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Prevalence of Mobility and Self-Care Disability -- United States, 1990

An estimated 43 million persons in the United States have a disability * (1); the estimated annual economic impact of disabilities -- representing loss of wages, medical-care expenditures, and additional household expenditures -- is approximately $176.7 billion (2). The Institute of Medicine recently recommended surveillance and systematic collection of information at the national and state levels to assist in program planning and evaluation for state-based programs for the prevention of disabilities and secondary conditions (i.e., health conditions resulting from a disability) (3). To characterize state-specific disability patterns and better plan for funding of disability services, the National Institute of Disability and Rehabilitation Research (NIDRR) and CDC assessed data from the 1990 census on two forms of disability: difficulty with mobility and self-care activities. This report summarizes the results of the assessment for persons aged greater than or equal to 16 years.

In the 1990 census, more than 41 million persons completed the "long form," which included questions about disability. Census respondents were asked, "Because of a health condition that has lasted 6 or more months, does this person have any difficulty 1) going outside the home alone (e.g., shopping or visiting a doctor's office) or 2) taking care of his or her own personal needs (e.g., bathing, dressing, or getting around inside the home)" (4). Persons who answered yes to the first part were considered to have a mobility disability. Persons who answered yes to the second part were considered to have a self-care disability.

In 1990, 13.2 million persons (70.5 per 1000 population) aged greater than or equal to 16 years had some mobility or self-care disability. Among persons aged greater than or equal to 65 years, an estimated 5.9 million reported having either a mobility or self-care disability (201.1 per 1000); approximately 29% of these persons reported both types of disability. The prevalence of mobility disability for respondents aged greater than or equal to 16 years was 43.2 per 1000; for persons aged 16-64 years and aged greater than or equal to 65 years, the prevalences were 21.9 and 156.0, respectively. The prevalence of self-care disability for respondents aged greater than or equal to 16 years was 47.7; for persons aged 16-64 years and greater than or equal to 65 years, the prevalences were 34.2 and 119.2, respectively (Table_1).

The median state-specific prevalence of mobility disability was 40.4 per 1000 population (range: 19.6-65.2); and self-care disability, 44.2 (range: 21.8-71.9). For persons aged 16-64 years, the median prevalence for mobility disability was 20.1 (range: 12.0-35.6); and self-care disability, 30.6 (range: 15.9-58.8). In comparison, for persons aged greater than or equal to 65 years, the median rate of mobility disability was 145.9 (range: 104.5-221.5); and self-care disability, 113.6 (range: 69.4-169.3).

Prevalence rates of mobility or self-care disability were highest in Mississippi, Alabama, the District of Columbia, West Virginia, and Arkansas. The mobility or self-care disability rate in Mississippi (104.1 per 1000 population) was more than three times that in Alaska (32.7), the lowest ranking state. Among persons aged greater than or equal to 65 years, the rate of mobility or self-care disability in Mississippi (276.9) was twice as high as in South Dakota (133.0), the lowest ranking state. 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; and Disabilities Prevention Program, Office of the Director, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: Although several national surveys that provide disability estimates differ in the aspects and focus of disability measures, the definitions used in those surveys are all within the framework of activity limitations (5). The findings in this report are consistent with previous estimates (6) indicating that a substantial proportion of persons in the United States have mobility and self-care disabilities.

Disability traditionally has connoted limitations in ability to perform life activities because of an impairment (1) (i.e., loss of mental, anatomical, or physiological structure or function as a result of active disease, residual losses from formerly active disease, or congenital losses or injury not associated with active disease {7}). The ADA defines disability as either a person with a physical or mental impairment that substantially limits one or more of the major life activities, a person with a medical record of such an impairment, or a person regarded as having such an impairment.

Efforts to clarify definitions and taxonomic schemes for disability have been conducted by the Public Health Service Task Force on Improving Medical Criteria for Disability Determination (Public Health Service, unpublished data, 1992) and by CDC, in collaboration with Statistics Canada, as a World Health Organization (WHO) collaborating center for the revision of WHO's International Classification of Impairments, Disabilities, and Handicaps (8). These efforts should assist in improving the systematic collection, analysis, and dissemination of information about impairments, limitations, and disabilities. This information will clarify the roles of prevention and early intervention and guide programs addressing the needs of persons with disabilities; such programs include CDC's Disabilities Prevention Program, National Center for Environmental Health; the U.S. Department of Education's NIDRR; and the National Institutes of Health's National Center for Medical Rehabilitation Research.

The 1990 census estimates included in this report represent one assessment of disability, but additional data are needed, such as the causes of these limitations and the extent to which these limitations are determined by personal impairments, by environmental barriers, or both. Efforts to compile these data should focus on the systematic collection of area-specific information about impairments, limitations, and disabilities. This information can be used for the development of public policy and program evaluation. The state-specific estimates of mobility and self-care limitations described in this report can guide states in prioritizing efforts for programs designed to prevent disabilities and secondary conditions in persons with disabilities.

References

  1. LaPlante MP. The demographics of disability. In: West J, ed. The Americans with Disabilities Act: from policy to practice. New York: Milbank Memorial Fund, 1991:55-77.

  2. Chirikos TN. Aggregate economic losses from disability in the United States: a preliminary assay. Milbank Q 1989;67(suppl 2):59-

  3. Pope AM, Tarlov AR, eds. Disability in America: toward a national agenda for prevention. Washington, DC: National Academy Press, 1991.

  4. CDC. Prevalence of work disability -- United States, 1990. MMWR 1993;42:757-9.

  5. LaPlante MP. Disabilities 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).

  6. LaPlante MP. Disability Statistics Abstract: People with disabilities in basic life activities in the US. Washington DC: US Department of Education, Office of Special Education and Rehabilitative Services/National Institute on Disability and Rehabilitation Research, 1992 (no. 3).

  7. Nagi SZ. Disability concepts revisited: implications to prevention. In: Pope AM, Tarlov, AR, eds. Disability in America: toward a national agenda for prevention. Washington, DC: National Academy Press, 1991:309-27.

  8. World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva: World Health Organization, 1980.

*  condition as defined by the Americans with Disabilities Act of 1990 (ADA) (Public Law 101-336) (1).
Table_1
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TABLE 1. Rate* of mobility disability or self-care disability among persons aged
>= 16 years, by age group and state -- United States, 1990
============================================================================================

                           16-64 yrs                >=65 yrs                 Total
                      --------------------    --------------------    --------------------
State                 Mobility   Self-care    Mobility   Self-care    Mobility   Self-care
------------------------------------------------------------------------------------------
Alabama                 29.8        46.5       212.1       158.5        59.9        65.0
Alaska                  12.8        17.6       129.8        90.5        19.6        21.8
Arizona                 20.4        29.7       130.3        93.4        39.1        40.6
Arkansas                29.0        38.9       191.4       143.3        59.5        58.5
California              21.3        38.0       147.2       115.9        38.2        48.5
Colorado                16.2        22.5       135.5        94.2        31.4        31.6
Connecticut             16.4        28.8       136.7       115.1        36.0        42.9
Delaware                19.9        33.1       144.6       106.5        38.8        44.2
District of Columbia    25.9        58.8       170.2       145.9        47.5        71.8
Florida                 24.0        37.1       133.2       111.8        48.8        54.1
Georgia                 24.5        39.9       198.4       143.5        47.0        53.3
Hawaii                  16.4        31.6       126.3       111.4        33.1        43.7
Idaho                   15.6        17.8       122.8        78.5        32.9        27.6
Illinois                20.8        34.7       154.8       117.7        41.8        47.7
Indiana                 19.9        30.5       152.8       111.9        40.7        43.3
Iowa                    15.7        22.8       127.6       102.6        36.7        37.8
Kansas                  15.6        25.5       131.8        98.5        36.0        38.3
Kentucky                32.6        36.7       207.0       138.8        60.5        53.0
Louisiana               29.9        47.2       197.5       152.6        54.2        62.5
Maine                   19.9        23.7       144.9        98.9        40.6        36.2
Maryland                18.5        36.6       156.5       116.8        37.2        47.4
Massachusetts           19.8        26.9       146.1       112.2        40.3        40.8
Michigan                23.1        33.3       158.5       117.4        43.6        46.0
Minnesota               14.1        20.1       124.5        94.8        31.2        31.6
Mississippi             34.4        52.8       221.5       169.3        65.2        71.9
Missouri                21.9        31.1       160.7       121.6        46.1        46.9
Montana                 16.3        19.8       119.3        78.4        33.8        29.7
Nebraska                14.3        21.3       115.5        85.5        32.2        32.7
Nevada                  18.5        28.7       125.2        96.7        33.0        38.0
New Hampshire           14.7        18.9       130.8        95.1        30.8        29.5
New Jersey              20.3        37.2       148.2       119.1        41.2        50.6
New Mexico              22.5        34.1       149.2       106.6        40.8        44.6
New York                32.6        36.7       207.0       138.8        60.5        53.0
North Carolina          24.2        38.0       186.3       136.9        48.9        53.0
North Dakota            23.6        15.9       104.5        75.4        37.6        26.7
Ohio                    21.9        31.1       160.7       121.6        46.1        46.9
Oklahoma                24.5        31.2       171.9       125.1        49.8        47.3
Oregon                  18.1        22.8       133.3        96.3        38.1        35.6
Pennsylvania            21.9        31.6       152.8       118.9        46.5        48.0
Rhode Island            21.1        30.1       143.1       114.8        43.1        45.4
South Carolina          27.0        47.6       184.3       140.8        50.3        61.5
South Dakota            15.5        20.9       105.2        69.4        32.5        30.1
Tennessee               27.5        34.8       197.1       138.3        54.3        51.2
Texas                   21.3        34.0       171.3       131.0        41.0        46.7
Utah                    13.9        18.9       137.3        92.2        29.6        28.2
Vermont                 14.5        16.0       131.0        82.0        31.3        25.5
Virginia                19.5        30.8       168.6       123.3        39.8        43.4
Washington              17.5        21.9       131.2        94.0        34.6        32.8
West Virginia           35.6        38.5       208.5       143.8        67.8        58.1
Wisconsin               16.9        22.1       124.8        96.9        34.7        34.5
Wyoming                 12.0        16.0       121.3        82.1        27.0        25.1

Overall                 21.9        34.2       156.0       119.2        43.2        47.7
------------------------------------------------------------------------------------------
*Per 1000 persons.

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

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