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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits 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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Visual Impairments: Determining Eligibility for Social Security Benefits   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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Visual Impairments: Determining Eligibility for Social Security Benefits 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

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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

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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.