Enabling America Assessing the Role of Rehabilitation Science and Engineering (1997) / Chapter Skim
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2 MAGNITUDE AND COST OF DISABILITY IN AMERICA
2 MAGNITUDE AND COST OF DISABILITY IN AMERICA
Pages 40-61
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From page 40... ...
Almost 4 percent of the U.S. population have disabling conditions so severe that they are unable to carry out the major activities of their age group (playing, attending school, working, or attending to self-care)
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From page 41... ...
In 1990, a new center, the National Center for Medical Rehabilitation Research (NCMRR) , was established at NIH to help coordinate and focus specifically on medical rehabilitation research.
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From page 42... ...
Total Prevalence Table 2-2 presents data on the prevalence of activity limitations associated with major classifications of impairments and diseases or disorders, including the number of people with the particular classification and limitation and the proportion of all activity limitations attributed to the classification. Overall, in excess of 61 million impairments or diseases and disorders contributed to activity limitations in 1992; of these, 16.3 million were impairments (26.7 percent of the total)
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From page 43... ...
impairments, orthopedic impairments were the most common classification contributing to limitations, with a total of 8.6 million conditions accounting for 14.1 percent of all conditions that contribute to limitations. In excess of 1 million cases each of visual or hearing impairment, learning disability or mental retardation, and paralysis contributed to limitations, although none of these classifications individually accounted for more than 2.6 percent of all conditions contributing to an impairment.
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44 at' ¢ o ~o ~m ~ ·_1 -i ~ ¢ ¢ .e U .
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In terms of prevalence, musculoskeletal and connective tissue and circulatory conditions are the most common diseases and disorders listed as the main cause of limitation. Impairment and Work Limitation NHIS asked people 18 to 69 years of age questions about work limitations.
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The most common diseases and disorders contributing to work limitations include musculoskeletal and connective tissue disorders (5.4 million individuals) , circulatory diseases (5.1 million individuals)
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are the second and third most prevalent causes, respectively, of disabling conditions in children. Diseases of the musculoskeletal system and connective tissue are not as dominant in children with disabilities as in adults with activity or work limitations (Table 2-5~.
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No disability (not limited in activity) Definitions of "major activity" Degree of activity limitation: Unable to perform major activity Limited in amount or kind of major activity Limited, but not in 547 2.8 2,479 7.4 1,021 7.6 19,110 97.2 30,899 92.6 12,429 92.4 Play activities 123 0.6 280 1.4 major activity1450.7 Total19,657100.0 Attending school Attending school 1850.6880.7 1,6745.0 6074.5 6201.93262.4 33,378100.013,450100.0 SOURCE: LaPlante and Carlson (1995~.
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992.0 Deformities1342.7 (spine bifida) 170.3 Orthopedic impairments1442.9 Other and ill-defined impairments691.4 All Diseases and Disorders2,90658.4 Infectious and parasitic diseases470.9 Neoplasms380.8 Endocrine, nutritional and metabolic diseases and immunity disorders721.4 Diseases of the blood and blood-forming organs320.6 Mental disorders (excluding mental retardation)
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From page 51... ...
Impairments have the highest risk of becoming a disabling condition. Of the conditions reported in NHIS to cause activity limitations, heart disease ranks first, followed by back disorders, arthritis, orthopedic impairments of the lower extremity, and asthma (LaPlante and Carlson, 1996)
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From page 52... ...
Disorders of the eye Learning disability and mental retardation Cancer Visual impairments Orthopedic impairment of shoulder and/or upper extremities Other unknown or unspecified causes Hearing impairments Cerebrovascular disease 61,047 7,932 7,672 5,721 2,817 2,592 2,569 2,035 1,577 1,575 1,342 1,294 1,196 1,188 1,175 1,174 100.0 13.0 12.6 9.5 4.6 4.2 4.2 3.3 2.6 2.6 2.2 2.1 2.0 1.9 1.9 1.9 SOURCES: LaPlante and Carlson (1995) , Table D; 1992 National Health Interview Survey.
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A separate questionnaire was administered to children, including a control group of children without special health needs. In the first phase, questions about developmental milestones for children under age 5 and about performance of activities of daily living for children ages 6 to 17 were asked.
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A supplemental survey containing extensive questions about disability status was performed as part of the sixth wave of the 1990 panel and the third wave of the 1991 panel. SIPP contains information on economic and social variables on people with disabling conditions that are not usually included in health surveys that ask about disability.
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From page 55... ...
For example, among people ages 35 to 54, those with no disabling condition had mean monthly earnings of $2,446, those with a disabling condition that was not severe had monthly earnings of $2,006 and those with a severe disabling condition had monthly earnings of $1,562. However, there was a strong negative association between education and disability status.
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Indirect costs can range from 10 to 37 percent of preillness income. Traumatic Brain Injury The Brain Injury Association estimates that each year more than 2 million people sustain a brain injury, and 373,000 of these are severe enough to require hospitalization.
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Cost-of-Illness Framework The impact of illness on society is frequently estimated by calculating the amount of medical care expenditures on behalf of people with disabling conditions (called direct costs in the cost-of-illness nomenclature) and the amount of wage losses or its equivalent in services provided by homemakers (called indirect costs)
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From page 58... ...
estimated both direct and indirect costs of disability using 1980 data. He reported an aggregate economic cost of disability of $176.8 billion, 51 percent due to medical care expenditures and the remainder due to the lost productivity of people with disabling conditions or family members who had to stop working to care for them.
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From page 59... ...
After taking differences in skill and experience into account, wage losses would still amount to $93.1 billion. The estimates of indirect costs due to wage losses in CPS are lower than the estimates in NHIS because of the lower overall prevalence of individuals with disabling conditions in the former survey.
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From page 60... ...
The topic of the forum was the future of disability statistics. Participants at the forum identified the following needs for future data collection efforts: more emphasis on social participation of people with disabling conditions, designing data sets that respond to policy questions, more emphasis on mental illness data, the need for more state-level data, more sharing of data across agencies, and use of repeated cross-sectional data to identify trends.
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From page 61... ...
Recommendation 2.1 The Disability Statistics Subcommittee of the Interagency Committee on Disability shouldfoster research to design and evaluate survey items to be used to ascertain the prevalence and impact of disability that accord with the contemporary model in which disability is jointly determined by characteristics of individuals and of their environments. Recommendation 2.2 These survey items should be incorporated in on-going surveys, including the National Health Interview Survey, Current Population Survey, and Survey of Income and Program Participation.
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