Prevalence of Work Disability -- United States, 1990

Work disability, defined as the inability to perform work as a result of a physical, mental, or other health condition, costs approximately $111.6 billion each year in direct and indirect medical costs and lost wages (1). National health objectives for the year 2000 are to increase the span of healthy life for persons in the United States and to reduce the proportion of persons experiencing disability from chronic conditions (as defined by CDC's National Health Interview Survey) to a maximum of 8% (baseline: 9.4% in 1988) (objective 17.2) (2). This report presents national and state-specific prevalence rates of work disability in the United States for 1990 and compares rates with those for 1980 (3).

Data on work disability among U.S. residents have been collected by the Bureau of the Census since 1970. In this analysis, rates of work disability were calculated for persons aged 16-64 years using data from the 1990 census. Work disability was defined on the census questionnaire as the inability to perform work resulting from a physical, mental, or other health condition of 6 months' duration or longer; categories are nonsevere (limitation in the type or amount of work a person can perform) and severe (inability to perform work of any type).

In 1990, an estimated 12.8 million persons aged 16-64 years had a work disability: 6.6 million were severe and 6.2 million, nonsevere. Rates of work disability varied widely among the states, ranging from 61.8 (New Jersey) to 126.2 (West Virginia) per 1000 population. Prevalence rates were highest in West Virginia, Kentucky (114.3), Arkansas (111.7), Louisiana (102.9) and Mississippi (109.8) (Table_1).

From 1980 to 1990, the prevalence of work disability declined nationally, from 85.2 to 81.5 per 1000 persons, and rates of severe and nonsevere work disability decreased by 3.9% and 4.7%, respectively. Rates of work disability declined for the District of Columbia and 29 states, primarily in the South, and increased for 21, primarily in the Midwest and West. For states with high rates of severe disability in 1980, rates remained high in 1990. The five states with the highest rates of severe disability also had high rates of nonsevere work disability. Reported by: MP LaPlante, PhD, Disability Statistics, Rehabilitation Research, and Training Center, Institute for Health and Aging, Univ of California at San Francisco. National Institute on Disability and Rehabilitation Research, US Dept of Education. Applications Br, Div of Surveillance and Epidemiology, Epidemiology Program Office; Disabilities Prevention Program, Office of the Director, National Center for Environmental Health; and National Institute for Occupational Safety and Health, CDC.

Editorial Note

Editorial Note: Although age-specific, all-cause mortality in the United States has steadily decreased since the late 1940s, self-reported disability increased from 1962 through 1984 (4). In addition, even though the findings in this report indicate national declines from 1980 to 1990 in the estimated rate of work disability, the proportion of U.S. residents affected by work disability and the variability in rates of work disability among states remain high. These findings are consistent with other studies (1,4).

Potential explanations for the declining trend in work disability and for the state-specific variability include changing patterns in self-reporting of health conditions, variations in categorization of functional disability based on job benefits and conditions (e.g., job retraining or reassignment, vocational rehabilitation, early retirement, or workers' compensation) (5), demographic factors (e.g., age, socioeconomic status, educational level, and marital status), and economic factors (e.g., the rate of unemployment in a particular state, opportunities for employment for persons with disabilities, and retirement patterns) (4-9).

In this report, the finding that rates of work disability increased in nearly half the states from 1980 to 1990 may reflect the change in age distribution in the United States. Age is a strong determinant of work disability: as the average age of the population increases there is usually a concomitant increase in the prevalence of work disability (4). In addition, the finding that states with the highest prevalence of severe work disability also had high rates of nonsevere work disability suggests that similar factors may influence rates of severe and nonsevere work disability.

The state-specific estimates of work disability in this report can provide guidance to states in planning and monitoring efforts to reduce the impact of work disabilities. These efforts should include collaboration among national, state, and local public health officials along with business and industry leaders to evaluate policies on job training or reassignment, vocational rehabilitation, and workers' compensation to ensure optimal retraining and rehabilitation of persons with disabilities. This level of collaboration is essential in implementing the guidelines of the Americans with Disabilities Act *.

References

1. Ycas MA. Trends in the incidence and prevalence of work disability. In: Thompson-Hoffman S, Storck IF, eds. Disability in the United States: a portrait from national data. New York: Springer, 1991:161-83.

2. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

3. LaPlante MP. Disability statistics report: state estimates of disability in America. Washington, DC: US Department of Education, Office of Special Education and Rehabilitative Services/ National Institute on Disability and Rehabilitation Research, 1993 (no. 3).

4. Wolfe BL, Haveman R. Trends in the prevalence of work disability f5om 1962 to 1984, and their correlates. Milbank Q 1990;68:53-80.

5. West J, ed. The Americans with Disabilities Act: from policy to practice. New York: Milbank Memorial Fund, 1991.

6. Kemna HJMJ. Working conditions and the relationship between schooling and health. J Health Econ 1987;6:189-210.

7. Lando ME, Cutler RR, Gamber E. Data book: 1978 survey of disability and work. Washington, DC: US Department of Health and Social Services, Social Security Administration, 1982; SSA publication no. 13-11745.

8. Chirikos TN, Nestel G. Economic determinants and consequences of self-reported work disability. J Health Econ 1984;3:117-36.

9. Chirikos TN. Accounting for the historical rise in work disability prevalence. Milbank Q 1986;64:271-301.

* Public Law 101-336.
Table_1
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TABLE 1. Rate* of work disability among persons aged 16-64 years and estimated
numbers of persons with any work disability, by state -- United States, 1990

===========================================================================================
                              No. persons   º                               No. persons
                             with any work  º                              with any work
State               Rate      disability    º State               Rate      disability
--------------------------------------------+-------------------------------------------
Alabama             96.8         245,000    º Montana             97.0          47,000
Alaska              66.3          23,000    º Nebraska            71.4          68,000
Arizona             83.1         188,000    º Nevada              83.4          66,000
Arkansas           111.7         159,000    º New Hampshire       72.7          53,000
California          74.2       1,422,000    º New Jersey          61.8         311,000
Colorado            78.4         167,000    º New Mexico          88.3          82,000
Connecticut         63.8         136,000    º New York            74.3         866,000
Delaware            77.4          33,000    º North Carolina      87.3         371,000
District of                                 º North Dakota        69.7          26,000
  Columbia          84.0          35,000    º Ohio                90.1         618,000
Florida             86.6         676,000    º Oklahoma           101.6         195,000
Georgia             88.4         368,000    º Oregon             100.1         178,000
Hawaii              65.9          44,000    º Pennsylvania        82.6         617,000
Idaho               90.4          54,000    º Rhode Island        85.8          55,000
Illinois            68.9         500,000    º South Carolina      91.1         199,000
Indiana             79.0         277,000    º South Dakota        78.1          32,000
Iowa                75.8         128,000    º Tennessee           97.3         304,000
Kansas              72.0         108,000    º Texas               76.0         813,000
Kentucky           114.3         265,000    º Utah                72.9          72,000
Louisiana          102.9         266,000    º Vermont             79.0          29,000
Maine              101.5          79,000    º Virginia            75.4         299,000
Maryland            70.5         221,000    º Washington          90.9         280,000
Massachusetts       72.0         284,000    º West Virginia      126.2         142,000
Michigan            90.4         536,000    º Wisconsin           73.2         224,000
Minnesota           73.9         204,000    º Wyoming             72.7          20,000
Mississippi        109.8         171,000    º
Missouri            85.4         271,000    º Overall             81.5      12,821,000
--------------------------------------------+--------------------------------------------
*Per 1000 persons.

Source: Bureau of the Census, 1990.
===========================================================================================

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