The Future of Disability in America (2007) / Chapter Skim
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3 Disability Trends
3 Disability Trends
Pages 65-97
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From page 65... ...
The good news is that for many people the chances of experiencing activity limitations or participation restrictions can be reduced through a variety of means. These include making effective assistive technologies and accessible general-use technologies more widely available (see Chapter 7)
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From page 66... ...
This chapter focuses on trends during the past two decades in a relatively narrow set of activity limitations, the health conditions that contribute to those limitations, and, where relevant, possible explanations for these trends. CURRENT ESTIMATES OF DISABILITY AND RELATED CONDITIONS As discussed in Chapter 2, the omission of key groups from national population surveys has important implications for the development of basic
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From page 67... ...
Stephen Kaye of the University of California at San Francisco to supply information from the public use data sets for the National Health Interview Survey.
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From page 68... ...
who live in the community report a disability.2 This estimate does not include people living in nursing homes and other institutional settings or children under age 5. The Medicare Current Beneficiary Survey estimates that approximately 2.2 million Medicare beneficiaries live in longterm care facilities and that about 350,000 of this population are adults under age 65 (CMS, 2005a)
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TABLE 3-1 Disability Rates by Sex and Age (Excluding Ages 0 to 4) , Civilian Population (Excluding Residents of Nursing Homes, Dormitories, and Other Group Housing)
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, the number of people with disabilities has almost certainly increased since 1988, when most of the data used in that report were collected. Table 3-2 lists the most common health conditions reported by respondents in the National Health Interview Survey as "causing" or contributing to limitations among people of different ages residing in the community.
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The respondents could mention more than one condition. SOURCE: NCHS (2005a, spreadsheet data for Figures 18, 19, and 20, based on the 2002 and 2003 National Health Interview Surveys)
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For some people in this age group who are aging with disabilities, their primary health condition (e.g., cerebral palsy or spinal cord injury) is a risk factor for the development of secondary health conditions that have the potential to contribute to additional impairments, activity limitations, or participation restrictions.
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From page 73... ...
The next section reviews these trends in more detail, and the subsequent section describes two public health successes: declines in the rates of spina bifida and lead poisoning. Activity Limitations Examining disability trends among children presents special challenges.
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From page 74... ...
. More recent data, based on new National Health Interview Survey questions that asked about the receipt of special education services, the need for assistance with personal care, and limitations in walking and cognition, suggest that increases in the numbers of children with activity limitations also occurred between 1997 and 2004 (Table 3-4)
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From page 75... ...
In part, there have been real changes in the epidemiology of illnesses and related disabilities among children. In addition, the trend may be capturing in part the increasing awareness by parents, health professionals, and other agencies 6 Other surveys besides the National Health Interview Survey suggest significant increases in the rates of certain potentially disabling chronic conditions among children and youth, especially in recent years.
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" SOURCE: H Stephen Kaye, Disability Statistics Center, University of California at San Francisco, unpublished tabulations from the National Health Interview Survey, as requested by the committee.
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found increasing rates of several health conditions, especially mental health conditions, asthma, orthopedic conditions, and hearing loss. Unfortunately, changes in the questions as part of the redesign of the National Health Interview Survey in 1997 make comparisons over the entire time period inappropriate.8 Instead, the committee focused its review on the role of changes in the prevalence of a few potentially disabling health conditions.
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From page 78... ...
and low birth weight (birth weight less than 2,500 grams) are risk factors for a number of short-term and long-term neurodevelopmental and other health problems and disabilities related to cerebral palsy, mental retardation, and sensory impairments, as well as more subtle disorders, such as attention deficit or hyperactivity disorder.
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. Obesity is a risk factor for a number of serious health conditions, such as diabetes, that are, in turn, risk factors for disabilities.
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did not allow an estimate of how much of the growth in the activity limitations among children in the 1970s might reflect an increased awareness and identification of these limitations, their data raised the possibility that these factors might have played a role. For example, after noting that the marginal increase in activity limitations in the late 1970s (from 3.7 to 3.8 percent)
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From page 81... ...
suggests, however, that the SSI changes had some impact but that the impact on the rates of reported potentially disabling conditions was fairly minimal. That study examined Medicaid claims for the period from 1989 to 1992 and found similar increases in the rates of asthma and mental health conditions among children insured by Medicaid, whether they received SSI benefits or not.
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From page 82... ...
On balance, such studies that do exist suggest that the rates of disability are rising among America's nonelderly adults, at least in part because of increases in the rates of obesity. Personal Care or Routine Care Limitations Figure 3-2 presents National Health Interview Survey data on personal care limitations (referred to as activities of daily living [ADLs]
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In a study that used National Health Interview Survey data for the population ages 18 to 69, Lakdawalla and colleagues analyzed trends in personal care (ADL) and routine care (IADL)
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In contrast to the questions about personal care and routine care needs, the National Health Interview Survey does not ask people whether they need assistance to work. Rather, it asks whether they have a health problem or disability that (1)
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SOURCE: H Stephen Kaye, Disability Statistics Center, University of California at San Francisco, unpublished tabulations from the National Health Interview Survey, as requested by the committee.
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SOURCE: H Stephen Kaye, Disability Statistics Center, University of California at San Francisco, unpublished tabulations from the National Health Interview Survey, as requested by the committee.
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From page 87... ...
and its implications. On the basis of data from the TABLE 3-5 Trends in Chronic Health Conditions Causing Limitations of Activity as Reported for Civilian, Noninstitutional Population, Ages 18 to 64, 1997 to 2004 Number of People with Activity Limitations Caused by Selected Chronic Health Conditions per 1,000 Population Type of Chronic Health Condition 1997 1998 1999 2000 2001 2002 2003 2004 Mental illness 14.2 13.2 13.2 13.1 15.3 17.3 16.0 14.5 Fractures and joint injuries 12.1 10.6 11.0 10.2 11.3 11.4 11.2 9.5 Lung 10.6 9.3 9.3 8.6 9.4 10.1 9.5 9.0 Diabetes 9.7 8.1 9.2 9.3 9.7 9.6 11.1 10.5 Heart, other circulatory 20.7 19.3 19.3 18.9 19.9 20.0 20.6 18.8 Arthritis, other musculoskeletal 42.5 38.9 37.7 33.8 37.5 38.0 37.7 35.5 SOURCE: Committee's analysis of National Health Interview Survey data, 1997 to 2004.
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From page 88... ...
SOURCE: Compiled from Medicare Current Beneficiary Survey, Health and Health Care Sourcebooks, 1992 to 2002. National Health and Nutrition Examination Surveys beginning in 1960, Figure 3-5 presents trend data on the rates of obesity among adults ages 20 to 39 and ages 40 to 59.
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From page 89... ...
This discussion relies primarily on data from the 1982 to 2004 National Health Interview Surveys. For older individuals, comparison of pre1997 survey data with data from the revised survey suggested only minor discontinuities in the data on personal care and routine care limitations.11 Therefore, the data are presented without discontinuity by year.
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As presented in Figure 3-6, data from the National Health Interview Survey showed a small decline in the prevalence of personal care limitations during the entire period, from 8.2 percent in 1982 to 7.8 percent in 2003. The Medicare Current Beneficiary
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30 25 20 Percent 15 10 5 0 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 Year Bathing/Showering Dressing Eating Getting out of bed/chairs Walking Using toilet FIGURE 3-7 Percentage of community-dwelling Medicare beneficiaries ages 65 and over who have difficulty in performing selected personal care activities without help or special equipment, 1992 to 2003. SOURCE: NCHS, 2007 (data from the Medicare Current Beneficiary survey obtained from tables compiled by CDC, available at http://209.217.72.34/aging/ TableViewer/tableView.aspx?
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. More recently, using data from the National Health Interview Survey for the period 1982 through 2002, Schoeni and colleagues (2005)
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Other services may include housekeeping and laundry services, medi cation reminders or help with medications, help with personal care activities, transportation, security, health monitoring, care management, and activities.
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. Like the review for the nonelderly adult population, this summary of trends in health conditions and certain kinds of disabilities draws upon many data sources, data from different time periods, and different measures.13 The committee also reviewed trends in conditions that contribute to disability using data from the 1997 to 2004 National Health Interview Survey.
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PROJECTING THE FUTURE OF DISABILITY IN AMERICA The number of people with impairments in body structures or functions is likely to grow substantially in the coming years. Unless substantial progress is made in reducing the chances of such impairments developing into activity limitations and participation restrictions, particularly at older ages, the number of people in the United States facing barriers to work, health care, and independent living will no doubt escalate.
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From page 96... ...
Other children have experienced impairments related to exposures to toxic substances. Furthermore, because disabling or potentially disabling conditions that are present at birth or that arise during childhood can have long-term consequences (Forrest and Riley, 2004; IOM, 2003a, 2005a, 2006a)
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From page 97... ...
. Taken together, these projections suggest that the number of people with disabilities is likely to increase in the coming years, unless steps are taken to reduce the environmental barriers that contribute to avoidable activity limitations and participation restrictions.
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