Dr. Amal Khoury

Contact: Brad Lifford
February 11, 2013

Study by ETSU professor reveals high prevalence of physical disability, chronic disease among women on Medicaid

JOHNSON CITY – A new study by a researcher with the East Tennessee State University College of Public Health shows that women with low incomes have a high prevalence of physically disabling conditions and chronic disease.

Dr. Amal Khoury, a professor and chair of the ETSU Department of Health Services Management and Policy, led a study of 75,000 women who are on Medicaid, the federal/state government's health insurance program for people with low incomes and resources. Khoury's work was published in Disability and Health Journal.

In Khoury's study, 33 percent of women on Medicaid had been diagnosed with high blood pressure and 20 percent were depressed, rates that are significantly higher than the general adult population. She and her collaborators looked at the prevalence of eight other chronic diseases and found that the women were at risk for those, too.

Looking at the rates of physical disability led to particularly troubling revelations, Khoury said. Of those 75,000 women, almost half had been diagnosed with a disabling condition, such as multiple sclerosis, arthritis, injury, back disorder or Parkinson's disease. Women with a physical disability had significantly higher rates of all 10 chronic diseases than women without disability. And among women who used a device – such as a walker, crutches or wheelchair – to aid in mobility, 72 percent suffered from hypertension, 40 percent from diabetes and pulmonary disease, and 35 percent from depression.

Khoury said those who took a glance at the conclusions without knowledge of the demographic parameters might rightly assume that the women included in the study were elderly – a variable that can raise the rates of chronic disease and disability. But advancing age was not a factor.  "We studied women who were from the age of 18 to 64, and the average age was 38," Khoury said. "You first look at this data in terms of the human cost, in terms of how disability and chronic disease affect these women in respect to their quality of life and their length of life. And then there's the cost to society. These are not women of retirement age. These are rates of chronic disease and disability in a working-age population, so the economic loss to society and the impact on health care costs is substantial."

Khoury's research team studied women in Florida, but she said the results could be applied to any of the 50 U.S. states, even those that have an alternative government insurance program. The enrollment criteria for TennCare closely resemble those of Medicaid, she said.
"Our findings support the need for improved chronic disease prevention in younger female Medicaid beneficiaries, especially those with physical disabilities," Khoury said. "Strategies to improve disease prevention, screening and treatment in the younger adult population may curtail higher disability rates in working-age adults and lower Medicaid and Medicare costs in the long run."

Rachel Ward, a doctoral student in the ETSU College of Public Health, is a listed co-author on the paper.