No One Left Behind? Comparing Poverty and Deprivation between People with and without Disabilities in the Maldives

Round 1

Reviewer 1 Report

First of all, thank you very much for giving me the opportunity to review this manuscript. The manuscript develops a vitally important theme. It focuses on the need to disaggregate the 2030 goals indicators to understand the situation of people with disabilities.

I would like to make a few observations with which I think they can improve the text.

Introduction

1.1. Many studies have pointed out that lack of paid work is the main factor of poverty and deprivation in people with disabilities. The authors should refer to these studies here.

1.2. It is necessary to distinguish the types of disability: there are many internal differences in the collective in relation to poverty, deprivation, etc. This would be good to make it clear in the text. For example, from line 49 you could enter this element.

Nested case-control study

2.1. It would be interesting and convenient to specify the rejection rate of the selected controls in a first instance (line 103).

Data analysis

3.1. Could we know the weights used in the sample? For example, in a new table (line 107…).

Results

4.1. Line 135: Therefore, it seems that the disability that has survived can be a very relevant category in the analysis, as an independent variable. However, authors do not use it as a control variable. Why?

Poverty and household living conditions

5.1. Line 159 and following: This is missing probability data. The text would be more concrete if these probabilities were included.

Health

6.1. Did the authors ask about the most reported health problems? Especially if these are chronic problems... (lines 167-168).

6.2. Lines 169-171: “Amongst people with disabilities, people with mental health difficulties were more likely to have experienced a health problem compared to people with other impairment types”: How much more likely is this? It would be better to also include the OR

6.3. Line 172: There are many studies that highlight that disabled older people have greater chronicity of diseases associated with aging. However, no relationship was found here. Was this proven well?

6.4. Line 189: “Primary school completion was lowest for people with physical and cognitive impairments”. Has this been quantified? It is necessary to show some data.

6.5. Lines 191-193: “Amongst people with disabilities, illiteracy was more common in women, older adults, people living outside of Male’ and people with intellectual impairments. Illiteracy was least common amongst people with mental health conditions” These differences are supposed to be significant, but you have to put the respective percentages or OR, if you prefer.

Discussion

7.1. Line 272: It might be of interest to explain territorial differences in wealth and specific programmes that reduce the impact on the poverty and vulnerability of people with disabilities.

Author Response

We are thankful to Reviewer 1 for their comments. We have detailed below how we have addressed them in the revised manuscript.

Introduction

1.1. Many studies have pointed out that lack of paid work is the main factor of poverty and deprivation in people with disabilities. The authors should refer to these studies here.

We have added text (line 27-29).

1.2. It is necessary to distinguish the types of disability: there are many internal differences in the collective in relation to poverty, deprivation, etc. This would be good to make it clear in the text. For example, from line 49 you could enter this element.

 We have now added text on this topic (line 49-51).

Nested case-control study

2.1. It would be interesting and convenient to specify the rejection rate of the selected controls in a first instance (line 103).

We do not have this data, but have added a clarification on how controls were selected (line 105-106).

Data analysis

3.1. Could we know the weights used in the sample? For example, in a new table (line 107…).

 We have added a supplementary table with the sampling weights.

Results

4.1. Line 135: Therefore, it seems that the disability that has survived can be a very relevant category in the analysis, as an independent variable. However, authors do not use it as a control variable. Why?

Apologies, but could this comment be clarified? I’m unsure what’s meant by a disability that has survived. The survey only collected data on living persons, not anyone deceased.

Poverty and household living conditions

5.1. Line 159 and following: This is missing probability data. The text would be more concrete if these probabilities were included.

We have added ORs (line 162-166).

Health

6.1. Did the authors ask about the most reported health problems? Especially if these are chronic problems... (lines 167-168).

Unfortunately, we do have good quality data on the most reported health problems, but they are a mix of chronic and acute conditions.

6.2. Lines 169-171: “Amongst people with disabilities, people with mental health difficulties were more likely to have experienced a health problem compared to people with other impairment types”: How much more likely is this? It would be better to also include the OR

We have added an OR (line 176).

6.3. Line 172: There are many studies that highlight that disabled older people have greater chronicity of diseases associated with aging. However, no relationship was found here. Was this proven well?

I would not say that our findings contradict this, as the question does not differentiate between acute and chronic conditions. We have added a clarification on the question wording to Table 1.

6.4. Line 189: “Primary school completion was lowest for people with physical and cognitive impairments”. Has this been quantified? It is necessary to show some data.

We have added figures from Table 4 to the text (line 190).

6.5. Lines 191-193: “Amongst people with disabilities, illiteracy was more common in women, older adults, people living outside of Male’ and people with intellectual impairments. Illiteracy was least common amongst people with mental health conditions” These differences are supposed to be significant, but you have to put the respective percentages or OR, if you prefer.

We have added ORs.

Discussion

7.1. Line 272: It might be of interest to explain territorial differences in wealth and specific programmes that reduce the impact on the poverty and vulnerability of people with disabilities.

We have added text on this (line 271-759).

Reviewer 2 Report

This is an important attempt to provide a blueprint for disaggregating data that relate to disability in line with SDGs. I cannot comment on the validity of the research methods, as I am not familiar with statistics. However, I believe the article can be improved in a particular way: by strengthening the very cursory reference to the CRPD. Art. 31 CRPD requires the disaggregation of data relating to disability, and imposes an obligation on states parties to the CRPD to collect such data, in order to inform national disability policies. This needs to be made much more explicit in the article, because the focus is very much about SDGs, but these are only part of the international protection of disability. Similarly, there is a good body of wider literature about disability and data collection, which could be mentioned in relation to Art. 31 CRPD. Even a few short paragraphs on the above will provide a much more informed approach to data collection and its importance. 

Author Response

We thank Reviewer 2 for their feedback. We have included more references to the UNCRPD, particularly Article 31, in several places in the revised manuscript (e.g. lines 43-46, 238).