WG Extended Set on Functioning

1. WG Extended Set on Functioning Proposed Guidelines for Analysis Mitchell Loeb National Center for Health Statistics, USA and Washington Group on Disability Statistics

2. WG short set of questions: Because of a Health problem: • Do you have difficulty seeing even if wearing glasses? • Do you have difficulty hearing even if using a hearing aid? • Do you have difficulty walking or climbing stairs? • Do you have difficulty remembering or concentrating? • Do you have difficulty with (self-care such as) washing all over or dressing? • Using your usual language, do you have difficulty communicating (for example understanding or being understood by others)? Response categories: No difficulty; Yes, some difficulty; Yes, a lot of difficulty; Cannot do at all

3. What can the WG Short Set produce? Domain specific outputs: • continuum of functioning on each of the 6 domains • a set of disability indicators for each individual domain of functioning Overall outputs: • continuum of functioning over all domains • a set of disability indicators (based on different cut-offs) suitable for disaggregation • a recommended disability indicator for disaggregation and international comparisons

4. Prevalence (weighted %) by domain and degree of difficulty At least: Source: NHIS 2013; n=16777; ages 18+

5. Disability prevalence USA Source: NHIS 2013; n=16777; ages 18+

6. WG Recommendation For purposes of reporting and generating internationally comparable data, the WG has recommended the following cutoff be used to define the population of persons with disabilities: • The sub-population identified as with disability includes those with at least one domain that is coded as a lot of difficultyor cannot do it at all.

7. Disability by employment Source: NHIS 2013; n=13404; ages 18-64

8. WG Extended Set: • includes additional domains of functioning that were not in the Short Set (upper body functioning, affect, pain, and fatigue) • includes more information per domain (for example, use of assistive devices/aids, and functioning with and without assistance)

9. Going from SS to Extended set What are the challenges in going from a single question per domain to multiple questions per domain? • To create domain specific indicators for domains with more than one question. • To combine multiple indicators to form a continuum of functional difficulty. • To determine the ‘added value’ of multiple questions and the additional domains.

10. Vision: Short/Extended set questions • Do you have difficulty seeing, even when wearing glasses? (SS) • Do you have difficulty clearly seeing someone’s face across a room, even when wearing glasses? • Do you have difficulty clearly seeing a picture on a coin, even when wearing glasses? Initial analyses using extended set questions (difficulty with near and far vision) did not create a continuum of functioning, so the questions were not included in the Extended set.

11. Do you have difficulty seeing, even when wearing glasses? SS Source: NHIS 2013; n=16767; ages 18+

12. Upper body: Short/Extended set questions • Do you have difficulty with self-care, such as washing all over or dressing? (SS) • Do you have difficulty raising a 2 liter bottle of water or soda from waist to eye level? • Do you have difficulty using your hands and fingers, such as picking up small objects, for example, a button or pencil, or opening or closing containers or bottles? Note: Q2 & Q3 are used for the upper body indicator. Q1 remains the self-care indicator.

13. Do you have difficulty with self-care, such as washing all over or dressing? SS Source: NHIS 2013; n=16755; ages 18+

14. Difficulty lifting 2 liter bottle by difficulty using hands/fingers Source: NHIS 2013; n=16750; ages 18+

15. Upper body Indicator Source: NHIS 2013; n=16750; ages 18+

16. Employment status last week by upper body indicator Source: NHIS 2013; n=12987; ages 18-64

17. Anxiety: Extended set questions • How often do you feel worried, nervous or anxious? (Frequency) • Thinking about the last time you felt worried, nervous or anxious, how would you describe the level of these feelings? (Intensity) • (Do you take medication for these feelings?)

18. Challenge to combining the questions into a single anxiety indicator • Medication variable: what did taking medication for anxiety mean? Should everyone reporting medication use be considered anxious? • Medication is an accommodation. (Prevalence of taking medication is 9.2%) • What kind of medication are they taking? • Are people reporting their anxiety with or without medication?

19. Anxiety: Frequency by Intensity Source: NHIS 2013; n=16646; ages 18+

20. Anxiety Indicator Source: NHIS 2013; n=16646; ages 18+

21. Employment status last week by Anxiety indicator Source: NHIS 2013; n=12914; ages 18-64

22. K6 score by Anxiety indicator Source: NHIS 2013; n=16646; ages 18+

23. WG Extended set: Pain, Fatigue, Anxiety, Depression (PFAD) Source: NHIS 2013; n=16777; ages 18+

24. WG Extended set: Defining the population with disability Source: NHIS 2013; n=16777; ages 18+

25. WG Extended set: Defining the population with disability Source: NHIS 2013; n=16777; ages 18+

26. WG Extended set: Defining the population with disability Source: NHIS 2013; n=16777; ages 18+

27. WG Extended set: Defining the population with disability Source: NHIS 2013; n=16777; ages 18+

28. WG Extended set: Defining the population with disability Source: NHIS 2013; n=16777; ages 18+

29. WG Extended set: Defining the population with disability Source: NHIS 2013; n=16777; ages 18+

30. WG Extended set: Defining the population with disability Source: NHIS 2013; n=16777; ages 18+

31. WG Extended set: Defining the population with disability Source: NHIS 2013; n=16777; ages 18+

32. WG Extended set: Defining the population with disability Source: NHIS 2013; n=16777; ages 18+

33. Defining the population with disability for disaggregation Source: NHIS 2013; n=16777; ages 18+

34. Defining the population with disability for disaggregation Source: NHIS 2013; n=13404; ages 18-64