People with intellectual disability have significantly higher age-adjusted rates of mortality and morbidity than their non-disabled peers. While self-rated health status is commonly used as an indicator of the health status of populations of interest, few studies have explored the self-rated health of adults with intellectual disability. We undertook secondary analysis of de-identified cross-sectional data from the first waves of two contemporary UK surveys: the Life Opportunities Survey (n = 37,513) and Understanding Society (n = 50,976). In the Life Opportunities Survey we identified 316 participants age 16–49 (1.7% of the age-restricted sample) as having intellectual disability. In Understanding Society we identified 415 participants age 16–49 (1.5% of the age-restricted sample) as having intellectual disability. Participants with intellectual disability were significantly more likely to report having fair or worse health than their peers (Life Opportunities Survey OR = 8.86 (6.54–12.01), p < 0.001; Understanding Society OR = 13.14 (10.65–16.21), p < 0.001). However the strength of this association was significantly attenuated when risk estimates were adjusted to take account of the increased rates of exposure of participants with intellectual disability to socio-economic disadvantage and (in the Life Opportunities Survey) exposure to discrimination and violence.
People with intellectual disability have significantly higher age-adjusted rates of mortality and morbidity than their non-disabled peers (Emerson and Hatton, 2014, Heslop et al., 2013 and Krahn and Fox, in press). This evidence, when combined with exposés of failings in healthcare systems (Heslop et al., 2013, Mencap, 2007, Mencap, 2012 and Michael, 2008) and increased attention to the human rights of disabled people (United Nations, 2006), has led regulatory bodies and governments to stress the importance of reducing the health inequalities experienced by people with intellectual disability (Department of Health, 2007, Disability Rights Commission, 2006, Krahn et al., 2010, Parliamentary and Health Service Ombudsman and Local Government Ombudsman, 2009 and US Department of Health and Human Services, 2002).
While self-rated health status is commonly used as an indicator of the health status of populations of interest (DeSalvo et al., 2006, Idler and Benyamini, 1997, Idler and Benyamini, 1999 and Jylha, 2009), few studies have explored the self-rated health of adults with intellectual disability (Emerson and Hatton, 2014 and Fujiura, 2012). Of these, only three have employed relatively robust population-based sampling frames (Emerson and Hatton, 2008, Haider et al., 2013 and Larson et al., 2001a) and only two of these collected information on the self-rated health of participants with and without intellectual disability (Haider et al., 2013 and Larson et al., 2001a). Larson and colleagues identified 3076 respondents with predominantly mild intellectual disability in the disability supplements to the 1994–95 US National Health Interview Survey (NHIS) (Larson et al., 2003, Larson et al., 2001a and Larson et al., 2001b). They reported that adults with intellectual disability were markedly more likely to rate their health as fair or poor (24%) than their peers without intellectual disability (10%). More recently, Haider and colleagues undertook a telephone survey of the health of 897 adults with intellectual disability in the State of Victoria, Australia (Haider et al., 2013). They reported that adults with intellectual disability were markedly more likely to rate their health (or have their health rated by a proxy) as fair or poor (24%) than their peers without intellectual disability (18%).
Current knowledge indicates that the reasons for the poorer health of people with intellectual disability primarily fall within two broad spheres (Emerson & Hatton, 2014). First, a range of secondary health conditions is associated with some specific causes of intellectual disability (e.g., higher rates of congenital heart defects in children with Down syndrome). Second, people with intellectual disability are much more likely than their non-disabled peers to be exposed to a range of well-established social determinants of poorer health (e.g., poverty, social exclusion, discrimination, reduced access to timely and effective healthcare).
To date no study has examined the extent to which the poorer self-rated health of adults with intellectual disability may reflect their increased rates of exposure to common social determinants of poorer health. However, previous research has demonstrated that: (1) poorer self-rated health among adults with intellectual disability is related to increased rates of exposure to indicators of socio-economic disadvantage and discrimination (Emerson, 2010 and Emerson and Hatton, 2008); and (2) the poorer maternal-rated health of children with intellectual disability can be partially accounted for by their increased rates of exposure to indicators of socio-economic disadvantage (Emerson and Hatton, 2007a and Emerson and Hatton, 2007b).
The aims of the present paper are: (1) to describe the self-rated general health status of British adults with intellectual disability; and (2) to examine the extent to which any between-group differences in health status may reflect between-group differences in rates of exposure to socio-economic disadvantage and discrimination.
