Adults with Communication Disabilities Experience Poorer Health and Healthcare Outcomes Compared to Persons Without Communication Disabilities

J Gen Intern Med. 2018 Dec;33(12):2147-2155. doi: 10.1007/s11606-018-4625-1. Epub 2018 Aug 24.


Background: Persons with speech, language, and/or voice disabilities (collectively referred to as communication disabilities (CD)) represent 10% of the US population, yet their healthcare outcomes have not been described. Generally, research shows that persons with disabilities have poorer health and healthcare outcomes than their non-disabled peers.

Objectives: To examine the health and healthcare outcomes of persons with CD compared to persons without CD.

Design: Retrospective cohort study of the 2012 National Health Interview Survey, which contained the first supplemental questions on CD. We compared proportional differences in outcomes; logistic and ordered logistic regression assessed the outcome measures across CD categories, controlling for demographics, non-communication disabilities, and chronic conditions. Findings are weighted to permit national inferences.

Participants: Adults (≥ 18 years old) were divided into 4 mutually exclusive groups: people with voice disabilities only; speech/language disabilities only; speech/language and voice disabilities; and people without CD.

Main measures: Chronic health conditions; self-rated health; access to care; unmet needs for care; healthcare utilization.

Key results: Adults with CD more frequently had ≥ 1 chronic condition (voice 67.9%, speech/language 68.6%, speech/language and voice 79.9%, no CD 50.1%, p < 0.001) and reported fair/poor health (voice 19.5%, speech/language 32.5%, speech/language and voice 48.3%, no CD 11.2%, p < 0.001) compared to those without CD. Adults with CD more frequently utilized healthcare compared to those without CD. However, persons with CD endorsed greater difficulties accessing care than those without CD, including identifying a usual source of care, trouble finding a physician, and delaying or foregoing care (e.g., delayed due to availability of care: voice 26.1%, speech/language 37.2%, speech/language and voice 30.8% no CD 16.1%, p < 0.001).

Conclusions: Persons with CD are medically complex and experience greater challenges accessing healthcare than persons without CD. Healthcare providers need support and tools to provide equitable care that addresses the medical needs of persons with CD.

Keywords: access to care; chronic conditions; communication disabilities; health care utilization; unmet needs for care.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Communication Disorders / diagnosis
  • Communication Disorders / epidemiology
  • Communication Disorders / therapy*
  • Cross-Sectional Studies
  • Delivery of Health Care
  • Female
  • Health Services Needs and Demand*
  • Health Status*
  • Health Surveys* / methods
  • Humans
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Retrospective Studies
  • Treatment Outcome
  • Young Adult