Racial and Ethnic Differences in Health by Disability

RTOI 2009-03

January 15, 2009

Project Description
Self-rated health status has been found to be an independent predictor of morbidity and mortality (1), and racial/ethnic disparities in health status persist among the U.S. adult population (2). Black and Hispanic adults are more likely to report their general health status to be lower (i.e., fair or poor) compared with white adults (2). In addition, the prevalence of disability has been shown to be higher among blacks and American Indians/Alaska Natives (29.9%) (3,4). Recent research suggests that within racial/ethnic populations, adults with a disability are more likely to report fair or poor health than adults without a disability (5). In addition, among adults with a disability, recent findings show differences in self-rated health, with 50.5% of American Indian/Alaska Natives reporting fair or poor health compared with 36.9% of whites and 49.9 percent of blacks with a disability (5).

The concept of health should be the same for people with and without disabilities (6). Differences in fair or poor health among people with disabilities compared to those without varied by race/ethnicity and are likely attributed, in part, to health-care and wellness promotion services being inaccessible, inappropriate, or unavailable for certain persons with disabilities (ref). Efforts to identify and reduce racial and ethnic disparities in care are inadequate if they do not explicitly include strategies to address the needs of persons with disabilities.

Purpose of the Project

  • Identify ongoing efforts to improve health by reducing racial or ethnic disparities in health-care and wellness promotion and describe whether people with disabilities are explicitly included in these efforts.
  • Determine how the permanence, severity, type, and duration of disability couple with race/ethnicity affect access to and quality of care.
  • Identify barriers to health-care for racial or ethnic minorities with disabilities.
  • Make recommendations related to the design of new- or adapting existing interventions that will improve access and quality of care and promote health and wellness for racial/ethnic minorities with disabilities.

Submission Requirement
Applications submitted in response to this proposal should present information that addresses the research plan activities listed below:

  • Describe the data, study design, and methods that will be used.
  • Describe in detail methods that will be used to define disability, health and identify racial/ethnic groups.
  • Note any known barriers to appropriate care and any known interventions that might be tailored to improve the health and wellness of racial and ethnic groups with disabilities.
  • Describe how the study might be useful in informing future work.
  • Describe how data will be obtained, stored, and analyzed.
  • Identify key staff and describe their project roles and responsibilities.
  • Include a detailed project timeline for the 3-year project.
  •  Describe how the study results will be disseminated.

Evaluation Criteria

In addition to the standard review criteria used to evaluate the scientific and technical merit of the research application (Significance, Approach, Innovation, Investigators, Environment, and Ethics) the following additional review criteria specific to this proposal will be considered in the determination of scientific merit and the priority score: 

  •  Research experience in the topic area of racial and ethnic disparities, especially in the context of disability.
  • Demonstrated support from agencies, groups, and others that will be used to identify eligible participants and conduct the research.
  • Previous experience with successfully completed projects with similar design including dissemination of results through publications.

Total Years of Project Length

Three (3) years.

Total Number of Project to be Funded

One (1)

Availability of Funds

Approximately $350,000 is available to fund the first year. Comparable levels of funding are anticipated for the following years of the project. Funding may vary and is subject to change. 

Research Status
It is expected that this project will be non-exempt research. It is anticipated that this project will require local IRB approval. Applicants should provide a federal wide assurance number for each performance site included in the project.


1. Lee SJ, Moody-Ayers SY, Landefeld CS, et al. The relationship between self-rated health and mortality in older black and white Americans. J Am Geriatr Soc 2007;55:1624-9.

2. Mead H, Cartwright-Smith L, Jones K, Ramos C, Woods K, Siegel B. Racial and ethnic disparities in U.S. health care: a chartbook. New York, NY: The Commonwealth Fund; 2008.

3. CDC. Disability and health state chartbook, 2006: profiles of health for adults with disabilities. Atlanta, GA: US Department of Health and Human Services, CDC; 2006.

4. US Department of Health and Human Services. Healthy people 2010 (conference ed, in 2 vols). Washington, DC: US Department of Health and Human Services; 2000.

5. CDC. Racial/Ethnic Disparities in Self-Rated Health Status Among Adults With and Without Disabilities -- United States, 2004 -- 2006. Atlanta, GA: US Department of Health and Human Services, CDC; 2008.

6. US Department of Health and Human Services. The Surgeon General's call to action to improve the health and wellness of persons with disabilities. Washington, DC: US Department of Health and Human Services, Office of the Surgeon General; 2005.

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