Health inequalities among people with disabilities: an umbrella review and evidence synthesis.

Abstract

People with disabilities frequently experience poorer health than others in the population, yet the extent of this health gap is unknown. We undertook an umbrella review of meta-analyses to assess the amount, strength and quality of the evidence of the association between disability and a broad range of health outcomes. We searched Cochrane Library, EMBASE, Medline, PsycINFO and Health Evidence to identify meta-analyses of quantitative studies, published January 1, 2000 to February 3, 2025, in any language. We included systematic reviews with meta-analyses that compared health outcomes between people with and without disabilities, across all study settings and geographical locations. Two reviewers assessed study eligibility and extracted data. We assessed risk of bias using the AMSTAR2 tool and evaluated the strength of evidence for each meta-analysis according to the Fusar-Poli and Radua criteria. We narratively described the association between disability and health outcomes, categorised according to ICD-11 categories. This study is registered with PROSPERO, CRD42025645729. The search generated 11,221 unique records, of which 58 systematic reviews that included meta-analyses were included. Together, these reviews drew on 1409 primary studies from 77 countries and produced 132 separate meta-analyses that evaluated 16 health outcomes. Overall, most systematic reviews were of moderate to low quality. Intellectual and developmental disabilities accounted for the largest share of the meta-analyses (n = 60, 45%). One-third of associations (n = 45, 34%) showed convincing or highly suggestive evidence linking disability to adverse health outcomes. The majority of meta-analyses (n = 113, 86%) found statistically significant and positive associations. No studies that examined disability in relation to diseases of the blood, diseases of the immune system, diseases of the musculoskeletal system or conditions related to sexual health were identified. People with disabilities are a diverse group, yet share the common experience of markedly worse health than their peers without disabilities. The evidence base is constrained by limited measurement of subjective health outcomes and definitions of disability that may not capture contextual factors. Consequently, the true association of disability and poor health outcomes may be underestimated. Health inequities experienced by people with disabilities necessitate health system reforms with efforts to embed inclusion and address social determinants of health. The National Institute for Health and Care Research, the Programme for Evidence to Inform Disability Action grant from the Foreign, Commonwealth and Development Office, the Conrad N. Hilton Foundation.