation in different areas of life," Social Science & Medicine, Elsevier, vol. 69(12), pages 1834-1844, December.
    8. Bickenbach, Jerome E. & Chatterji, Somnath & Badley, E. M. & Üstün, T. B., 1999. "Models of disablement, universalism and the international classification of impairments, disabilities and handicaps," Social Science & Medicine, Elsevier, vol. 48(9), pages 1173-1187, May.
    9. Johan Ormel & Fruehling V. Rijsdijk & Mark Sullivan & Eric van Sonderen & Gertrudis I. J. M. Kempen, 2002. "Temporal and Reciprocal Relationship Between IADL/ADL Disability and Depressive Symptoms in Late Life," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 57(4), pages 338-347.
    10. Mathew D. Gayman & R. Jay Turner & Ming Cui, 2008. "Physical Limitations and Depressive Symptoms: Exploring the Nature of the Association," The Journals of Gerontology: Series B, The Gerontological Society of America, vol. 63(4), pages 219-228.
    11. Tania Burchardt, 2003. "Being and becoming: Social exclusion and the onset of disability," CASE Reports casereport21, Centre for Analysis of Social Exclusion, LSE.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Justine Herve & Katherine Theiss & Sophie Mitra, 2025. "Are women with disabilities more at risk of intimate partner violence?," Fordham Economics Discussion Paper Series dp2025-01er:dp2025-01, Fordham University, Department of Economics.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Patricia Cubí‐Mollá & Mireia Jofre‐Bonet & Victoria Serra‐Sastre, 2017. "Adaptation to health states: Sick yet better off?," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 1826-1843, December.
    2. Flores, Gabriela & Ingenhaag, Michael & Maurer, Jürgen, 2015. "An anatomy of old-age disability: Time use, affect and experienced utility," Journal of Health Economics, Elsevier, vol. 44(C), pages 150-160.
    3. de Hond, Anne & Bakx, Pieter & Versteegh, Matthijs, 2019. "Can time heal all wounds? An empirical assessment of adaptation to functional limitations in an older population," Social Science & Medicine, Elsevier, vol. 222(C), pages 180-187.
    4. Tindara Addabbo & Elena Sarti & Dario Sciulli, 2013. "Disability, life satisfaction and social interaction in Italy," Department of Economics (DEMB) 0016, University of Modena and Reggio Emilia, Department of Economics "Marco Biagi".
    5. Miles Kimball & Ryan Nunn & Dan Silverman, 2015. "Accounting for Adaptation in the Economics of Happiness," NBER Working Papers 21365, National Bureau of Economic Research, Inc.
    6. Stöckel, Jannis & van Exel, Job & Brouwer, Werner B.F., 2023. "Adaptation in life satisfaction and self-assessed health to disability - Evidence from the UK," Social Science & Medicine, Elsevier, vol. 328(C).
    7. Gao, Ni & Harris, Mark & Ryan, Mandy & Robinson, Suzanne & Norman, Richard, 2025. "Is time a gift for health and life satisfaction? Exploring the relationship between time allocation and adaptation to a breast cancer diagnosis," Social Science & Medicine, Elsevier, vol. 371(C).
    8. Tindara Addabbo & Elena Sarti, 2013. "Access to work and disability: the case of Italy," Center for the Analysis of Public Policies (CAPP) 0111, Universita di Modena e Reggio Emilia, Dipartimento di Economia "Marco Biagi".
    9. Peña-Longobardo, L.M. & Rodríguez-Sánchez, B. & Oliva-Moreno, J., 2021. "The impact of widowhood on wellbeing, health, and care use: A longitudinal analysis across Europe," Economics & Human Biology, Elsevier, vol. 43(C).
    10. Isabelle Weld-Blundell & Marissa Shields & Alexandra Devine & Helen Dickinson & Anne Kavanagh & Claudia Marck, 2021. "Vocational Interventions to Improve Employment Participation of People with Psychosocial Disability, Autism and/or Intellectual Disability: A Systematic Review," IJERPH, MDPI, vol. 18(22), pages 1-33, November.
    11. Bucciol, Alessandro & Zarri, Luca, 2020. "Wounds that time can’t heal: Life satisfaction and exposure to traumatic events," Journal of Economic Psychology, Elsevier, vol. 76(C).
    12. repec:mod:depeco:0016 is not listed on IDEAS
    13. Powdthavee, Nattavudh & Stutzer, Alois, 2014. "Economic Approaches to Understanding Change in Happiness," IZA Discussion Papers 8131, IZA Network @ LISER.
    14. Powdthavee, Nattavudh, 2012. "Resilience to economic shocks and the long reach of childhood bullying," LSE Research Online Documents on Economics 51520, London School of Economics and Political Science, LSE Library.
    15. Bussière, Clémence & Sicsic, Jonathan & Pelletier-Fleury, Nathalie, 2016. "Simultaneous effect of disabling conditions on primary health care use through a capability approach," Social Science & Medicine, Elsevier, vol. 154(C), pages 70-84.
    16. Bussière, Clémence & Sirven, Nicolas & Tessier, Philippe, 2021. "Does ageing alter the contribution of health to subjective well-being?," Social Science & Medicine, Elsevier, vol. 268(C).
    17. Kavanagh, Anne M. & Aitken, Zoe & Baker, Emma & LaMontagne, Anthony D. & Milner, Allison & Bentley, Rebecca, 2016. "Housing tenure and affordability and mental health following disability acquisition in adulthood," Social Science & Medicine, Elsevier, vol. 151(C), pages 225-232.
    18. Asya Bellia & Lorenzo Corsini, 2021. "Disability and happiness: the role of accessibility," Discussion Papers 2021/284, Dipartimento di Economia e Management (DEM), University of Pisa, Pisa, Italy.
    19. repec:plo:pone00:0068632 is not listed on IDEAS
    20. Chen, Lei & Kietzman, Kathryn, 2026. "The role of financial difficulty on the health and well-being of adults with functional limitations that may require long-term services and supports," Social Science & Medicine, Elsevier, vol. 388(C).
    21. Andrada DUMBRAVEANU, 2014. "The more, the better: life satisfaction in the bitter welfare state," The Journal of Accounting and Management, Danubius University of Galati, issue 3, pages 7-13, December.
    22. Ricardo Pagán-Rodríguez, 2012. "Longitudinal Analysis of the Domains of Satisfaction Before and After Disability: Evidence from the German Socio-Economic Panel," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 108(3), pages 365-385, September.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:315:y:2022:i:c:s0277953622008061. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.