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BMC Public Health

Open Access

Inequalities in socio-economic characteristics and health and wellbeing of men with and without disabilities: a cross-sectional analysis of the baseline wave of the Australian Longitudinal Study on Male Health

  • Anne M. Kavanagh1Email author,
  • Zoe Aitken1,
  • Eric Emerson2, 3,
  • Sash Sahabandu4,
  • Allison Milner1, 5,
  • Rebecca Bentley1,
  • Anthony D. LaMontagne1, 5,
  • Jane Pirkis6 and
  • David Studdert7, 8
BMC Public HealthBMC series – open, inclusive and trusted201616(Suppl 3):1042

https://doi.org/10.1186/s12889-016-3700-y

Published: 31 October 2016

Abstract

Background

Internationally, men with disabilities have higher rates of social and economic disadvantage and poorer health and wellbeing than men without disabilities. No single study has provided comprehensive, population-level information about the magnitude of such differences among adult men using a well-validated instrument to measure disability.

Methods

We analysed baseline data from Ten to Men – an Australian longitudinal study of male health. Ten to Men used a stratified multi-stage cluster random sample design to recruit a national sample of males aged 10 to 55 years residing in private dwellings. Data were collected between October 2013 and July 2014 from 15,988 males. This analysis was restricted to 18–55 year old participants with data available on age and disability (n = 13,569). We compared the demographic, socio-economic characteristics and health and wellbeing of men with and without disabilities using chi squared tests for proportions and t tests for continuous variables. Linear regression adjusted for age was used to assess the association between disability status and health and wellbeing, which were measured using the SF-12 mental and physical health component scores and the Personal Wellbeing Index.

Results

Men with disabilities were older and more likely to be born in Australia, speak English at home, be Aboriginal and Torres Strait Islander and were less likely to be married or de facto, or to live in urban areas. They were less likely to have completed secondary school, be employed and live in affordable housing, and were more likely to live on low incomes, in more socio-economically disadvantaged areas, and in rental accommodation and to experience shortages of money. Among employed men, those with disabilities were less likely to be in high skilled jobs, worked less hours on average, and were more likely to report that they would prefer to work more. Men with disabilities had lower levels of social support and community participation and poorer mental and physical health and overall wellbeing.

Conclusion

Adult men with disabilities experience marked social and economic disadvantage and poorer health and wellbeing. Improving the health and wellbeing of disabled men should be a priority for public health researchers and policy-makers.

Background

Australians with disabilities have significantly worse life outcomes than their peers without disabilities. They have lower levels of social and economic wellbeing and poorer health on a variety of health status measures, including ones unrelated to their impairment [1, 2]. For example, people with disabilities are more likely to be overweight or obese, smoke, be physically inactive and have poor diets; they also have poorer self-rated health, life satisfaction, and mental health [312]. They have higher rates of chronic conditions such as diabetes and heart disease and are more likely to use clinical services but less likely to use preventative health care [8, 1317].

The inequalities extend beyond direct measures of health and wellbeing. Compared to Australians without disabilities, Australians with disabilities have lower levels of employment, education, income, community participation and social support, and higher levels of housing stress, poverty and inter-personal violence [10, 12, 1820]. Inequalities between people with and without disabilities in Australia are starker than in other Organisation for Economic Cooperation and Development (OECD) countries. Relative to Australians without disabilities, the income of Australians with disabilities is the lowest of all OECD countries and they have one of the lowest levels of labour force participation [21]. Analyses of national data from the Australian Survey of Disability, Ageing and Carers involving over 30,000 adults revealed that men with disabilities were more likely to experience concentrated disadvantage (i.e. multiple indicators of disadvantage such as low income, housing stress and unemployment) than men without disabilities (22 % vs 5 %) [22]. The disadvantaged circumstances of men with disabilities are likely to have flow on effects to health and wellbeing. Emerging evidence suggests that socio-economic disadvantage makes a substantial contribution to disability-related inequalities in health [23].

There is an absence of comprehensive analyses of the social, economic and health and wellbeing outcomes between Australian men with and without disabilities that is in part due to the limitations of current studies. Health-related studies do not collect adequate data on disability and rarely include measures of wellbeing. The main source of data on disability in Australia is the Australian Bureau of Statistics (ABS) Survey of Disability, Ageing and Carers, but it has limited socio-economic data on people without disabilities and does not collect information on health [20].

This paper used data collected from adult men who participated in the first wave of the Australian Longitudinal Study of Male Health (Ten to Men) – a large nationally representative study of Australian boys and men which included the Washington Group short set of questions on disability, an internationally validated instrument to measure disability [24]. We capitalised on the unique combination of disability, social determinants and health and wellbeing data collected in the baseline wave to provide a comprehensive comparison of a large sample of adult men both with and without disabilities across a range of social, economic, and health and wellbeing indicators.

Methods

Data source

Ten to Men is a national longitudinal study of boys and men aged 10 to 55 years. In waves spaced approximately 2–3 years apart, we will collect data on a range of life domains, including demographic and socio-economic characteristics, physical and mental health and wellbeing, health behaviours, and use and knowledge of health services. The baseline survey was conducted between October 2013 and July 2014. The total sample consisted of 15,988 males, who were sampled using a multi-stage, clustered, random sample design. All eligible males residing in private households were approached, with separate cluster samples drawn from regional strata in order to oversample males from regional areas. Data were collected from males 15 years and older using a self-completion questionnaire and by interview and parent self-completion questionnaire for boys aged 10 to 14 years. The response fraction was 35 %. Response rates for individual questions in the survey varied between 82 and 100 %. More details on the study can be found elsewhere [25].

The sample for this analysis consisted of 13,569 of the 13,884 participants aged 18 to 55 years and excluded those who did not report their age (0.9 %) or did not respond to the disability questions (1.4 %).

Disability variable

The Ten to Men survey included the Washington Group short set of questions on disability, a widely used instrument for measuring disability which has been validated in many countries [24]. It consists of six questions relating to core functional domains (seeing, hearing, walking, cognition, self-care and communication) with answers reported on a severity scale (no difficulty, some difficulty, a lot of difficulty and cannot do at all). We classified participants as having a disability if they reported that they had a lot of difficulty or cannot do at all on one or more of the core domains [24].

Other variables

The survey included questions on a range of demographic and socio-economic variables including age, race/ethnicity, relationship status, education, employment, housing, income and financial security. Age was classified into the following groups: 18 to 24, 25 to 34, 35 to 44, and 45 to 55 years. Variables measuring race/ethnicity included country of birth (Australia, other); language spoken at home (English, other); and Aboriginal and Torres Strait Islander (ATSI, not ATSI). Relationship status was coded as married or in a de facto relationship, separated or divorced or widowed, and single. Area of residence was defined as metropolitan, inner regional, and outer regional. Socio-economic variables included education (did or did not complete secondary school); household income (≥$150,000, $100,000 to $149,999, $50,000 to $99,999, $30,000 to $49,999, $1 to $29,999, nil or negative income), and labour force status (employed, unemployed and looking for work, and not in the labour force). If employed, occupation was classified according to skill level (high, medium and low skill); employment arrangements (permanent, fixed-term or casual, self-employed); number of hours worked; preference for hours worked in relation to current hours worked (about the right amount, prefer fewer hours, prefer more hours); access to paid leave (e.g. sick or annual leave) (yes, no); experienced shortage of money in the last 12 months (yes, no - based on whether they answered yes to one or more of six questions regarding financial security such as could not pay bills on time); housing tenure (outright owner, mortgagor, living in rental accommodation, other); and housing affordability (affordable, unaffordable - defined as paying more than 30 % of household income on accommodation).

Area-level socio-economic disadvantage was categorised using population quintiles of the Index of Relative Socio-economic Disadvantage (IRSD), measured at Statistical Area Level 1 (SA1), the smallest geographic unit in the Australian Standard Geographic Classification. The IRSD is a composite index that summarises a range of information about the economic and social conditions of the people living within specific geographic areas [26]. A low IRSD score indicates relatively greater disadvantage.

Social support was measured using eight questions relating to emotional and informational support developed for the Medical Outcomes Study [27]. The questions elicit the availability of different kinds of support, which is graded on a five point scale ranging from “none of the time” to “all of the time”. Responses to these questions were summed and described as a continuous variable. Social participation was measured using three variables: current active membership in a club or association (yes, no), participation in ongoing community service activities (yes, no), and frequency of attendance at events that bring people together, such as fetes, festivals and community events (very often/often/sometimes, rarely/never). Participants were also asked about any experience of discrimination over the past two years, which was coded as no (never) or yes (rarely, occasionally, fairly often, very often).

Several of the many measures of general health and wellbeing collected in Ten to Men were used in this analysis. The Physical Component Summary (PCS) and the Mental Component Summary (MCS) scores are summary measures of physical health and mental health, respectively, derived from the Short Form 12 (SF-12) health survey [28]. The summary scores are validated, psychometrically based measures that are standardised to a mean of 50 and standard deviation of 10, and a range from 0 (worst health) to 100 (best health). The Personal Wellbeing Index – Adult (PWI-A) is a multi-item scale which measures subjective wellbeing [29]. The PWI-A is based on responses to seven questions that measure satisfaction within specific life domains: standard of living, health, life achievements, personal relationships, safety, feeling part of a community, and future security. Responses are recorded on an 11-point Likert scale ranging from 0 (completely dissatisfied) to 10 (completely satisfied). We analysed the seven domains individually and in aggregate via the PWI-A, which is created by summing the seven items to yield an overall score of subjective wellbeing.

Statistical analysis

First, we calculated the population-weighted prevalence of disability among Australian men aged 18 to 55 years, by age group. We compared the patterns of demographic, social and economic variables between men with and without disabilities using proportions and means, and tested for differences using Chi squared and t tests respectively. To ensure that any differences in health and wellbeing between the groups were not confounded by systematic differences in the distribution of age, we also used population weighted linear regression analysis that adjusted for age.

The sample weights used in the weighted estimates (prevalence and age-adjusted health and wellbeing comparison) were calculated based on the inverse of the probability of selection at the level of the individual participant [30].

The number and proportion of missing observations for each variable are described in Additional file 1: Table S1.

Results

Demographic characteristics

In total, 957 men in the sample were classified as having a disability, a population weighted prevalence of 6.8 % (95 % CI 6.8 %, 6.8 %). The population-weighted prevalence of disability was 6.4 % (95 % CI 6.3 %, 6.4 %) among men aged 18–24, 5.9 % (95 % CI 5.9 %, 6.0 %) among 25–34 year olds, 6.0 % (95 % CI 6.0 %, 6.1 %) among 35–44 year olds and 8.4 % (95 % CI 8.4 %, 8.5 %) among 45–55 year olds.

Compared to men without disabilities, men with disabilities were older and were more likely to be born in Australia, speak English at home, and be ATSI (Table 1). On the other hand, men with disabilities were less likely to be residing in metropolitan areas or living in a married or de facto relationship.
Table 1

Demographic characteristics of men with and without disabilities

 

Disability

No disability

P value

N

%

n

%

Age

 18–24 years

126

13.4

1844

14.6

p < 0.001

 25–34 years

190

20.2

2866

22.7

 35–44 years

242

25.7

3833

30.4

 45–55 years

384

40.8

4084

32.3

 Mean, SD

39.5

11.0

38.0

10.6

p < 0.001

Country of birth

 Australia

775

82.3

9597

76.0

p < 0.001

 Other

167

17.7

3030

24.0

Language spoken at home

 English

870

94.2

11,405

91.3

p = 0.003

 Other

54

5.8

1081

8.7

Indigenous status

 Not ATSI

888

95.1

12,308

97.9

p < 0.001

 ATSI

46

4.9

267

2.1

Relationship status

 Married/de facto

518

55.7

8501

67.8

p < 0.001

 Separated/widowed/divorced

118

12.7

773

6.2

 Single

294

31.6

3261

26.0

Area of residence

 City

469

49.8

7427

58.9

p < 0.001

 Inner regional

262

27.8

2817

22.3

 Outer regional

210

22.3

2374

18.8

Socio-economic characteristics

Men with disabilities were more disadvantaged than non-disabled men on all but two of the 12 socio-economic variables analysed (Table 2). They were less likely to have completed secondary school (39 % vs 62 %) and live in affordable housing (55 % vs 63 %) and were more likely to live on low incomes, in more socio-economically disadvantaged areas (28 % vs 18 %), live in rental accommodation (41 % vs 29 %) and to experience shortages of money (55 % vs 30 %).
Table 2

Socioeconomic characteristics of men with and without disabilities

 

Disability

No disability

P value

n

%

n

%

Education

 Completed secondary

357

39.4

7598

61.9

p < 0.001

 Did not complete secondary

549

60.6

4678

38.1

Household income (annual)

  ≥ $150,000

92

11.8

2417

22.3

p < 0.001

 $100,000–$149,999

124

15.9

2901

26.8

 $50,000–$99,999

268

34.4

3773

34.8

 $30,000–$49,999

142

18.2

1108

10.2

 $1–$29,999

144

18.5

561

5.2

 Nil/negative

9

1.2

70

0.7

Labour force status

 Employed

578

63.1

10,808

87.2

p < 0.001

 Unemployed

127

13.9

984

7.9

 Not in the labour force

211

23.0

597

4.8

Skill levela

 High

142

26.4

4022

39.1

p < 0.001

 Medium

209

38.8

3692

35.9

 Low

187

34.8

2581

25.1

Employment arrangementsa

 Permanent

378

67.1

7447

70.0

p = 0.113

 Fixed term/casual

99

17.6

1540

14.5

 Self employed

86

15.3

1646

15.5

Number of hours workeda

 Mean, SD

39.3

19.3

41.7

15.9

p < 0.001

Hours of work preferreda

 About right amount

243

43.9

5606

52.7

p < 0.001

 Prefer fewer hours

179

32.3

3357

31.6

 Prefer more hours

132

23.8

1673

15.7

Access to paid leavea

 Yes

312

65.0

6217

68.5

p = 0.111

 No

168

35.0

2862

31.5

Shortage of money

 No

410

45.1

8612

70.2

p < 0.001

 Yes

500

55.0

3663

29.8

Housing tenure

 Outright owner

134

14.8

1881

15.2

p < 0.001

 Mortgagor

341

37.7

6302

51.1

 Rented accommodation

371

41.0

3530

28.6

 Other

59

6.5

626

5.1

Housing affordability

 Affordable

425

55.2

6800

63.2

p < 0.001

 Unaffordable

345

44.8

3960

36.8

SEIFA

 Q5 (less disadvantaged)

102

10.8

2406

19.1

p < 0.001

 Q4

152

16.1

2759

21.9

 Q3

198

21.0

2957

23.4

 Q2

226

24.0

2279

18.1

 Q1 (more disadvantaged)

264

28.0

2221

17.6

aAmong employed men

Men with disabilities were much less likely to be employed than their non-disabled counterparts (63 % vs 87 %). Among those who were employed, men with disabilities were less likely to be in high skilled jobs (26 % vs 39 %), worked fewer hours per week (on average 39 vs 42 h) and were more likely to report that they would prefer to work more (24 % vs 16 %). However, there were no statistically significant differences between workers with and without disabilities with respect to employment arrangements and access to paid leave.

Social support, participation and discrimination

Men with disabilities had lower levels of social support (mean score of 60 vs 71), were less likely to be a member of club or association (29 % vs 39 %), to have participated in community service (19 % vs 25 %), and to attend community events (26 % vs 37 %), whereas they were substantially more likely to have experienced discrimination (61 % vs 46 %) (Table 3).
Table 3

Social support, participation, and discrimination of men with and without disabilities

 

Disability

No disability

P value

n

%

n

%

Social support

 Mean (SD)

60.1

30.0

70.5

26.1

p < 0.001

Group membership

 Yes

268

29.4

4758

38.9

p < 0.001

 No

643

70.6

7472

61.1

Community service

 Yes

171

18.8

3081

25.2

p < 0.001

 No

739

81.2

9155

74.8

Community events

 Sometimes/very often

234

25.7

4573

37.3

p < 0.001

 Never/rarely

677

74.3

7698

62.7

Discrimination

 No

347

39.0

6612

54.4

p < 0.001

 Yes

544

61.1

5540

45.6

Health and wellbeing

For every one of the health and wellbeing measures examined, mean scores were lower among men with disabilities than they were among men without them (PCS: 45.5 vs 54.5; MCS: 41.5 vs 50.5; PWI-A: 54.4 vs 71.5) (Table 4). For the variables describing satisfaction with each of the life domains, there was a 1.3 to 2.3 point difference between people with and without disabilities.
Table 4

Health and wellbeing of men with and without disabilities

 

Disability

No disability

P value

Mean

SD

Mean

SD

SF-12 Physical Component Score

45.4

11.8

54.5

6.6

p < 0.001

SF-12 Mental Component Score

41.5

11.9

50.5

8.7

p < 0.001

Personal Wellbeing Index

54.4

21.8

71.5

16.2

p < 0.001

Satisfaction with life domains

 Standard of living

5.9

2.6

7.4

2.0

p < 0.001

 Health

4.5

2.6

6.8

2.0

p < 0.001

 Life achievements

4.8

2.9

6.8

2.2

p < 0.001

 Personal relationships

6.2

3.1

7.5

2.4

p < 0.001

 Safety

7.0

2.8

8.3

1.8

p < 0.001

 Feeling part of a community

5.1

2.9

6.8

2.3

p < 0.001

 Future security

4.8

3.1

6.8

2.4

p < 0.001

Men with disabilities scored 16.8 points lower (95 % CI −18.7, −14.9) on the PWI-A after adjusting for age in the regression analyses, the PCS score was on average 9.4 points lower (95 % CI −10.5, −8.4) and the MCS score was 8.8 points lower (95 % CI −9.8, −7.7). Overall adjusting for age had trivial effects on the size of these differences (see Additional file 2: Table S2 for coefficients).

Discussion

This analysis of data gathered in a large national study of adult Australian men showed that men with disabilities had higher levels of social and economic disadvantage and poorer health and wellbeing than their non-disabled peers. They were disadvantaged on most socio-economic indicators across all domains, including education, employment, working conditions, housing, income, education, and discrimination. They also had lower levels of: (1) community participation and social support; and (2) life satisfaction across all domains and lower levels of overall wellbeing, measured using SF-12 summary scores and the PWI-A.

Nearly seven percent of our sample was classified as disabled, however, there is a lack of international and national consensus on how best to measure disability in large-scale surveys [3133]. As a result, disability prevalence estimates are strongly influenced by variation in conceptual or legal definitions of disability and the methods used to operationalise them. The majority of previous Australian surveys of disability, socio-economic conditions and health have relied on responses to a single question about disability which asked participants whether they had an impairment, long-term health condition, or disability which restricted everyday activities and lasted, or was likely to last, for a period of six months or more. Using this definition, the estimated prevalence of disability among 15 to 54 year old men was 18.1 % in the most recent wave of the Household, Income and Labour Dynamics in Australia Survey (HILDA) (unpublished analysis). The ABS Survey of Disability, Ageing and Carers, which uses an extensive range of questions to determine disability status and characteristics, found the crude prevalence of any disability among 15 to 54 year old males was 11.2 % and the prevalence of severe disabilities was 2.3 % [20].

Our findings correspond with those of previous Australian studies using HILDA and the ABS surveys – the Survey of Disability, Ageing and Carers and General Household Social Survey [12, 22, 3437]. However, this paper adds to the existing literature by covering a broader range of social and economic domains and indicators of health and wellbeing and using an internationally validated instrument to measure disability. Moreover, whereas previous studies have focused largely on health status measures, ours includes measures of subjective wellbeing or life satisfaction. While our estimates of the associations between disability and socio-economic disadvantage and disability and mental health are consistent with those found elsewhere, the differences we report are higher than reported previously. For example, previous analyses of HILDA have reported a 2–3 point lower MCS score among people with disabilities [35, 36], while we estimated a nine point difference (nearly one standard deviation) in Ten to Men. This difference probably reflects the way disability was coded using the Washington Group questions, where we only categorised people as disabled who reported ‘a lot of difficulty or could not do at all’ across at least one of the six core domains. Although HILDA uses SF-36 and Ten to Men uses SF-12, this is not a convincing explanation for the discrepancy because validation studies in European countries found very high correlations between the component scores derived from the SF-12 and SF-36 [38].

Strengths and limitations

The strengths of the study are its national scope, large sample size, comprehensive range of measures across multiple domains of the social determinants of health, and use of well-validated measures of disability and wellbeing. This study used the Washington Group questions to classify disability, a measurement tool designed to improve disability statistics and enable better comparisons of data, which has been validated internationally. The Washington Group questions are a significant advance on this approach. Additionally, this study uses the PWI-A to measure wellbeing. No study has previously examined the relationship between disability and a well-validated measure of personal wellbeing. Wellbeing is a positive construct, which may have a different relationship with disability compared to outcomes describing poor health.

The study also has a number of limitations. The response fraction was 35 % and thus selection bias due to non-response was likely. Adult participants in Ten to Men were slightly older than the general population they represent, more likely to have been born in Australia and to live in regional areas (reflecting the oversampling of these areas). The question of discrimination did not ask about types of discrimination (e.g. race/ethnicity, gender, disability) and so we were unable to determine the extent to which people with disabilities were exposed to disability-related discrimination. We used the MCS and PCS of SF-12 to measure health status, however the SF-12 includes questions (e.g. difficulty climbing stairs) that overlap with Washington Group questions (e.g. difficulty walking) and therefore we would expect lower scores among people with disabilities. In contrast, the PWI-A is a global measure of satisfaction across a range of life domains and we demonstrate approximately one standard deviation difference in PWI-A between people with and without disabilities and substantial differences across all domains of life.

Because the adult Ten to Men questionnaire was administered as a self-complete postal questionnaire in English it is likely to under-represent men who have difficulty reading and responding to a questionnaire due to visual, intellectual or cognitive impairments, or for whom English is not their first language. This is likely to result in an underestimate of disability prevalence and reduce the generalisability of the results to the Australian population. The lower prevalence of disability among men not born in Australia and men who did not speak English at home may reflect the fact that people who migrate tend to be healthier.

Disability is a contested concept and approaches to measurement have varied substantially [32, 39]. Our definition of disability was based on the Washington Group questions. Caution must be exercised in interpreting comparisons of our prevalence estimates with those from prior Australian studies. We were unable to use ABS modules for disability in Ten to Men because they are designed to be administered face-to-face and the ABS Survey of Disability, Ageing and Carers is wider in scope and includes people living in private dwellings, self-care retirement villages and establishments providing long-term cared accommodation. A population-based Norwegian study of adults aged 20 to 67 years compared ten approaches to measurement of disability including modified versions of the Washington Group questions and the ABS short form module. They found low concordance between the Washington Group questions and the ABS short module (kappa 0.14); only 47 % of people defined as having a disability using either approach were classified as disabled using both (this was 63 % for severe disability) [40]. Because the Washington Group questions have four response categories describing severity of the disability, multiple disability definitions can be created with different prevalence estimates. The Washington Group recommended the use of a cut-off of ‘a lot of difficulty’ or ‘cannot do at all’ recorded for at least one of the core domains for use in reporting of disability statistics [32]. Other criticisms of the Washington Group questions include that that they are relatively insensitive to detection of people with mental health problems because emotional functioning is not included in the core domains, and they classify many people with mild to moderate disability as non-disabled, even though they experience important limitations in their daily lives [5, 33, 41]. As people with mental health problems are more likely to experience disadvantage and have poorer overall health than people without disabilities, we believe that our estimates of associations between disability and socio-economic disadvantage and health and wellbeing are conservative.

We could not examine whether the socio-economic disadvantage experienced by men with disabilities contributed to inequalities in health and wellbeing between men with and without disabilities because this analysis is cross-sectional, and socio-economic disadvantage is likely to be both a cause and consequence of disability. However, given the well-established knowledge base about the social determinants of health and wellbeing it is likely that the disadvantaged socio-economic circumstances of men with disabilities make a substantial contribution to their poorer health.

Future research directions

We classified men as having a disability if they reported a lot of difficulty or could not do activities across one or more of six core domains. Future analyses could explore a range of different cut-offs and compare outcomes among men with different types of impairments as previous research has shown that people with psychological and intellectual impairments tend to fare worse on socio-economic and health outcomes than people with sensory and speech and physical impairments [12, 22].

Analysis of the wealth of data on health behaviours; mental and physical health and wellbeing; and health service use collected in Ten to Men will provide further insight into the extent of disability-related health inequalities in Australian men. Ten to Men presents a unique opportunity to explore the health and wellbeing of disabled males over the short and longer term. This is particularly important because Australia is undergoing massive reform in the delivery of disability services with the introduction of the National Disability Insurance Scheme (NDIS). The NDIS provides individualised funding and support to Australians with severe, permanent disabilities. Ten to Men will provide an opportunity to track whether the implementation of the NDIS reduces disability-related socio-economic and health inequalities. Finally, the Washington Group questions were included in the second wave of Ten to Men and thus it will be possible to identify the men who acquire a disability and assess the causes and consequences of disability acquisition.

Policy directions

Our findings demonstrate that Australian men with disabilities might be considered a ‘vulnerable population’ because they experience concentrated disadvantage that places them at higher risk of poor health and wellbeing than their non-disabled peers [42, 43]. While the NDIS is a welcome policy reform it will not necessarily solve the social and economic disadvantage and poorer health and wellbeing of men with disabilities because it does not fund housing, employment services, education or health services which will continue to be funded and provided under current state and federal arrangements. This means that policies and services that can address the socio-economic disadvantage and poorer health and wellbeing of men with disabilities will happen outside the NDIS. The results of these analyses highlight the importance of addressing social and economic disadvantage to improve the health of men with disabilities. This will require cross-sectoral engagement beyond the disability and health sectors and responses tailored to the particular concerns of Australian men with disabilities.

Conclusion

Adult men with disabilities experience considerable social and economic disadvantage and poorer health and wellbeing than their non-disabled peers. They have been an under-recognised group in public health research and policy and require specific attention. Ten to Men is a unique international resource that can be used to better understand the lives of Australian men with disabilities.

Abbreviations

ABS: 

Australian Bureau of Statistics

ATSI: 

Aboriginal and Torres Strait Islander

HILDA: 

Household Income & Labour Dynamics in Australia (panel study)

IRSD: 

Index of Relative Socio-economic Disadvantage

MCS: 

Mental Component Summary score of the Short Form 12

NDIS: 

National Disability Insurance Scheme

PCS: 

Physical Component Summary score of the Short Form 12

PWI-A: 

Personal Wellbeing Index—Adult

SA1: 

Statistical Area Level 1

SF-12: 

Short Form 12

Declarations

Acknowledgements

The research on which this paper is based on was conducted as part of the Australian Longitudinal Study on Male Health by the University of Melbourne. We are grateful to the Australian Government Department of Health for funding and to the boys and men who provided survey data.

Declaration

Publication of this article was funded by the Ten to Men Study. This article has been published as part of BMC Public Health Vol 16 Suppl 3, 2016: Expanding the knowledge on male health: findings from the Australian Longitudinal Study on Male Health (Ten to Men). The full contents of the supplement are available online at https://bmcpublichealth.biomedcentral.com/articles/supplements/volume-16-supplement-3.

Availability of data and materials

Ten to Men response data are available to researchers via a request and review process. Information on accessing Ten to Men data is available at http://www.tentomen.org.au/index.php/researchers.html. Copies of Wave 1 questionnaires, Wave 1 data books, and the Ten to Men Data User’s Manual are also available at that site.

Enquires about potential collaborations including sub-studies involving members of the Ten to Men cohort can be addressed to the Study Coordinator at info@tentomen.org.au.

Authors’ contributions

AK, ZA and ALaM were responsible for the analytical design. ZA and SS undertook data analysis. AK, ZA, EE, AM, RB, ALaM, JP and DS interpreted the analysis. AK and ZA drafted the manuscript. All authors undertook critical revision of the manuscript and have approved this manuscript version for submission.

Competing interests

The authors declare that they have no competing interests.

Consent for publication

Not applicable.

Ethics approval and consent to participate

The Australian Longitudinal Study on Male Health was approved by the University of Melbourne Human Research Ethics Committee (HREC 1237897 & 1237376). Participants provided written consent for their participation.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne
(2)
Centre for Disability Research and Policy, Faculty of Health Sciences, University of Sydney
(3)
Centre for Disability Research, Faculty of Health and Medicine, Lancaster University
(4)
Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne
(5)
School of Health & Social Development, Deakin University
(6)
Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne
(7)
Centre for Health Policy/PCOR, Stanford University School of Medicine
(8)
Stanford Law School

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Copyright

© The Author(s). 2016

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