Elevated COVID-19 Risks for Californians with Disabilities
Learn about the elevated COVID-19 risks faced by Californians with disabilities, including exposure to the virus and severe illness. Find out who is at high risk and how the initial vaccine rollout targeted certain groups, with a focus on the impact in California. Discover data on COVID-19 deaths among different age groups and the chronic health conditions prevalent among individuals receiving home and community-based services.
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Elevated COVID Elevated COVID- -19 risks for Californians with disabilities Californians with disabilities 19 risks for Steve Kaye University of California San Francisco & Disability Rights Education & Defense Fund (DREDF)
COVID-19 risks & disabled Californians Two types of risk Exposure to the virus Severe illness, for example, resulting in hospitalization and/or death Some disabled Californians are at high risk for exposure Congregate settings: nursing homes, group homes Workers entering home: attendants, healthcare workers Some disabled Californians are at high risk for severe illness/death Older people with disabilities People with certain chronic health conditions, multiple conditions People with intellectual or developmental disabilities (I/DD) Initial vaccine rollout targeted nursing homes & older adults Missing: Non-elderly adults getting services at home & in community
CA community-resident Covid-19 deaths per 100,000 people, by age group California non-institutional COVID-19 deaths, by age <15 0.0 15-44 6.9 45-64 63.2 2.8 X 65-74 177.5 75-84 372.9 85+ 884.7 Deaths per 100,000 population Source: Author s analysis of CDC mortality data
Who gets paid services at home/in community? Mostly IHSS recipients & clients of Regional Centers/ Department of Developmental Services (DDS) Nationally, > of Medicaid Home and Community-Bases Services (HCBS) recipients get services from outside the home ~300,000 IHSS recipients are under 65 Average number of chronic health conditions: 4.2 84% have mobility limitations 25% use breathing equipment High rates of hospitalization and ER usage ~300,000 Regional Center/DDS clients under 65 Most live in family home, own home, or group home (not prioritized) Most need help with Activities of Daily Living
Chronic conditions among US HCBS users Hypertension Arthritis Higher weight* Lung/breathing Heart condition Diabetes 58% 55% 49% 45% 32% 31% Stroke 20% 20% Typically 5 out of full list of 15 conditions, 3 of these categories Epilepsy/seizures Cancer 15% Kidney disease Liver disease 11% 8% 0% 20% 40% 60% 80% 100% *BMI 30 Source: Author s analysis of 2016 18 data from the National Health Interview Survey
Some conditions more prevalent among Black & Latino/a HCBS users 54% Hypertension 66% 51% 53% 55% Latino/a Higher weight* 46% Black non-Latino 34% Diabetes 26% 27% White non-Latino Bold = significantly greater than Whites 19% Stroke 24% 17% *BMI 30 0% 20% 40% 60% 80% 100% Source: Author s analysis of 1999 2018 data from the National Health Interview Survey
Top risk factors associated with Covid-19 hospitalizations, ages 50 64 100% 90% Percent of hospitalizations 80% 70% 60% 50% 35% 40% 28% 30% 22% 20% 10% 0% *BMI 30 Higher weight* Hypertension Diabetes Source: O'Hearn M, Liu J, Cudhea F, Micha R, Mozaffarian D. Coronavirus Disease 2019 Hospitalizations Attributable to Cardiometabolic Conditions in the United States: A Comparative Risk Assessment Analysis. J Am Heart Assoc. 2021 Feb 25
Risk factors for COVID-19 mortality, age <70 Cancers 2.2 6.7 I/DD 3.6 4.8 Dementia 1.8 2.9 Kidney/liver 1.6 2.3 Heart failure 2.3 Mobility 1.9 Odds ratio Relative mortality risk compared to someone without that condition Epilepsy 1.8 Ulcers 1.6 Odds Ratio Adapted from FAIR Health, West Health Institute, & Makary, M. (2020). Risk Factors for COVID-19 Mortality among Privately Insured Patients: A Claims Data Analysis. New York: FAIR Health, Inc, Fig 8
Effect of multiple risk factors on COVID mortality risk, age<70 Effect of multiple risk factors on COVID mortality risk, age<70 1.0 0 Number of comorbid conditions 1.7 1 2.8 2 Odds ratio Relative mortality risk compared to someone with no conditions 4.8 3 6.1 4 14.3 5+ 0 2 4 6 8 10 12 14 16 Odds ratio Adapted from FAIR Health, West Health Institute, & Makary, M. (2020). Risk Factors for COVID-19 Mortality among Privately Insured Patients: A Claims Data Analysis. New York: FAIR Health, Inc, Fig 15
Key points Certain disability groups are at especially high risk from COVID-19 Risk of exposure and/or risk of serious illness & death IHSS recipients, who typically have 3 5 chronic health conditions, have >3 times the mortality risk from COVID-19 as people in the same age group without chronic conditions Regional Center/DDS clients have 4 5 times the mortality risk from COVID-19 as people in the same age group without I/DD This increased risk for mortality puts these people in a risk category equivalent to other Californians in a higher age group. For example, IHSS/DDS service recipients between 45 and 64 years of age are at greater mortality risk from COVID-19 than the general, community-resident population between 65 and 74 years of age. Black & Latino/a HCBS users at especially high risk of serious illness
