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Measuring Disability in Canadian Questionnaires: A First Look. Sally Kader Health Statistics Division Statistics Canada. Objectives. To assess the differences in estimates of disability from filter (screening) questions in different surveys
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Measuring Disability in Canadian Questionnaires: A First Look Sally Kader Health Statistics Division Statistics Canada
Objectives • To assess the differences in estimates of disability from filter (screening) questions in different surveys • To examine the association between disability as measured by the filter questions and other measures of health or functional limitations
Surveys with disability questions • Census • Health Surveys: Canadian Community Health Survey (CCHS), National Population Health Survey (NPHS) • Post-Censal Surveys: Participation and Activity Limitations Survey (PALS), Aboriginal Peoples Survey (APS) • Labour Surveys: Labour Force Survey (LFS), Survey of Labour and Income Dynamics (SLID), Workplace and Employee Survey • Other Surveys: National Longitudinal Survey of Children and Youth, General Social Survey (GSS)
Health 2000 CCHS 1998 NPHS 1996 NPHS Non-health 2001 Census 1999 SLID 2000 GSS Sources of data
Filter questions: Census prior to 2001 • Is this person limited in the kind or amount of activity he/she can do because of a long-term physical condition, or mental condition or a health problem: • ...at home? • …at school or at work? • …in other activities, for example, in transportation to and from work, or in leisure time activities? • Does this person have any long-term disabilities or handicaps? • Responses • No, not limited • Yes, limited
Filter questions: Census 2001 • Do you have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities? • Does a physical condition or mental condition or health problem reduce the amount or the kind of activity you can do • … at home? • …at work or at school? • …in other activities, for example, transportation or leisure? • Responses • Yes, often • Yes, sometimes • No, never
Prevalence of population identified as “disabled”, by survey
Selected health status measures • Self-perceived health (SPH) • NPHS and CCHS only • A global evaluation of one’s health on a 5-point scale. • Response categories: “excellent”, “very good”, “good”, “fair” or “poor.” • Indicator scored as 1 if response is “fair” or “poor.”
Selected health status measures • Health Utilities Index (HUI) • NPHS and CCHS only • A set of 30 questions covering 8 components: vision, hearing, speech, mobility, dexterity, pain, emotion, cognition. • Each component has 2 levels: none/mild and moderate/severe. • Indicator scored as 1 if response indicates moderate/severe impairment in any component.
Selected health status measures • Activities of daily living (ADL and IADL) • NPHS and CCHS only • A set of 6 questions about needing help in preparing meals, shopping for groceries or other necessities, housework, heavy chores, personal care, moving inside house. • Response categories: Yes/No. • Indicator scored as 1 if “Yes” response to any of the questions.
Prevalence under disability filter questions and selected health status measures
Defining disagreement between filter questions and selected health status measures • False negatives • No to all the filter questions • A positive score on another health measure • False positives • Yes to at least one of the filter questions • A zero score on health measure under consideration
Method used to adjust prevalence estimates of disability • Adjusted prevalence • NPHS and CCHS only • Exclude false positives • Estimate prevalence based on filter questions only
Percentage of disagreement between filter questions and other selected health status measures Data Source: NPHS 1996
Percentage of disagreement between filter questions and other selected health status measures Data Source: NPHS 1998
Percentage of disagreement between filter questions and other selected health status measures Data Source: CCHS 2000
Summary • As expected, the redesigned filter questions yield higher estimates of the prevalence of disability than do former filter questions or other measures of health or functional limitation. • CCHS estimates of prevalence of disability, based on the redesigned filter questions, are higher than those obtained from other surveys
CCHS: Higher rates • Possible explanations: • New questions • Question placement • Proxy rates • Larger percentage of respondents choosing “sometimes” • Health context
Limitations • Proxy reporting rates vary • Method of questionnaire administration (in-person, telephone or self-completed)
Next steps • Evaluate the possible effects of: • Health context of survey • Proxy reporting • Method of questionnaire administration (in-person, telephone or self-completed) • Question placement in survey • Short time span