People with disabilities are less likely to have completed year 12 or be in paid work, and are more likely to be living on low incomes and these inequalities persisted or worsened over time. Of particular concern is the high proportion of people with disabilities who are experiencing disadvantage across multiple domains and the increase in that proportion between 1998 and 2003. Across most indicators, the proportion living in disadvantage increased with a worsening of the level of disability. In 2009, women and men with severe or profound disabilities had high odds of living in multiple disadvantage (women: OR 3.8, 95% CI 3.2–4.5 and men: OR 13.2, 95% CI 10.7–16.3) - a situation that had worsened considerably since 1998 (women: OR 2.0, 95% CI 1.6–2.5 and men: OR 5.3, 95% CI 4.0–7.0). The exception to this pattern was the proportion of people with disabilities living in private rental (the tenure type most commonly linked to disadvantage in Australia) where men and women with mild, moderate and severe/profound disabilities were not over-represented although the proportion in private rental did increase between 1998 and 2009 reflecting the pattern in the overall population.
With the exception of educational outcomes, women and men with no specific limitations or restrictions had similar levels of disadvantage as women and men without disabilities. To some extent this is to be anticipated because although this group might experience difficulties in activities such as household chores or reading and writing, by definition, their limitations do not impact on their capacity to carry out core activities or to participate in paid work.
The proportion of people living in private rental was highest among women and men with no disabilities or those with employment restrictions, breaking the usual trend where people with more severe disabilities do worst. Part of the explanation for this may be that people with severe/profound and disabilities are more likely to have access to public housing and supported accommodation. It may also reflect the fact that tenure is a household characteristic rather than an individual attribute. Many people with a disability live with persons without an impairment and the relationship between housing circumstance and severity of disability is both complex and difficult to predict . Furthermore, low levels of private rental cannot be taken as evidence of improving conditions for people with a disability, rather it may be a reflection of the concentration of persons with a disability in public rental housing and the inability of many persons with a disability to enter the housing market in any form. This latter group is often forced to remain living with relatives for extended periods. The high levels of private rental for people with employment restrictions, who also do poorly on other measures of disadvantage, points to the need for housing and other social policies to address the unique needs of this group. This group are also at higher risk of becoming homeless .
Overall, we tended to observe higher absolute and relative inequalities in socio-economic outcomes when we compared men with and without disabilities than when we made the same comparison for women. However, women without disabilities and women with milder disabilities had lower incomes, were less likely to be in paid work, and had higher levels of multiple disadvantage than men but the levels of disadvantage were similar for women and men with moderate and severe/profound disabilities. This means that when comparisons are made between men with moderate/severe/profound disabilities and men without disabilities the absolute and relative inequalities are starker than when women with more severe disabilities are compared to women without disabilities. These findings highlight the complex intersections between gender, disability and socio-economic disadvantage which requires greater attention in future research.
Of particular concern is the proportion of women and men with severe/profound disabilities experiencing multiple disadvantage and the worsening of this indicator over time. The inter-relationships between different domains of disadvantage are likely to impact on the long-term health of people with disabilities. For example, Warner and Brown found that in the US, the combined disadvantage of being a women and black resulted in a more accelerated course of disablement than for white men, white women and black men . Our findings are consistent with the work of Llewellyn et al. who found that young Australians with disabilities had over five times the odds of living in multiple disadvantage than their able-bodied peers . The fact that disadvantage occurs on many fronts simultaneously reinforces the need to tackle disadvantage among people with disabilities in a coordinated way across sectors rather than employing silo, sector-specific approaches.
Most of the increases in multiple disadvantage occurred between 1998 and 2003 with small changes (increases or decreases) between 2003 and 2009. Between 1998 and 2003, Australia had a conservative government where there were shifts to universalist, often non-means tested, welfare policies (e.g. childcare rebates) rather than policies developed specifically for disadvantaged groups including people with disabilities. The period 1998 to 2003 was also a period of profound economic and policy change across Australia with significant increases in house prices, a reduction in housing affordability, the introduction of the Goods and Service Tax (GST) and an associated spike in inflation. All of these changes adversely affected living conditions for the most vulnerable within Australian society.
The Labor Government, elected in 2007, has invested in the development of disability-specific policy and practice initiatives such as the first National Disability Strategy  and the establishment of disability employment services , however, these reforms were not introduced until 2010 or later and therefore the potential effects are not reflected in this analysis. It is possible that these initiatives, and the introduction of DisabilityCare may reduce the levels of disadvantage experienced by people with disabilities. Because DisabilityCare largely targets people with significant, permanent disabilities is may have a relatively greater effect on this group - an outcome which it is critical to measure. We have provided a potential template for monitoring these socio-economic circumstances in the future in Australia and some direction for how this might be done internationally.
Strengths and limitations
One limitation of our analysis is that we primarily focused on individual socio-economic conditions rather than those that occur at the household level. This was partly because some household data items were not available for all time points (for example, there was no equivalised household income included in the 1999 data). It is possible that people with disabilities may have access to other resources in the household that could improve their living conditions. The opposite may also be true, particularly as many carers have reduced capacity to participate in the labour force and many households have more than one person living with a disability. Nonetheless employment, education and, to a lesser extent, personal income are important in shaping the lived experience of people with disabilities as they provide people with disabilities with access to their own social and economic capital.
There are other potential problems with the indicators we used. First, education level is likely to be established by age 25 and thus is a consequence of early life and childhood circumstances. However, it is also a marker of potential opportunities in the future. Education is a resource that enables adult women and men to access economic and social opportunities including paid work. We chose the measure private rental as an indicator of housing vulnerability as rental is less stable than either government (public) housing or owner occupiers (mortgagees or outright owners). While the non-private renters group (to home owners, those in government rental housing, etc.) is quite heterogeneous, they represent a more stable tenure type than private rental. We also selected this measure because recent research has highlighted both the high incidence of precarious housing within the rental market, and the negative impacts this uncertainty has for physical, and most especially, mental health . However, we acknowledge that our measure does not capture income or wealth - owner-occupiers have more assets than public or private renters. While it is usual to consider employment in terms of the proportion of people who are (or are not) unemployed, many people with disabilities might be disengaged from the labour force (and be on a disability pension rather than unemployment benefits) and the usual measure of unemployment would underrepresent this. Instead we used a measure of the proportion of people not in paid work to allow us to capture all those who were not participating in the paid labour force.
Because we use repeat cross-sectional data, it is not possible to explore cause and effect of disability and disadvantage, however, it is known that people who live in disadvantage are more likely to acquire a disability and vice versa. However this addresses a different set of questions and there have been detailed longitudinal analyses that explore this relationship . We were also unable to examine other important demographic measures such as Indigenous status as this information is not currently available for analysis in the basic CURF. In addition to disability severity, the type of impairment (i.e. sensory, physical, intellectual) should be assessed in the future as disadvantage may also vary by type of impairment.
Based on the experience of other OECD countries, there is evidence to suggest that the substantial disparities observed in Australia can be reduced, if not eliminated, through social policy or other intervention . Reductions in these socio-economic disparities will have flow on effects improving the health of people with disabilities. It is important that public health researchers, policy-makers and practitioners identify people with disabilities as a priority population in the same was as they have Indigenous Australians and people from culturally and linguistically diverse groups.