Disability in America Toward a National Agenda for Prevention (1991) / Chapter Skim
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2 Magnitude and Dimensions of Disability in the United States
2 Magnitude and Dimensions of Disability in the United States
Pages 41-75
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From page 41... ...
Similarly, this analysis focuses on the prevalence of disabling conditions, not on the causes of these limitations. This is followed by a brief discussion of the economic costs of disability.
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From page 42... ...
According to the current definition, the major activities are "playing" for children under age 5, "attending school" for children ages 5-17, "working or keeping house" for adults ages 18-69, and "living independently" for adults age 70 and over. As discussed below in the section on trends, however, these definitions have changed over time (National Center for Health Statistics, 1989a)
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From page 43... ...
Identification of these causes depends on the respondents' understanding of their conditions, their perceptions of how limiting they are, and their willingness to report them. In a separate set of questions, the NHIS also collects data on the overall prevalence of specific chronic conditions, without regard to whether the condition causes any activity limitation (National Center for Health Statistics, 1989a)
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From page 44... ...
Questions on work limitations were asked of persons ages 16-72. Unlike the NHIS, limitations due to acute conditions were not excluded.
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are unable to carry on the major activity for someone their age (National Center for Health Statistics, 1989a)
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Source: National Center for Health Statistics, 1989a. definition of major activity from work to activities of daily living.
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From page 47... ...
The prevalence of activity limitation decreases from 23.2 percent for people with incomes below $13,000 to 8.1 percent for people with annual family incomes above $45,000. The differential is larger for the most severe activity limitations: the proportion of people unable to carry out their major activities decreases from 9.1 percent in the lowest income group to 1.4 percent in the highest income group.
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From page 48... ...
Other Perspectives The NHIS data (National Center for Health Statistics, 1989a) also provide perspectives on aspects of disability beyond activity limitation.
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From page 49... ...
National Health Interview Survey: Unable to carry out major activity; limited in amount or kind of major activity; or limited, but not in major activity. International Center for the Disabled~ouis Harris Survey: Prevented from full participation in work, school, or other activities; having a physical disability, seeing, hearing, or speaking impairment, an emotional or mental disability, or a learning disorder; or considering oneself disabled or considered disabled by others.
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From page 50... ...
tioning. On the basis of functional limitations, the SIPP estimated that 39.5 million people, 17 percent of the noninstitutionalized population, had some degree of disability.
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aNational Health Interview Survey: Major Activity: More = unable to carry out major activity; Less = limited in amount or kind of major activity. ADL/IADL: More = needing assistance in any ADL; Less = needing assistance only in IADLs.
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From page 52... ...
Department of Health and Human Services, 1989d. The SIPP also provides estimates of persons receiving disability benefits from Social Security Disability Insurance, Supplemental Security Income, or the Veterans Administration.
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A second change allowed for all people ages 18-69 to report on limitations in their ability to work. Previously, women who did not work because of chronic conditions were not classified as limited in their major activity if they were able to keep house.
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From page 54... ...
Prevalence rates are relatively flat for most age groups over the entire period, but there is some increase in the prevalence of activity limitation in the early 1970s, especially for those age 45-64. The changes of definition clearly show up between 1981 and 1983 in Figure 2-6 as an increase in the proportion of children with limitation in major activity and a decrease in the proportion of people 65 and over with limitation in major activity.
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From page 55... ...
50 ~ 40 o ._ Q 30 o Q o 20 a) ~ 10 Before 1983, <17 and 17-44 O 1970 1975 1980 1985 Year Age < 18 ——Age 18-44 -- -- - Age 45-64 Age 65+ 1990 FIGURE 2-6 Trends in prevalence of limitation in major activity, by age group Source: National Center for Health Statistics, 1970-1988.
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From page 56... ...
CONDITIONS LEADING TO DISABILITY A wide variety of chronic conditions are responsible for activity limitation in the United States. Looking at the single "main cause" of activity limitation as reported by respondents in the NHIS, orthopedic impairments account for 16.0 percent of activity limitations, arthritis for 12.3 percent, heart disease for 11.5 percent.
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From page 57... ...
SOURCE: National Health Interview Survey; adapted from LaPlante, 1989b. conditions most commonly cited by the respondents in 1983-1985 as the main cause of their activity limitations (LaPlante, 1989b)
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From page 58... ...
account for 27 percent and chronic diseases (two-thirds of which are asthma) account for 26 percent of all activity limitations.
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From page 59... ...
These increasing percentages are applied to an increasing base of people with mobility limitations, so the prevalence of people with limitations caused mainly by arthritis increases more than 20-fold from 4.6 per 1,000 at ages 18-44 to 109.3 per 1,000 at ages 85 and older. The importance of chronic diseases (circulatory, respiratory, cancer, diabetes, etc.)
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From page 60... ...
The right half of Table 2-4 shows the prevalence of the 15 most commonly cited conditions responsible for activity limitations, regardless of whether the condition was listed as the main cause. This list is generally similar to the list of main causes.
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From page 61... ...
has tabulated the NHIS activity limitation data, a calculation was made of the number of years lived with various kinds of activity limitations. Based on these results, the committee then calculated the life expectancy without disability and in the various activity-limited states.5 Because the NHIS figures refer to only the noninstitutionalized population, the committee's calculations underestimate time with activity limitations.
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From page 62... ...
As Figure 2-10 further shows, of the 12.8 years of activity limitation expected at birth, the population would average 3.6 years of being unable to carry out a major activity, 5.3 years with a limitation in major activity, and 4.0 years with some other activity limitation. At age 65, the expected years of activity limitation would consist of 1.8 years of being unable to carry out a major activity, 2.6 years with some limitation in major activity, and 2.6 years with a less severe limitation.
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From page 63... ...
For men, however, the largest share of activity limitation, 2.4 years, or 41 percent, is in activities other than their major activity. Limitations in the amount and kind of major activity account for the largest share of women's years of limitation3.3 years, or 42 percent.
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From page 64... ...
and NHIS data (National Center for Health Statistics, 1972, 1986) shows that while life expectancy at birth increased 4.1 years from 70.9 to 75.0, the number of years with activity limitations increased by 2.4 years from 10.4 to 12.8 years.
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From page 65... ...
Disability that begins early in life is most commonly associated with developmental disabilities and mobility limitations caused by injuries. Disability that begins later in life is more commonly associated with chronic diseases and mobility limitations due to arthritis.
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From page 66... ...
Thus, despite the length of time that people live with developmental disabilities and mobility limitations due to injuries at early ages, more disability years are experienced by people whose disability appears later in life (after age 45) , primarily because of chronic diseases and mobility limitation due to arthritis.
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From page 67... ...
In 1979, 15 percent of the noninstitutionalized population that was limited in activity due to chronic conditions made 29 percent of the visits to physicians and accounted for 40 percent of the hospitalizations. Persons with activity limitations made 9.5 physician visits per person, compared with about 3.9 visits for persons with no activity limitation (National Center for Health Statistics, 1981a)
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From page 68... ...
Health services research is neededfor the development and application of improved methodologies to measure the effectiveness of the health and social service systems on maintaining those persons with disabling conditions at maximal functional capacity and quality of life. Several estimates of the high economic costs of disability in the United States are now available.
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From page 69... ...
amounted to $87.3 billion; included are social insurance programs, individual and employer programs, and income support; 2. medical care expenditures, which amounted to $79.3 billion in 1986; included are expenditures under public programs (Medicare, Medicaid, Department of Defense, Veterans Administration, and Workers' Compensation)
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From page 70... ...
analyzed data from the 1980 National Medical Care Utilization and Expenditure Survey to obtain data on the use, charges, and financing of medical care for children (under 21 years of age) with disabilities.
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From page 71... ...
Persons limited in activity due to one condition incurred medical expenditures of $49.4 billion; for those with two or more conditions, expenditures amounted to $13.6 billion. Sixteen percent of the total noninstitutionalized population with a limiting chronic condition incurred 41 percent of total medical care expenditures (Figure 2-12~.
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From page 72... ...
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From page 73... ...
Although the above estimates of the costs of disability vary because of the different methodologies employed, it is clear that disability imposes a large economic cost on the public and private sectors of our society. The data show that the economic cost of multiple chronic conditions causing activity limitations is significant and high, a result that is not very surprising because the probability of disability and medical care use is greater for persons with multiple or comorbid conditions regardless of other factors.
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From page 74... ...
As was apparent in the life table analyses, there are very few data extant on transitions in the disabling process. Although one can estimate on a cross-sectional basis the relationship between chronic conditions and activity limitation in the NHIS, and between different measures of activity limitation and disability in the SIPP, it is not possible to say much about the transitions from particular chronic conditions to particular functional limitations to different types of disability, for example, work disability.
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From page 75... ...
SIPP data point to about 46 million people with some type of work or functional limitation. With definitions focused only on inability to work or to carry out other major activities, or on receipt of disability benefits, the number of people with disabilities is substantially smaller.
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