Current Trends Prevalence of Disabilities and Associated Health Conditions -- United States, 1991-1992

An estimated 35-49 million persons in the United States have a disability (1); estimated direct and indirect annual costs related to disability (including medical expenses and lost workdays) total $170 billion (2). Because definitions of disability used in previous analyses generally contained limited measures of disability, the prevalence of disability in the United States may have been underestimated. The Survey of Income and Program Participation (SIPP), a subsample of the 1990 U.S. census, collected comprehensive data about disability using several measures. The U.S. Bureau of the Census and CDC analyzed data from SIPP to provide more precise prevalence estimates of disability and health conditions associated with disability in the United States during 1991-1992. This report summarizes the findings from that analysis.

From October 1991 through January 1992, SIPP collected information about disability during personal household interviews of a representative sample (n=97,133 persons in 34,100 households) of the U.S. civilian, noninstitutionalized population. Only data for persons aged greater than or equal to 15 years are presented in this analysis. The measures of disability used in SIPP were derived from D- and I-codes in the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (1). Disability was assessed using five measures: 1) ability to perform functional activities * (ICIDH D-codes 21, 23, 26, 40-45, and 48), 2) activities of daily living (ADLs) ** (ICIDH D-codes 30, 33, 35, 36, 37-39, and 46), or 3) instrumental activities of daily living (IADLs) *** (ICIDH D-codes 50, 51, 60, and 61), 4) presence of selected impairments **** (ICIDH D-codes 15 and 16 and I-codes 14- 18), and 5) use of assistive aids (e.g., wheelchair or cane). Participants were asked whether they had "difficulty" performing functional activities, ADLs, and IADLs; whether they had selected impairments; and whether they used assistive aids for 6 months or longer. In addition, participants who had difficulty with activities other than seeing, hearing, and having their speech understood by others were asked to select up to three conditions (from a list of 30) that they believed caused limitation or difficulty with a functional activity, ADL, or IADL. Data were weighted to calculate national estimates.

Based on SIPP, during 1991-1992, of the 195.7 million persons in the United States aged greater than or equal to 15 years, 34.2 million (17.5%) had difficulty performing one or more functional activities (Table_1, page 737); most persons had difficulty climbing one flight of stairs (17.5 million {8.9%}) or walking one quarter mile (17.3 million {8.9%} persons). A total of 7.9 million (4.0%) persons had difficulty performing one or more ADLs, and 11.7 million (6.0%) persons had difficulty performing one or more IADLs. Use of a wheelchair for 6 months or longer was reported by 1.5 million ( less than 1%) persons. Of the persons who did not use a wheelchair, 4.0 million (2.0%) persons had used a cane, crutches, or a walker for 6 months or longer.

For all five measures of disability, the age-specific prevalence of disability was higher for persons aged greater than or equal to 65 years than persons aged less than 65 years Table_1, page 737). The prevalence of disability among men and women was 18.7% and 20.2%, respectively.

Overall, 42.0 million (21%) persons reported one or more conditions they believed to be associated with their disability Table_2, page 738). The most commonly reported condition was arthritis or rheumatism (7.2 million {17.1%}), followed by back or spine problems (5.7 million {13.5%}), and heart trouble (including coronary heart disease and arteriosclerosis) (4.6 million {11.1%}). Reported by: JM McNeil, Bur of the Census, Economics and Statistics Administration, US Dept of Commerce. Statistics and Epidemiology Br, Div of Surveillance and Epidemiology, Epidemiology Program Office; Disabilities Prevention Program, Office of the Director, National Center for Environmental Health, CDC.

Editorial Note

Editorial Note: The prevalence estimates of disability in this report indicate that nearly one fifth (19.4%) of the U.S. population aged greater than or equal to 15 years has a disability. Prevalence estimates of disability derived from SIPP are based on broader measures of disability than previously used for estimates derived from the 1992 Current Population Survey (3), the 1990 census (4), and the National Health Interview Surveys (5,6). This broader definition -- which included an assessment of limitations in functional activities, ADLs, IADLs, and selected impairments -- provided a more comprehensive assessment of the scope, extent, and epidemiology of disability in the United States.

Definitions used for surveillance and assessment of disability are more clearly understood by linking them to a conceptual framework of consequences of disease and injury, such as the ICIDH (7). In the ICIDH, three concepts define the consequences of disease and injury: 1) impairment (i.e., the loss of psychological, physiological, or anatomical structure or function), 2) disability (i.e., the limitation in functional performance resulting from an impairment), and 3) handicap (i.e., the disadvantage experienced by a person as a result of impairments and/or disabilities, which limits interaction of the person with the physical and social environment).

Despite the usefulness of the estimates based on SIPP, the findings in this report are subject to limitations that may underestimate the public health impact of disability in the United States. For example, SIPP failed to collect data about the effects of physical and social barriers (e.g., within the home, community, school, or workplace) and ex-periences with discrimination. Recent efforts underscore the importance of clarifying the role of environment in determining the consequences of an impairment or disability (8). Therefore, efforts to provide more precise national estimates of disability should include development of measures that address environmental factors (i.e., physical and social barriers) and the effects of discrimination. Revision of the ICIDH is under way and should improve collection of valid and reliable survey information about physical and social barriers (8,9).

References

1. McNeil JM. Americans with disabilities, 1991-1992. Washington, DC: US Department of Commerce, Bureau of the Census, 1993. (Current population reports; series P70, no. 33).

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

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

5. CDC. Prevalence of mobility and self-care disability -- United States, 1990. MMWR 1993;42: 760-1,767-8.

6. LaPlante MP. Data on disability from the National Health Interview Survey, 1983-1985. Washington, DC: Department of Education, National Institute on Disability and Rehabilitation Research, 1988.

7. LaPlante MP, Hendershot GE, Moss AJ. Assistive technology devices and home accessibility features: prevalence, payment, need, and trends. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1992. (Advance data no. 217).

8. World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva: World Health Organization, 1993.

9. Badley EM. An introduction to the concepts and classifications of the International Classification of Impairments, Disabilities, and Handicaps. Disabil Rehabil 1993;15:161-78.

10. Fougeyrollas P. Documenting environmental factors as determining variables in the performance of day-to-day activities and the fulfillment of social roles by persons with impairments and functional limitations. ICIDH International Network 1993;5:8-13.

* Functional activities: ability to 1) "see words and letters in ordinary newspaper print," 2) "hear normal conversations," 3) "have speech understood by others," 4) "lift and carry up to 10 pounds (e.g., a full bag of groceries)," 5) "climb a flight of stairs without resting," and 6) "walk one quarter mile." 

** ADLs: ability to 1) "get around inside the home"; 2) "get in and out of bed or a chair"; and 3) take a bath or shower, dress, and eat; and 4) get to and use the toilet. 

*** IADLs: ability to 1) "get around outside the home," 2) "keep track of money and bills," 3) "prepare meals," 4) "do light housework," and 5) "use the telephone." 

**** Learning disabilities; mental retardation; other developmental disabilities; and Alzheimer disease, senility, dementia, and other mental or emotional conditions.

Table_1
Note: To print large tables and graphs users may have to change their printer settings to landscape and use a small font size.

TABLE 1. Number * and percentage of persons who had "difficulty" performing functional
activities, activities of daily living, or instrumental activities of daily living or
who reported use of assistive aids for 6 months or longer, by age group - Survey of
Income and Program Participation, United States, 1991-1992
=======================================================================================
                                  >=15 years           15-64 years         >=65 years
                              ------------------   -----------------   ----------------
Measure of disability           No.        (%)        No.      (%)       No.     (%)
---------------------------------------------------------------------------------------
Total surveyed                195,729    (100.0)   165,040   (100.0)   30,688  (100.0)

Functional activities
  Seeing words and letters
    in ordinary newspaper
    print                       9,685    (  5.0)     4,801   (  2.9)    4,884  ( 15.9)
  Hearing normal conversations 10,928    (  5.6)     5,522   (  3.4)    5,406  ( 14.5)
  Having speech understood
    by others                   2,284    (  1.2)     1,517   (  0.9)      767  (  2.5)
  Lifting and carrying
    up to 10 lbs               16,205    (  8.3)     7,827   (  4.7)    8,378  ( 27.3)
  Climbing one flight
    of stairs without resting  17,469    (  8.9)     8,068   (  4.9)    9,400  ( 30.6)
  Walking one quarter mile     17,319    (  8.9)     7,937   (  4.8)    9,381  ( 30.6)

Activities of daily living
  Getting around inside home    3,664    (  1.9)     1,307   (  0.8)    2,357  (  7.7)
  Getting in and out
    of bed or a chair           5,280    (  2.7)     2,374   (  1.4)    2,905  (  9.5)
  Taking a bath or shower       4,501    (  2.3)     1,592   (  1.0)    2,909  (  9.5)
  Getting dressed               3,234    (  1.7)     1,327   (  0.8)    1,907  (  6.2)
  Eating                        1,077    (  0.6)       431   (  0.3)      646  (  2.1)
  Getting to or using
    the toilet                  2,084    (  1.1)       726   (  0.4)    1,358  (  4.4)

Instrumental activities
  of daily living
  Getting around
    outside the home            7,809    (  4.0)     2,885   (  1.8)    4,924  ( 16.0)
  Keeping track of money
    and bills                   3,901    (  2.0)     1,597   (  1.0)    2,303  (  7.5)
  Preparing meals               4,530    (  2.3)     1,680   (  1.0)    2,850  (  9.3)
  Doing light housework         6,313    (  3.2)     2,565   (  1.6)    3,747  ( 12.2)
  Using the telephone           3,130    (  1.6)     1,140   (  0.7)    1,990  (  6.5)


Use of assistive aids for
  6 months or longer
  Wheelchair               1,494    (  0.8)       529   (  0.3)      965  (  3.1)
  Cane, crutches,
    or walker              3,962    (  2.0)     1,115   (  0.7)    2,847  (  9.3)
---------------------------------------------------------------------------------------
* In thousands.
=======================================================================================

TABLE 2. Number * and percentage of persons aged >=15 years reporting selected
conditions + as the cause of their disability -- Survey of Income and Program
Participation, United States, 1991-1992
===============================================================================
Condition                                          No.     (%)
-------------------------------------------------------------------------------
Alcohol- or drug-related problem or disorder       300   (  0.7)
AIDS or AIDS-related condition                     105   (  0.3)
Arthritis or rheumatism                          7,184   ( 17.1)
Back or spine problems (including
  chronic stiffness or deformity
  of the back or spine)                          5,679   ( 13.5)
Blindness or other visual impairment
  (difficulty seeing well enough
  to read a newspaper, even with glasses)        1,481   (  3.5)
Broken bone/fracture                               830   (  2.0)
Cancer                                             896   (  2.1)
Cerebral palsy                                     182   (  0.4)
Deafness or serious trouble hearing              1,099   (  2.6)
Diabetes                                         1,619   (  3.9)
Epilepsy                                           259   (  0.6)
Head or spinal cord injury                         592   (  1.4)
Heart trouble (including coronary
  arteriosclerosis)                              4,649   ( 11.1)
Hernia or rupture                                  413   (  1.0)
High blood pressure (hypertension)               2,161   (  5.1)
Kidney stones or chronic kidney trouble            400   (  1.0)
Learning disability                                235   (  0.6)
Lung or respiratory trouble (asthma,
  bronchitis, emphysema, respiratory
  allergies, tuberculosis, or other
  lung trouble)                                  2,840   (  6.8)
Mental or emotional problem or
  disorder                                         784   (  1.9)
Mental retardation                                 501   (  1.2)
Missing legs, feet, arms, hands,
  or fingers                                       302   (  0.7)
Paralysis of any kind                              716   (  1.7)
Senility/Dementia/Alzheimer's                      381   (  0.9)
Speech disorder                                    151   (  0.4)
Stiffness or deformity of the foot,
  leg, arm, or hand                              2,024   (  4.8)
Stomach trouble (including ulcers,
  gall bladder, or liver conditions)               537   (  1.3)
Stroke                                           1,047   (  2.5)
Thyroid trouble or goiter                          139   (  0.3)
Tumor, cyst, or growth                             176   (  0.4)
Other                                            4,287   ( 10.2)

Total                                           41,969   (100.0)
-------------------------------------------------------------------------------
* In thousands.
+ Participants who had difficulty with activities other than seeing,
  hearing, and having their speech understood by others were asked
  to select up to three conditions.
===============================================================================

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