title: Employment as a health determinant for working-age, dually-eligible people with disabilities.
abstract: BACKGROUND
  Individuals with disabilities are a health disparity population with high rates of risk factors, lower overall health status, and greater health care costs. The interacting effect of employment, health and disability has not been reported in the research.
  
  
  OBJECTIVE
  This study examined the relationship of employment to health and quality of life among people with disabilities.
  
  
  METHODS
  Self-reported survey data and secondary claims data analyses of 810 Kansans ages 18-64 with disabilities who were dually-eligible for Medicare and Medicaid; 49% were employed, with 94% working less than 40 hours per week. Statistical analyses included ANOVA for differences between the employed and unemployed groups' health status, risk scores, and disease burdens; chi-square analyses for differences in prevalence of health risk behaviors and differences in quality of life by employment status; and logistic regression with health status measures to determine factors associated with higher than average physical and mental health status.
  
  
  RESULTS
  Findings indicated participants with any level of paid employment had significantly lower rates of smoking and better quality of life; self-reported health status was significantly higher, while per person per month Medicaid expenditures were less. Employment, even at low levels, was associated with better health and health behaviors as well as lower costs. Participants reported being discouraged from working by medical professionals and federal disability policies.
  
  
  CONCLUSIONS
  Although cause-effect cannot be established from this study, findings strongly support changes to provider practices and federal disability policy to support employment at all levels for people with disabilities.
authors.affiliation: Institute for Health and Disability Policy Studies, University of Kansas, USA. jhall@ku.edu
authors.forename: Jean P
authors.initials: JP
authors.lastname: Hall
authors.forename: Noelle K
authors.initials: NK
authors.lastname: Kurth
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Hunt
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D006233:Persons with Disabilities; D004608:Eligibility Determination; D004651:Employment; D005260:Female; D006262:Health; D015438:Health Behavior; D017048:Health Care Costs; D006306:Health Surveys; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011788:Quality of Life; D012307:Risk Factors; D012309:Risk-Taking; D057566:Self Report; D012907:Smoking; D014481:United States; D055815:Young Adult