ObjectiveTo investigate whether uncertainty surrounding the death is associated with the inaccurate reporting of intellectual disability as the underlying cause of death.DesignNational Vital Statistics System 2005–2017 US Multiple Cause-of-Death Mortality files.SettingUSA.ParticipantsAdults with an intellectual disability reported on their death certificate, aged 18 and over at the time of death. The study population included 26 555 adults who died in their state of residence between 1 January 2005 and 31 December 2017.Primary outcome and measuresDecedents with intellectual disability reported on their death certificate were identified using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for intellectual disability (F70–79). Bivariate analysis and multilevel logistic regression models were used to investigate whether individual-level and state-level characteristics indicative of increased uncertainty at the time of death were associated with the inaccurate reporting of intellectual disability as the underlying cause of death.ResultsInaccurate reporting of intellectual disability as the underlying cause of death was associated with sociodemographic characteristics, death context characteristics and comorbidities indicative of an increased amount of uncertainty surrounding the death. Most striking were increased odds of having intellectual disability reported as the underlying cause of death for decedents who had a choking event (OR=14.7; 95% CI 12.9 to 16.6, p<0.001), an external cause of death associated with a high degree of uncertainty, reported on their death certificate.ConclusionIt is imperative that medical personnel not let increased uncertainty lead to the inaccurate reporting of intellectual disability as the underlying cause of death as this practice obscures cause of death trends for this population. Instead, even in instances when increased uncertainty surrounds the death, certifiers should strive to accurately identify the disease or injury causing death, and report the disability in Part II of the death certificate.
Background Racial‐ethnic differences in educational attainment have not been explored among adults with intellectual disability (ID). Because adults with ID and racial‐ethnic minority groups have been historically marginalised from educational pathways through life, they have likely experienced cumulative disadvantage. Therefore, investigating the intersection of ID and race‐ethnicity is necessary to increase understanding of educational attainment among adults with ID. Methods Using 1986–2017 National Health Interview Survey data, we examined the educational trajectories of adults with ID, stratified by race‐ethnicity (N = 4610). Generalised ordered logistic regression models were utilised to estimate the effect of birth cohort on educational attainment by race‐ethnicity among adults with ID. Results Results support prior findings that educational attainment increased for adults with ID around the 1950–1959 birth cohort; however, this was only the case for non‐Hispanic Whites. For racial‐ethnic minority groups, the probability of attaining a high school degree did not increase until comparatively later birth cohorts: non‐Hispanic Black adults did not have their largest gains in educational attainment until the 1960–1969 birth cohort; Hispanic adults did not have their largest gains in attainment until the 1980–1999 birth cohort. Conclusion This study provides evidence of improvements in educational attainment for all adults with ID across birth cohorts. However, racial‐ethnic disparities were also present – educational attainment levels for non‐Hispanic Blacks remained lower than for non‐Hispanic Whites across all birth cohorts in the study. Hispanics were able to catch up to and surpass both non‐Hispanic Whites and non‐Hispanic Blacks by the end of the study period, despite lower levels of education in the early birth cohorts. Results from this study highlight the need to attend to race‐ethnicity when examining educational outcomes among adults with ID.
The authors examine how two state-level coronavirus disease 2019 (COVID-19) policy indices (one capturing economic support and one capturing stringency measures such as stay-at-home orders) were associated with county-level COVID-19 mortality from April through December 2020 and whether the policies were more beneficial for certain counties. Using multilevel negative binominal regression models, the authors found that high scores on both policy indices were associated with lower county-level COVID-19 mortality. However, the policies appeared to be most beneficial for counties with fewer physicians and larger shares of older adults, low-educated residents, and Trump voters. They appeared to be less effective in counties with larger shares of non-Hispanic Black and Hispanic residents. These findings underscore the importance of examining how state and local factors jointly shape COVID-19 mortality and indicate that the unequal benefits of pandemic policies may have contributed to county-level disparities in COVID-19 mortality.
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