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Prevalence of disabilities and associated health conditions - United States, 1991-1992.

An estimated 35-49 million persons in the United States have a disability (1); estimated direct and indirect annual costs related to disability (including medical expenses and lost workdays) total $170 billion(2). Because definitions of disability used in previous analyses generally contained limited measures of disability, the prevalence of disability in the United States may have been underestimated. The Survey of Income and Program Participation (SIPP), a subsample of the 1990 U.S. census, collected comprehensive data about disability using several measures. The U.S. Bureau of the Census and CDC analyzed data from SIPP to provide more precise prevalence estimates of disability and health conditions associated with disability in the United States during 1991-1992. This report summarizes the findings from that analysis.

From October 1991 through January 1992, SIPP collected information about disability during personal household interviews of a representative sample (n = 97,133 persons in 34,100 households) of the U.S. civilian, noninstitutionalized population. Only data for persons aged [greater than or equal to] 15 years are presented in this analysis. The measures of disability used in SIPP were derived from D- and I-codes in the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (1). Disability was assessed using five measures: 1) ability to perform functional activities(*) (ICIDH D-codes 21, 23, 26, 40-45, and 48), 2) activities of daily living (ADLs)([dagger]) (ICIDH D-codes 30, 33, 35, 36, 37-39, and 46), or 3) instrumental activities of daily living (IADLs)([sections]) (ICIDH D-codes 50, 51, 60, and 61), 4) presence of selected impairments([paragraph]) (ICIDH D-codes 15 and 16 and I-codes 14-18), and 5) use of assistive aids (e.g., wheelchair or cane). Participants were asked whether they had "difficulty" performing functional activities, ADLs, and IADLs; whether they had selected impairments; and whether they used assistive aids for 6 months or longer. In addition, participants who had difficulty with activities other than seeing, hearing, and having their speech understood by others were asked to select up to three conditions (from a list of 30) that they believed caused limitation or difficulty with a functional activity, ADL, or IADL. Data were weighted to calculate national estimates.

Based on SIPP, during 1991-1992, of the 195.7 million persons in the United States aged [greater than or equal to] 15 years, 34.2 million (17.5%) had difficulty performing one or more functional activities (Table 1, page 737); most persons had difficulty climbing one flight of stairs (17.5 million [8.9%]) or walking one quarter mile (17.3 million [8.9%] persons). A total of 7.9 million (4.0%) persons had difficulty performing one or more ADLs, and 11.7 million (6.0%) persons had difficulty performing one or more IADLs. Use of a wheelchair for 6 months or longer was reported by 1.5 million (<1%) persons. Of the persons who did not use a wheelchair, 4.0 million (2.0%) persons had used a cane, crutches, or a walker for 6 months or longer.

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For all five measures of disability, the age-specific prevalence of disability was higher for persons aged [greater than or equal to] 65 years than persons aged <65 years (Table 1, page 737). The prevalence of disability among men and women was 18.7% and 20.2%, respectively.

Overall, 42.0 million (21%) persons reported one or more conditions they believed to be associated with their disability (Table 2, page 738). The most commonly reported condition was arthritis or rheumatism (7.2 million [17.1%]), followed by back or spine problems (5.7 million [13.5%]), and heart trouble (including coronary heart disease and arteriosclerosis) (4.6 million [11.1%]).

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Reported by: JM McNeil, Bur of the Census, Economics and Statistics Administration, US Dept of Commerce. Statistics and Epidemiology Br, Div of Surveillance and Epidemiology, Epidemiology Program Office; Disabilities Prevention Program, Office of the Director, National Center for Environmental Health, CDC.

Editorial Note: The prevalence estimates of disability in this report indicate that nearly one fifth (19.4%) of the U.S. population aged [greater than or equal to] 15 years has a disability. Prevalence estimates of disability derived from SIPP are based on broader measures of disability than previously used for estimates derived from the 1992 Current Population Survey (3), the 1990 census (4), and the National Health Interview Surveys (5,6). This broader definition--which included an assessment of limitations in functional activities, ADLs, IADLs, and selected impairments--provided a more comprehensive assessment of the scope, extent, and epidemiology of disability in the United States.

Definitions used for surveillance and assessment of disability are more clearly understood by linking them to a conceptual framework of consequences of disease and injury, such as the ICIDH (7). In the ICIDH, three concepts define the consequences of disease and injury: 1) impairment (i.e., the loss of psychological, physiological, or anatomical structure or function), 2) disability (i.e., the limitation in functional performance resulting from an impairment), and 3) handicap (i.e., the disadvantage experienced by a person as a result of impairments and/or disabilities, which limits interaction of the person with the physical and social environment).

Despite the usefulness of the estimates based on SIPP, the findings in this report are subject to limitations that may underestimate the public health impact of disability in the United States. For example, SIPP failed to collect data about the effects of physical and social barriers (e.g., within the home, community, school, or workplace) and experiences with discrimination. Recent efforts underscore the importance of clarifying the role of environment in determining the consequences of an impairment or disability (8). Therefore, efforts to provide more precise national estiates of disability should include development of measures that address environmental factors (i.e., physical and social barriers) and the effects of discrimination. Revision of the ICIDH is under way and should improve collection of valid and reliable survey information about physical and social barriers (8,9).

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References

(1.)mcNeil JM> Americans with disabilities, 1991-1992. Washington, DC: US Department of Commerce, Bureau of the Census, 1993. (Current population reports; series P70, no. 33).

(2.)Chirikos TN. Aggregate economic losses from disability in the United States: a preliminary assay. Milbank Q 1989; 67(suppl 2):59-91.

(3.)CDC. Prevalence of work disability--United States, 1990. MMWR 1994; 42:757-9.

(4.)CDC. Prevalence of mobility and self-care disability--United States, 1990. MMWR 1993; 42:760-1, 767-8.

(5.)LaPlante MP. Data on disability from the National Health Interview Survey, 1983-1985. Washington, DC: Department of Education, National Institue on Disability and Rehabilitation Research, 1988.

(6.)LaPlante MP, Hendershot GE, Moss AJ. Assistive technology devices and home accessibility features: prevalence, payment, need, and trends. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1992. (Advance data no. 217).

(7.)World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva: World Health Organization, 1993.

(8.)Badley EM. An introduction to the concepts and classifications of the International Classification of Impairments, Disabilities, and handicaps. Disabil Rhabil 1993; 15:161-78.

(9.)Fougeyrollas P. Documenting environmental factors as determining variables in the performance of day-to-day activities and the fulfillment of social roles by persons with impairments and functional limitations. ICIDH International Network 1993; 5:8-13.

(*)Functional activities--ability to 1) "see words and letters in ordinary newspaper print," 2) "hear normal conversations," 3) "have speech understood by others," 4) "lift and carry up to 10 pounds (e.g., a full bag of groceries)," 5) "climb a flight of stairs without resting," and 6) "walk one quarter mile."

([dagger])ADLs--ability to 1) "get around inside the home"; 2) "get in and out of bed or a chair"; and 3) take a bath or shower, dress, and eat; and 4) get to and use the toilet.

([sections])IADLs--ability to 1) "get around outside the home," 2) "keep track of money and bills," 3) "prepare meals," 4) "do light housework," and 5) "use the telephone."

([paragraph])Learning disabilities; mental retardation; other developmental disabilities; and Alzheimer disease, senility, dementia, and other mental or emotional conditions.
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Publication:Morbidity and Mortality Weekly Report
Date:Oct 14, 1994
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