Poverty and Disability: A State-Level Geospatial Analysis.

Abstract

Individuals with disabilities are a growing yet understudied population. Nurses are in a prime position to address social determinants of health (SDOH), which is defined as the conditions in which people work, live, and learn that affect health. SDOH are largely responsible for the health inequities seen among individuals with disabilities. The purpose of this study was to explore the relationships between state-level poverty rates and state-level social determinants, such as housing, education, employment, health, and health care for adults with disabilities using geospatial, state-level data. This secondary data analysis used national data from the 2021 American Community Survey. Data on state poverty rates and rates of particular social determinants were used to examine differences between high- and low-poverty states for adults with disabilities. Rates, rather than numbers of adults with disabilities in poverty, were used to control for state size. The median poverty rate (27.8%) for adults with disabilities was used to create a dichotomous variable for low-poverty (n = 26) and high-poverty (n = 25) states. Independent samples t-tests were used to compare geospatial and SDOH data to understand differences between high- and low-poverty states. More adults with disabilities, regardless of race, live in high-poverty states, particularly those with ambulatory and cognitive disabilities. Adults with disabilities residing in low-poverty states have higher employment rates and more private insurance coverage. More adults with disabilities in high-poverty states smoke, live in mobile homes, and are less educated. Using an SDOH lens in caring for individuals with disabilities helps nurses better understand how economic stability, education, health, health care access, the built environment, and the community, rather than individual factors, impact the health of adults with disabilities. To improve the health of disabled persons, nurses must have a greater awareness of the influence that social determinants have on health for individuals with disabilities. Nurse training programs must build disability cultural competence into nursing curricula. Universal screening for SDOH, particularly for individuals with disabilities residing in high-poverty states, is pivotal for the best chance of improving the health and well-being of individuals with disabilities.