title: Disability, caregiver's dependency and patterns of access to rehabilitation care: results from a national representative study in Peru.
abstract: OBJECTIVE
  To determine the prevalence of disability in Peru, explore dependency on caregiver's assistance and assess access to rehabilitation care.
  
  
  METHODS
  Data from Disability National Survey (ENEDIS), including urban and rural areas, were analyzed. Disability was defined as a permanent limitation on movement, vision, communication, hearing, learning/remembering or social relationships. Dependency was defined as the self-reported need for a caregiver to help with daily activities; and access to rehabilitation care was defined as the self-report of any therapy for disabilities. Estimates and projections were calculated using sample strata, primary sampling units and population weights, and prevalence ratios (PRs) and 95%CI were reported.
  
  
  RESULTS
  From 798,308 people screened, 37,524 (5.1%; 95%CI 4.9--5.2%) had at least one disability. A total of 37,117 were included in further analysis, mean age 57.8 (SD ± 24.1) years, 52.1% women. Dependency was self-reported by 14,980 (40.5%; 95%CI: 39.2-41.9%) individuals with disabilities. A family member, usually female, was identified as a caregiver in 94.3% (95%CI: 93.3-95.3%) of dependent participants. Only 2881 (10.7%; 95%CI: 9.7-11.9%) of people with disabilities reported access to rehabilitation care. Major inequality patterns of disability burden versus access to rehabilitation care were observed by age and education level. Older age groups had higher disability burden yet lower chances of access to rehabilitation care. Conversely, the higher the education level, the lesser the overall disability burden but also the higher chances of reporting receiving care. Private healthcare insurance doubled the probability of having access to rehabilitation compared with those without insurance.
  
  
  CONCLUSIONS
  Approximately 1.6 million Peruvians have at least one disability, and 40% of them require assistance with daily activities. Informal caregiving, likely female and relative-provided, is highly common. Rehabilitation care access is low and inequitable. Our results signal a major need to implement strategies to guarantee the highest standard of health care for people with disabilities.
  
  
  CONCLUSIONS
  Major inequality patterns in terms of burden of disability versus access to rehabilitation care were observed: those groups who concentrate more disability reported receiving less rehabilitation care. Caregiving is mostly informal and provided by a direct relative, mainly a woman, who resigned to their usual activities in order to help care for the person with disability. As a result, there is a need to develop appropriate support and training for caregivers. Access to care services in Peru is low and inequitable, but especially for people with disabilities: they experience greater barriers when accessing healthcare services even in the case of having health insurance.
authors.affiliation: a Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas , Lima , Peru .|b CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru .
authors.forename: Antonio
authors.initials: A
authors.lastname: Bernabe-Ortiz
authors.affiliation: b CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru .
authors.forename: Francisco
authors.initials: F
authors.lastname: Diez-Canseco
authors.affiliation: c Sociedad y Discapacidad - SODIS , Lima , Peru , and.
authors.forename: Alberto
authors.initials: A
authors.lastname: Vásquez
authors.affiliation: b CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima , Peru .|d Department of Medicine , School of Medicine, Universidad Peruana Cayetano Heredia , Lima , Peru.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003858:Dependency, Psychological; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010568:Peru; D012044:Regression Analysis; D012424:Rural Population; D057566:Self Report; D012959:Socioeconomic Factors; D014505:Urban Population; D055815:Young Adult
keywords: Activities of daily living; Peru; care; care givers