Health and Functional Status of Working Age People with Disabilities in the United States

1. Health and Functional Status of Working Age People with Disabilities in the United States Gerry E. Hendershot Consultant on Disability and Health Statistics The Future of Disability Statistics: What We Know and Need to Know October 5, 2006

2. Gerry Hendershot reading to grandson Thomas Hendershot Foti from the International Classification of Functioning, Disability, and Health (ICF), 2003

3. A Guide to Disability Statistics from the National Health Interview Survey Benjamin H. Harris Gerry E. Hendershot David C. Stapleton

4. Data Source • National Health Interview Survey (NHIS) • Conducted annually by the National Center for Health Statistics (NCHS) • Large, nationally representative sample of the household population of all ages in the U.S. • Face-to-face standardized interviews in sample households using laptop computer • Free public use data within about six months

5. Study Population • People of working age, 18-64 years • Community dwelling (does not include the institutional population, e.g., nursing homes, long-term care facilities, and prisons) • Respondents to NHIS (does not include nonrespondents, although there is a correction for nonresponse)

6. Conceptual model • International Classification of Functioning, Disability, and Health (ICF) • Functioning is multi-dimensional: body, person, community • “Disability” includes impairment of body structure or function, limitation of personal activity, restriction of community participation

7. Disability Indicators • Impairments of body structures or functions: Mental, Physical, Sensory • Limitations in personal activities: Activities of Daily Living (ADL) • Restrictions in community participation: Instrumental Activities of Daily Living (IADL), Work

8. Impairment Measures • Sensory: hard-of-hearing/deaf, or blind • Physical: respondent reports that without assistance of devices or other persons, it is very difficult or impossible to walk 3 blocks, climb 10 stairs, stand or sit for 2 hours, stoop, bend, kneel, reach above head, grasp objects, lift 10 lbs., or push a chair

9. Impairment Measures (continued) • Mental: How often in the past 30 days have you felt very sad (repeated for restless, nervous, hopeless, worthless, or that everything was an effort)--None of the time=0, Little=1, Some=2, Most=3, All the time=4? Persons with a cumulative score of 13 or more were classified as having an impairment

10. Activity Limitation Measure • ADL: Because of a physical, mental, or emotional problem do you need the help of other persons with personal care needs, such as eating, bathing, dressing, or getting around inside the home?

11. Participation Restriction Measures • IADL: Because of a physical, mental, or emotional problem do you need help from other persons in handling routine needs, such as everyday chores, shopping, or getting around for other purposes? • Work: Does a physical, mental, or emotional problem now keep you from working at a job, or limit the amount or kind of work you can do?

12. Summary Measure of Disability • Respondent has a disability if one or more of the following is reported: • Sensory impairment • Physical impairment • Mental impairment • ADL limitation • IADL restriction • Work restriction

13. Comparing people with and without disabilities with the summary measure Health Outcomes • Self-reported health status • Change in health in the last 12 months • Body Mass Index (weight for height)

14. “Would you say your health in general is excellent, very good, good, fair, or poor? “ • People with disabilities are 10 times more likely than those without disabilities to report that their health is fair or poor rather than excellent, very good, or good.

15. “Compared with 12 months ago, would you say your health is better, worse, or about the same?” • People with disabilities are 7 times more likely than those without disabilities to report that their health is worse now than it was 12 months ago.

16. Body Mass Index = [weight (kg)/height (m)]2 • People with disabilities are 7 times more likely than those without disabilities to be obese.

17. Comparing different types of disability Health Outcomes • Fair/poor health • Worsening of health in the last 12 months • Obesity

18. Self-reported fair/poor health by detailed disability types • People with ADL limitations, IADL restrictions, and work restrictions are more likely to report fair/poor health than people with sensory, physical, or mental impairments.

19. Health worse now than 12 months ago by detailed disability types • People with mental impairments, ADL limitations and IADL restrictions are more likely to report their health is worse than people with mental or sensory impairments or work restrictions

20. Obesity by detailed disability types • People with physical impairments, ADL limitations, and IADL restrictions are more likely than those with sensory or physical impairments or work restrictions to be obese.

21. Disability as defined in this study Back/neck (33%) Arthritis (33%) Fractures (14%) Depression/Anxiety (13%) Other muskuloskeletal (12%) Less serious disability Back/neck (27%) Arthritis (21%) Other muskuloskeletal (14%) Fracture (15%) Lung (9%) Leading medical causes of disability (and prevalence rates)

22. Leading medical causes of disability: Comments • Comparing people with a disability as defined in this study to people with less serious disabilities: • 4 of the 5 leading causes are the same for both groups • The prevalence rates of those four causes are similar, except that arthritis is much higher among persons with disability as defined in this study • People with disabilities as defined in this study are 4 times more likely to have depression/anxiety

23. Summary of Findings • Compared to people without disabilities, people with disabilities are: • More likely to be in poor health • More likely to have had a recent decline in health • More likely to be obese • People with ADL limitations and IADL restrictions are more likely than persons with other types of disability to have adverse health outcomes

24. Conclusion • The health of working age people with disabilities is not as good as that of their counterparts without disabilities. • There are differences in health outcomes among people with different kinds of disability. • The National Health Interview Survey is a good source of statistics on the health of persons with disabilities.