Analysis of the Impact of the Use of Rehabilitation Services on Employment Outcomes for People With Disabilities: Based on Propensity Score Matching

Abstract

Objective

To evaluate the association between rehabilitation services and employment among persons with physical disabilities in China, and to examine other disability types in secondary analyses. Using propensity score matching on data from a northwestern province, we provide empirical evidence to guide policy development.

Design

Cross-sectional study using propensity score matching, logistic regression analysis, the chi-square test, and the t test.

Setting

Persons with disabilities in urban and rural areas of the Ningxia Hui Autonomous Region, China.

Participants

A total of N=1870 persons with disabilities aged 16-60 years holding a disability certificate issued by the People’s Republic of China.

Interventions

This study employed propensity score matching to approximate a randomized controlled trial, designating persons with disabilities receiving rehabilitation services as the experimental group and those not receiving rehabilitation services as the control group.

Main Outcome Measures

The primary outcomes were employment status and use of rehabilitation services among persons with disabilities, while demographic characteristics were secondary outcomes.

Results

Rehabilitation services were positively associated with employment among persons with disabilities. Subgroup analyses by disability type revealed that this association was strongest among individuals with physical disabilities; those receiving rehabilitation services increased the employment rate by 8.8 percentage points (95% CI, 0.8-16.3; P=.025). In contrast, no statistically significant associations were found for other disability types, including visual, hearing, intellectual, and multiple disabilities (all P>.05). At the disability level, the largest increase was observed among individuals with level 3 (moderate) disabilities, whose employment rate rose by 22.1 percentage points (95% CI, 10.5-35.2; P<.001), whereas no statistically significant associations were found for disability levels 1, 2, and 4 (all P>.05). Significant associations were also observed among rural residents, men, unmarried individuals, those in nuclear families, and those reporting poor subjective health (all P<.05).

Conclusions

Rehabilitation services have a facilitating effect on the employment of persons with disabilities, which is regulated by the complexity of the nature of household registration, marital status, family structure, disability level, disability type and subjective health status.