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Appendix A
EMPLOYMENT AND ECONOMIC CONSEQUENCES OF VISUAL IMPAIRMENT
Andrew J. Houtenville
School of Industrial and Labor Relations, Cornell University
Working-age people with disabilities work less and have less household income than working-age people without disabilities.1 There are also dramatic differences in the kinds and levels of disabilities within the working age population with disabilities.2 Those with severe vision impairments are particularly disadvantaged, for they face many barriers in accessing employment. This paper explores the economic experience and program participation of working-age people with chronic vision-related conditions over the past two decades and compares their experience with those of other working-age people with chronic conditions.
1
See Trupin et al. (1997) and Burkhauser, Daly, and Houtenville (2000).
2
See Trupin et al. (1997) for a comparison of the labor force participation of people with various disabilities.
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DATA AND IMPORTANT SAMPLING ISSUES
The National Health Interview Survey (NHIS) contains the economic and chronic condition information needed to conduct this study. The NHIS is a complex multistage probability sample of the civilian noninstitutionalized population of the United States.3 The NHIS is collected by the National Center for Health Statistics (NCHS) in the Department of Health and Human Services. The federal government uses data from the NHIS to monitor trends in illness and disability. Researchers use data from the NHIS to analyze access to health care and health insurance and to evaluate federal health programs.
The NHIS collected information on an average of about 60,000 working-age individuals (100,000 individuals in total) annually from 1983 through 1996.4 This paper separates survey participants into subgroups by chronic condition and gender. Some of these subgroups contain very small numbers of individuals, i.e., very small sample sizes. Smaller sample sizes lead to less precise sample estimates. This paper pools multiple years together to boost the sample sizes in these subgroups.
Specific health conditions and impairments are captured in two distinct methods. The differences between these two methods are very important in the interpretation of statistics generated using the NHIS. Very early the survey participants are randomly asked one of six condition checklists. These checklists directly inquire about
3
The NHIS excludes those on active duty with the armed forces and U.S. nationals living in foreign countries. The dependents of those on active duty with the armed forces are included. The NHIS also excludes those in long-term care facilities, which may disproportionately represent people with disabilities.
4
The NHIS interviews are performed in person in households. Adult (17 years of age and over) members of the household present at the time of the interview are asked to respond for themselves. A responsible adult (19 years of age and over) answers for children and adults not present at the time of the interview. Between 65 and 70 percent of adults answer for themselves (Massey, Moore, Parsons, & Tadros, 1989).
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specific conditions. Table A-1 contains the checklist relevant to vision and the other conditions addressed in this report. In addition to the checklists, in later parts all survey participants are asked screening questions to reveal general health, doctor’s visits, hospital utilization, sick days, and functioning difficulties. If participants answer yes to these screening questions, they are then asked what conditions caused these issues. The top panel of Table A-2 contains the set of screening questions, while the bottom panel contains an example of the probing questions that follow a screening question.
Thus only one-sixth of NHIS participants are directly asked about blindness and visual impairment and can also reveal blindness or visual impairment if they reveal having general health/functioning difficulties. The remaining five-sixths of NHIS participants reveal blindness or visual impairment only if they reveal having general health/functioning difficulties. As a result, the subsample of NHIS participants reporting blindness in the one-sixth sample is a random subsample of those reporting blindness. The subsample of NHIS participants reporting blindness in the five-sixths sample is a choice-based subsample of those reporting blindness because being in this subsample depends on responses (choices) to the screening questions.5
From this point forward, the term “random sample” refers to the one-sixth of the NHIS sample who were directly asked about their condition, and the term “choice-based” sample is used to refer to those who where asked about their condition after having revealed general health/functioning difficulties.
Prevalence, employment, income, and program participation statistics are calculated separately for random and choice-based samples. There are likely to be important differences between the two samples. The prevalence of blindness should be higher in the random sample than in the choice-based sample, because there are likely to be people reporting blindness who do not have general health/functioning difficulties, i.e., who answer “no” to the question in the bottom panel
5
The same is true for the subsample reporting visual impairment and the other conditions addressed in this paper.
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TABLE A-1 Condition Checklist Received by the Random Sample
H1.2a. Does anyone in the family {read names} NOW HAVE –
If “Yes,” ask 2b and c.
b. Who is that?
c. Does anyone else now have –
A.
Deafness in one or both ears?
B.
Any trouble hearing with one or both ears?
C.
Tinnitus or ringing in the ears?
D.
Blind in one or both eyes?
E.
Cataracts?
F.
Glaucoma?
G.
Color blindness?
H.
A detached retina or any other condition of the retina?
I.
Any other trouble seeing with one or both eyes EVEN when wearing glasses?
J.
A cleft palate or harelip?
K.
Stammering or stuttering?
L.
Any other speech defect?
M.
Loss of taste or smell which has lasted 3 months or more?
N.
A missing finger, hand or arm, toe, foot, or leg?
O.
A missing joint?
P.
A missing breast, kidney, or lung?
Q.
Palsy or cerebral palsy?
R.
Paralysis of any kind?
S.
Curvature of the spine?
T.
REPEATED trouble with neck, back, or spine?
U.
Any TROUBLE with fallen arches or flatfeet?
V.
A clubfoot?
W.
A trick knee?
X.
PERMANENT stiffness or any deformity of the foot, leg, or back?
Y.
PERMANENT stiffness or any deformity of the fingers, arm, or hand?
Z.
Mental retardation
AA.
Any condition caused by an accident or injury which happened more than 3 months ago? If “Yes,” ask: What is the condition?
Note: In the NHIS, conditions are determined in two ways. First, participants receive one of six condition lists that ask them if they have a specific condition (this table contains list #2). Second, participants are asked broad questions to reveal general health and functioning (see the top panel of Table A-2). If participants reveal they have health or functioning difficulties, they are then asked what conditions cause these difficulties (see the second
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panel of Table A-2). This method misses those with conditions who have no such difficulties, while the first method captures those with conditions who have no health or functioning difficulties. So only one-sixth of the sample is directly asked about blindness. This one-sixth of the sample is a random sample, because being asked about blindness is not dependent on one’s response to another question. The remaining five-sixths of the sample is choice-based, because revealing blindness is dependent on one’s response (choice) to another question.
Source: National Health Interview Survey Core Questionnaire, 1985-94, National Center for Health Statistics, Series 10, No. 199.
of Table A-2. Similarly, employment rates and mean incomes are likely to be higher and program participation rates are likely to be lower among random sample members reporting blindness than among choice-based sample members reporting blindness. Choice-based members reporting blindness have already revealed health and functioning difficulties and are thus less likely to work or earn income and more likely to participate in government programs.6
6
In the random sample there could be people who say “no” to the direct question about blindness, but say “yes” to the screening question and reveal blindness as the reason they said “yes.” This should not occur if respondents answer correctly when asked directly about blindness. There is no way of measuring how often this occurs. The public release data files include the condition but not whether the condition comes from the direct questions or the screening questions. Responding in this way could lead to an understatement of employment rate because the survey does not capture healthy people with blindness whom for some reason did not say “yes” to the direct question and answered “no” to the screening question. However, even if we did know whether the report of blindness came from the direct answer or screening questions, we would be left with the unanswerable question of which answer is correct.
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TABLE A-2 Broad Health Questions Used to Screen for Condition Information
Screening Questions
1.
Does any impairment or health problem NOW keep [you] from working at a job or business?
2.
Does any impairment or health problem NOW keep [you] from doing any housework at all?
3.
Is [you] limited in ANY WAY in any activities because of an impairment or health problem?
4.
During those 2 weeks, did [you] miss any time from a job or business because of illness or injury?
5.
During those 2 weeks, did [you] miss any time from school because of illness or injury?
6.
During those 2 weeks, did [you] stay in bed because of illness or injury?
7.
Was there any {OTHER} time during those 2 weeks that [you] cut down on the things [you] usually does because of illness or injury?
8.
During those 2 weeks, how many times did [you] see or talk to a medical doctor? {include all types of doctors, such as dermatologists, psychiatrists, and ophthalmologists, as well as general practitioners and osteopaths.}
9.
{Besides the time(s) mentioned in [previously]} During those 2 weeks, did anyone in the family receive health care at home or go to a doctor’s office, clinic, hospital or some other place? 2b. Who received this care?
10.
{Besides the time(s) you already told me about} During those 2 weeks, did anyone in the family get any medical advice, prescriptions or test results over the phone from a doctor, nurse, or anyone working with or for a medical doctor?
An Example of Probing Questions (These are the probing questions for the first screening question above.)
A.
What (other) condition causes this?
Ask if injury or operation: When did [the (injury) occur? / [you] have the operation?]
Ask if operation over 3 months ago: For what condition did [you] have the operation?
B.
Besides (condition) is there any other condition that causes this limitation?
C.
Is this limitation caused by any (other) specific condition?
D.
Which of these conditions would you say is the MAIN cause of this limitation?
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Source: Design and Estimation of the 1985-94 National Health Interview Survey, Series 2, No. 110, National Center for Health Statistics, Hyattsville, MD, 1989.
Note: In the NHIS, conditions are determined in two ways. First, participants receive one of six condition lists that ask them if they have a specific condition (see Table A-1). Second, participants are asked broad questions to reveal general health and functioning (the questions in the top panel of this table). If participants reveal they have health or functioning difficulties, they are then asked what conditions cause these difficulties (for example, the questions in the second panel of this table). This method misses those with conditions who have no such difficulties, while the first method captures those with conditions who have no health or functioning difficulties. So only one-sixth of the sample is directly asked about blindness. This one-sixth of the sample is a random sample, because being asked about blindness is not dependent on one’s response to another question. The remaining five-sixths of the sample is choice-based, because revealing blindness is dependent on one’s response (choice) to another question.
CONCEPTUAL FRAMEWORK AND DEFINITIONS
Nagi (1965) developed a framework for defining disability, in which diseases/disorders result in the impairment of required functions that then interact with the socioeconomic and physical environment and lead to disability. Using the Nagi framework, this paper distinguishes those with chronic vision-related diseases/disorders, such as cataracts, from those with chronic visual impairments, such as being blind in one eye. Those with cataracts are not necessarily visually impaired.7 This distinction is important in the context of economic experience because impaired function, rather than a specific disease/disorder, is expected to have a greater influence on employment and program participation.
7
It is also possible for an individual to be visually impaired and not report having a vision-related disease/disorder.
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The central focus of this paper is the economic experience of those who are blind in both eyes, for they are the group among people with vision-related conditions at the greatest risk of economic difficulties. They are also most likely to be eligible for Social Security Disability Insurance (SSDI) payments, Supplemental Security Income (SSI) benefits, and other government programs based on their medical conditions. The economic experience of those who are blind in both eyes is compared with that of those with other visual impairments. Economic statistics are also provided for those with vision-related diseases/disorders, which include glaucoma, cataracts, color blindness, and an “other” category, which consolidates conjunctivitis, disorders of the lacrimal system, disorders of binocular eye movements, and diseases of the retina.8
For comparison purposes the economic experiences of those with some other functional impairments are provided in this report. These functional impairment groups are also seriously at risk of low rates of employment and diminished economic well-being. These categories are deafness in both ears, other hearing impairment, mental retardation, paraplegia, hemiplegia, quadriplegia, and cerebral palsy.
Defining Chronic Conditions
The NHIS provides extensive information on chronic conditions. The term “condition” refers to diseases/disorders and impairments. Chronic conditions are conditions that exist for three or more months, although some conditions are considered chronic regardless of duration.
As mentioned above, the NHIS captures condition information in two ways: (1) checklists of specific conditions and (2) screening questions followed by open-ended probing questions. The next step is to consolidate and classify survey responses from all points in the survey into a set of condition categories based on the International Classification of Diseases. NCHS hires special medical coders to perform this complex task.
8
This consolidation is required because of the small sample sizes.
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According to the NHIS Medical Coding Manual, participants are classified as being blind in both eyes if they describe their condition as blind, no vision, or can’t see. If there is no clear indication that only one eye is involved, it is assumed that both eyes are involved.
The NHIS also provides a category entitled “other visual impairments.” Participants who are blind in one eye are in this category. This category also includes those who describe their eyesight, seeing, sight, or vision as being bad, blurred, defective, limited, poor, double, problem with, trouble with, or who use phrases like partially blind, blind spots, half-blind. Double-vision, color blindness, night blindness, and day blindness are combined into a single “other visual impairments” group. In addition, any active vision-related diseases/ disorders reported by participants are also classified, regardless of whether they cause visual impairment. The NHIS provides the following categories of diseases/disorders: glaucoma, cataracts, color blindness, conjunctivitis, disorders of the lacrimal system, disorders of binocular eye movements, diseases of the retina, and others vision-related of eye and adnexa.
The NHIS defines other chronic impairments in a similar manner to visual impairments. Participants who are reported as being deaf in both ears, having no useful hearing in both ears, or can’t hear in both ears are classified as deaf in both ears. Those reported being partially deaf in both ears or a little deaf in both ears are coded as other hearing impairment. If only one ear is involved, a code of “other hearing impairment” is given. If the medical coder is unable to determine whether one or both ears are involved, the individual is coded as other hearing impairment. Hearing problems relating to allergies or earwax are not classified.
Mental retardation includes mental deficiency or retardation, and those describing themselves as can’t learn, slow learner. Mental retardation is considered chronic regardless of onset.
The NHIS codes paralysis as partial or complete and for various parts or portions of the body. Paraplegia is complete paralysis of the lower body, both legs, or from the waist down. Hemiplegia is complete paralysis of one side of the body, including limbs. Quadriplegia is complete paralysis of the entire body or four limbs. Paralysis must
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exist for three or more months to be considered chronic. Cerebral palsy (and its synonyms) is chronic regardless of date of onset and includes those who describe themselves as congenitally “spastic.”
Definitions of Economic Variables
Economic experience is captured via employment rates, mean household size-adjusted income, and receipt of SSDI and SSI payments. The employment rate is based on the following NHIS questions. “During [the past two calendar weeks], did [you] work at any time at a job or business not counting work around the house? (Include unpaid work in family [farm/business].)” Persons not working were asked, “[e]ven though [you] did not work during those 2 weeks, did [you] have a job or business?” Persons who answer “yes” to the first question or “yes” to the second question are considered employed.
Household income is the sum of all income in the household. Households can contain more than one family. The NHIS uses the following questions to determine family income: “Was the total FAMILY income during the past 12 months—that is, yours, [and other family members] more or less than $20,000? Include money from jobs, social security, retirement income, unemployment payments, public assistance, and so forth. Also include income from interest, dividends, net income from businesses, farm, or rent and any other money income received.” And then, “[of the income brackets provided] which [bracket] best represents the total combined FAMILY income during the past 12 months—that is, yours, [and other family members]? Include wages, salaries, and other items we just talked about.” The respondents can choose from 26 income brackets. To obtain a dollar value for family income, family income is assigned the midpoint of the chosen income bracket. Respondents choosing the top bracket ($50,000 and above) are assigned the mean annual family income among those families above $50,000 as estimated from the Current Population Survey.
Household income is adjusted for household size to get a better measure of an individual’s access to household resources. This paper
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follows the common practice of dividing household income by the square root of household size. This accounts for the fact that $500 per week provides a higher standard of living for a single-person household than it does for individuals belonging to larger households.9 Because we are comparing income across years, we adjust income using the consumer price index-urban (CPI-U); all income values are in 1998 dollars.
Receipt of SSDI and SSI payments is determined with relatively straightforward questions and refers to receipt of payments in the month prior to the survey. SSDI and SSI recipiency information is available only for 1990-1992, 1994, and 1995.
This paper focuses on working-age men and women (ages 25 to 61). Using this age range avoids confusing reductions in work or economic well-being associated with disability with reductions or declines associated with retirement at older ages or initial transitions in and out of the labor force related to job shopping at younger ages. Men and women are evaluated separately.
RESULTS
To get an idea of the size of populations with the various chronic conditions used in this study, Annex Table A-1 shows the prevalence rates of these chronic conditions in the working-age population in the United States, by gender and the random and choice samples. Annex Tables A-2a through A-2d show the sample sizes used to generate the economic statistics reported below.
Tables A-3 through A-7 compare differences across subgroups. These tables contain employment rates (Table A-3), mean household size-adjusted incomes (Table A-4), the percentages receiving SSDI payments
9
Using the square root of household size reduces the impact of an each additional household member. An alternative is household income per household member, which places equal weight on adding a second person to a household and adding a sixth person to a household.
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ACKNOWLEDGMENT
The author thanks Richard V. Burkhauser and Corrine Kirchner for their helpful comments.
REFERENCES
Burkhauser, R. V., Daly, M. C., & Houtenville, A. J. (2000). How working age people with disabilities fared over the 1990s business cycle. In P. P. Budetti, R. V. Burkhauser, J. M. Gregory, & H. A. Hunt (eds.), Ensuring health and income security for an aging workforce . Kalamazoo, MI: W.E. UpJohn Institute for Employment Research.
Fawcett, G. M. (1996). Living with disability in Canada: An economic portrait. Hull, Quebec: Human Resources Development Canada, Office for Disability Issues.
Kirchner, C., Schmeidler, E., & Todorov, A. (1999). Looking at employment through a lifespan telescope: Age, health, and employment status of people with serious visual impairment. New York, NY: American Foundation for the Blind (subcontractor to Rehabilitation Research and Training Center on Bindness and Low Vision, Mississippi State University).
Massey, J. T., Moore, T. F., Parsons, V. L., & Tadros, W. (1989). Design and estimation for the National Health Interview Survey, 1985-1994. (Report No. PHS 89-1384). Hyattsville, MD: U.S. Department of Health and Human Services.
Nagi, S. Z. (1965). Some conceptual issues in disability and rehabilitation. In M. B. Sussman (ed.), Sociology and rehabilitation. Washington, DC: American Sociological Association.
Trupin, L., Sebesta, D. S., Yelin, E., & LaPlante, M. P. (1997). Disability statistics report: Trends in labor force participation among persons with disabilities, 1983-1994. (Report No. 10). San Francisco, CA: Disability Statistics Rehabilitation Research and Training Center, Institute for Health and Aging, University of California.
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Annex Table A-1 Prevalence Rates of Various Chronic Impairments, Diseases, and Disorders Among Noninstitutionalized Working-Age Civilians (Ages 25 to 61) Pooled Over 1983 Through 1996, by Sample and Gender
Group
Visual impairments
-Blind in both eyes
-Other visual impairments
Vision-related diseases/disorders
-Glaucoma
-Cataracts
-Color blindness
-Other vision-related diseases/disordersc
Other impairments
-Hearing impairments
—Deaf in both ears
—Other hearing impairments
-Mental retardation
-Paraplegia, hemiplegia, or quadriplegia
-Cerebral palsy
Note: Asterisks signify when the difference between the random sample and choice-based sample is statistically significant at the 99 percent (***), 95 percent (**), and 90 percent (*) levels. NA refers to groups where sample size is insufficient.
a In the NHIS, conditions are determined in two ways. First, participants receive one of six condition lists that ask them if they have a specific condition (see Table A-1). Second, participants are asked broad questions to reveal general health and functioning (see Table A-2, top panel). If participants reveal they have health or functioning difficulties, they are then asked what conditions cause these difficulties (see Table A-2, bottom panel). This method misses those with conditions who have no such difficulties, while the first method captures those with conditions that have no health or functioning difficulties. So only one-sixth of the sample is directly asked
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Men
Women
Random Samplea
Choice-Based Samplea
Relative Prevalenceb
Random Samplea
Choice-Based Samplea
Relative Prevalenceb
4.89
0.57
0.12***
2.38
0.39
0.17***
0.17
0.10
0.60***
0.17
0.08
0.48***
4.71
0.47
0.10***
2.21
0.31
0.14***
4.16
0.31
0.08***
1.97
0.36
0.18***
0.50
0.09
0.17***
0.47
0.11
0.24***
0.62
0.10
0.16***
0.82
0.10
0.12***
2.68
0.02
0.01***
0.27
0.00
0.00***
0.48
0.12
0.25***
0.51
0.16
0.32***
10.75
1.14
0.11***
5.94
0.62
0.10***
0.53
0.08
0.15***
0.26
0.06
0.24***
10.22
1.06
0.10***
5.68
0.55
0.10***
0.46
0.35
0.76***
0.35
0.25
0.71***
0.20
0.16
0.81*
0.09
0.06
0.66**
0.11
0.07
0.64**
0.09
0.06
0.63**
about blindness. This one-sixth of the sample is a random sample because being asked about blindness is not dependent one’s response to another question. The remaining five-sixths of the sample is choice-based because revealing blindness is dependent one’s response (choice) to another question.
b The relative prevalence is the prevalence in the random sample divided by the prevalence in the choice-based sample.
c The category other includes conjunctivitis, disorders of the lacrimal system, disorders of binocular eye movements, and diseases of the retina.
Source: Author’s calculations using the National Health Interview Survey, 1983-1996.
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Annex Table A-2a Sample Size of Noninstitutionalized Working-Age Civilian Men (Ages 25 to 61) in the Random Sample with Various Chronic Impairments, Diseases, and Disorders, 1983-1996
Year
Group
1983
1984
1985
1986
1987
1988
No visual impairments
3,652
3,599
3,130
2,128
4,344
4,281
Visual impairments
204
187
180
113
219
233
Blind in both eyes
2
5
4
3
8
11
Other visual impairments
202
182
176
110
211
222
Vision-related diseases/ disorders
184
148
150
93
219
193
Glaucoma
14
20
22
8
23
24
Cataracts
29
27
32
11
28
27
Color blindness
126
90
83
67
144
126
Other vision-related diseases/disordersa
19
16
17
8
28
26
Other impairments
Hearing impairments
454
412
389
237
494
483
Deaf in both ears
29
29
21
12
21
23
Other hearing impairments
425
383
368
225
473
460
Mental retardation
15
12
14
16
14
21
Paraplegia, hemiplegia, or quadriplegia
6
5
8
7
10
3
Cerebral palsy
3
6
1
5
3
6
Note: In the NHIS, conditions are determined in two ways. First, participants receive one of six condition lists that ask them if they have a specific condition (see Table A-1). Second, participants are asked broad questions to reveal general health and functioning (see Table A-2, top panel). If participants reveal they have health or functioning difficulties, they are then asked what conditions cause these difficulties (see Table A-2, bottom panel). This method misses those with conditions who have no such difficulties, while the first method captures those with conditions that have no health or functioning difficulties. So only one-sixth of the sample is directly asked about blindness. This one-sixth of the sample is a random sample because
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1989
1990
1991
1992
1993
1994
1995
1996
Sum
4,146
4,270
4,225
4,569
3,945
4,255
3,709
2,341
52,594
194
205
218
257
220
217
188
108
2,743
1
10
9
11
5
12
8
6
95
193
195
209
246
215
205
180
102
2,648
149
165
171
218
184
193
176
95
2,338
17
20
26
26
22
31
15
16
284
29
23
27
39
24
25
33
16
370
90
109
103
147
123
118
109
56
1,491
18
19
20
22
21
25
25
9
273
421
491
442
558
465
485
409
235
5,975
17
19
14
36
16
31
23
10
301
404
472
428
522
449
454
386
225
5,674
16
29
21
20
18
19
24
12
251
3
7
5
9
13
12
8
10
106
2
6
3
5
4
4
5
4
57
being asked about blindness is not dependent on one’s response to another question. The remaining five-sixths of the sample is choice-based because revealing blindness is dependent on one’s response (choice) to another question.
a The category other includes conjunctivitis, disorders of the lacrimal system, disorders of binocular eye movements, and diseases of the retina.
Source: Author’s calculations using the National Health Interview Survey, 1983-1996.
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Annex Table A-2b Sample Size of Noninstitutionalized Working-Age Civilian Men (Ages 25 to 61) in the Choice-Based Sample with Various Chronic Impairments, Diseases, and Disorders, 1983-1996
Year
Group
1983
1984
1985
1986
1987
1988
No visual impairments
19,018
19,154
16,561
11,286
22,453
22,731
Visual impairments
120
122
104
66
127
135
Blind in both eyes
27
16
20
11
18
22
Other visual impairments
93
106
84
55
109
113
Vision-related diseases/ disorders
87
58
61
30
51
71
Glaucoma
25
12
17
6
14
22
Cataracts
32
15
23
13
22
21
Color blindness
7
6
1
3
3
2
Other vision-related diseases/disordersa
27
25
24
11
12
29
Other impairments
Hearing impairments
100
87
74
50
116
107
Deaf in both ears
21
12
17
5
7
9
Other hearing impairments
79
75
57
45
109
98
Mental retardation
65
41
45
42
64
90
Paraplegia, hemiplegia, or quadriplegia
40
38
29
16
36
30
Cerebral palsy
12
14
10
6
10
10
Note: In the NHIS, conditions are determined in two ways. First, participants receive one of six condition lists that ask them if they have a specific condition (see Table A-1). Second, participants are asked broad questions to reveal general health and functioning (see Table A-2, top panel). If participants reveal they have health or functioning difficulties, they are then asked what conditions cause these difficulties (see Table A-2, bottom panel). This method misses those with conditions who have no such difficulties, while the first method captures those with conditions that have no health or functioning difficulties. So only one-sixth of the sample is directly asked about blindness. This one-sixth of the sample is a random sample because
OCR for page 317
Visual Impairments: Determining Eligibility for Social Security Benefits
1989
1990
1991
1992
1993
1994
1995
1996
Sum
21,553
22,469
22,502
23,771
20,743
21,864
19,118
12,175
275,398
109
126
130
171
135
123
111
63
1,642
19
25
28
33
22
25
18
10
294
90
101
102
138
113
98
93
53
1,348
69
69
76
122
63
62
68
32
919
22
19
26
34
23
17
21
5
263
23
22
17
52
15
17
14
9
295
1
3
6
12
2
3
7
2
58
25
30
29
32
26
27
29
17
343
93
2,278
103
118
90
104
76
55
3,451
12
81
11
13
15
11
12
7
233
81
2,197
92
105
75
93
64
48
3,218
67
82
75
109
96
78
77
54
985
33
29
30
35
40
36
34
21
447
17
19
23
19
18
18
16
5
197
being asked about blindness is not dependent on one’s response to another question. The remaining five-sixths of the sample is choice-based because revealing blindness is dependent on one’s response (choice) to another question.
a The category other includes conjunctivitis, disorders of the lacrimal system, disorders of binocular eye movements, and diseases of the retina.
Source: Author’s calculations using the National Health Interview Survey, 1983-96.
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Visual Impairments: Determining Eligibility for Social Security Benefits
Annex Table A-2c Sample Size of Noninstitutionalized Working-Age Civilian Women (Ages 25 to 61) in the Random Sample with Various Chronic Impairments, Diseases, and Disorders, 1983-1996a
Year
Group
1983
1984
1985
1986
1987
1988
No visual impairments
4,219
4,211
3,657
2,491
5,020
4,929
Visual impairments
118
89
81
65
146
121
Blind in both eyes
5
6
1
4
15
6
Other visual impairments
113
83
80
61
131
115
Vision-related diseases/ disorders
89
75
66
52
101
93
Glaucoma
15
14
21
9
29
25
Cataracts
30
32
30
23
33
44
Color blindness
12
9
4
9
13
11
Other vision-related diseases/disordersa
36
23
14
12
31
22
Other impairments
Hearing impairments
275
263
246
149
304
294
Deaf in both ears
23
11
10
10
18
10
Other hearing impairments
252
252
236
139
286
284
Mental retardation
9
13
6
9
15
15
Paraplegia, hemiplegia, or quadriplegia
1
10
2
3
2
7
Cerebral palsy
2
4
1
2
6
3
Note: In the NHIS, conditions are determined in two ways. First, participants receive one of six condition lists that ask them if they have a specific condition (see Table A-1). Second, participants are asked broad questions to reveal general health and functioning (see Table A-2, top panel). If participants reveal they have health or functioning difficulties, they are then asked what conditions cause these difficulties (see Table A-2, bottom panel). This method misses those with conditions who have no such difficulties, while the first method captures those with conditions that have no health or functioning difficulties. So only one-sixth of the sample is directly asked about blindness. This one-sixth of the sample is a random sample because
OCR for page 319
Visual Impairments: Determining Eligibility for Social Security Benefits
1989
1990
1991
1992
1993
1994
1995
1996
Sum
4,750
4,916
4,890
5,256
4,586
4,811
4,267
2,704
60,707
106
110
123
137
118
113
106
71
1,504
6
9
4
12
8
5
16
7
104
100
101
119
125
110
108
90
64
1,400
96
105
102
130
95
103
101
53
1,261
31
25
26
32
22
29
35
13
326
37
42
50
58
41
37
33
27
517
10
13
18
20
9
21
14
5
168
25
31
17
25
28
22
24
12
322
265
283
312
330
300
296
238
156
3,711
13
6
10
13
9
10
6
10
159
252
277
302
317
291
286
232
146
3,552
12
23
26
22
10
17
22
16
215
0
6
3
4
6
2
5
4
55
3
4
3
2
4
5
5
7
51
being asked about blindness is not dependent on one’s response to another question. The remaining five-sixths of the sample is choice-based because revealing blindness is dependent on one’s response (choice) to another question.
aThe category other includes conjunctivitis, disorders of the lacrimal system, disorders of binocular eye movements, and diseases of the retina.
Source: Author’s calculations using the National Health Interview Survey, 1983-1996.
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Visual Impairments: Determining Eligibility for Social Security Benefits
Annex Table A-2d Sample Size of Noninstitutionalized Working-Age Civilian Women (Ages 25 to 61) in the Choice-Based Sample with Various Chronic Impairments, Diseases, and Disorders, 1983-1996
Year
Group
1983
1984
1985
1986
1987
1988
No visual impairments
20,934
21,214
18,429
12,658
25,058
25,278
Visual impairments
91
100
85
47
99
84
Blind in both eyes
16
16
14
12
23
11
Other visual impairments
75
84
71
35
76
73
Vision-related diseases/ disorders
98
66
83
45
103
82
Glaucoma
31
17
23
15
39
22
Cataracts
36
22
28
16
28
27
Color blindness
0
0
0
0
0
0
Other vision-related Diseases/disordersa
34
29
37
20
47
39
Other impairments
Hearing impairments
63
58
63
33
77
60
Deaf in both ears
15
6
11
7
18
4
Other hearing impairments
48
52
52
26
59
56
Mental retardation
44
51
37
40
57
66
Paraplegia, hemiplegia, or quadriplegia
12
19
16
5
16
20
Cerebral palsy
8
12
9
5
14
13
Note: In the NHIS, conditions are determined in two ways. First, participants receive one of six condition lists that ask them if they have a specific condition (see Table A-1). Second, participants are asked broad questions to reveal general health and functioning (see Table A-2, top panel). If participants reveal they have health or functioning difficulties, they are then asked what conditions cause these difficulties (see Table A-2, bottom panel). This method misses those with conditions who have no such difficulties, while the first method captures those with conditions that have no health or functioning difficulties. So only one-sixth of the sample is directly asked about blindness. This one-sixth of the sample is a random sample because
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Visual Impairments: Determining Eligibility for Social Security Benefits
1989
1990
1991
1992
1993
1994
1995
1996
Sum
24,070
25,056
25,039
26,326
22,980
24,308
21,317
13,300
305,967
94
88
97
133
100
114
88
56
1,276
16
20
17
30
24
25
22
15
261
78
68
80
103
76
89
66
41
1,015
82
93
76
121
82
70
66
50
1,117
27
35
30
40
23
25
31
17
375
27
23
18
47
20
11
10
6
319
0
0
0
2
0
0
0
0
2
36
38
31
39
41
36
27
29
483
84
1,150
62
95
87
82
76
38
2,028
11
36
12
22
14
14
13
10
193
73
1,114
50
73
73
68
63
28
1,835
75
66
52
76
66
64
55
38
787
14
15
20
24
7
13
13
8
202
11
17
14
15
17
20
14
7
176
being asked about blindness is not dependent on one’s response to another question. The remaining five-sixths of the sample is choice-based because revealing blindness is dependent on one’s response (choice) to another question.
aThe category other includes conjunctivitis, disorders of the lacrimal system, disorders of binocular eye movements, and diseases of the retina.
Source: Author’s calculations using the National Health Interview Survey, 1983-1996.
Representative terms from entire chapter:
random sample