Functioning and Disability
Household Pulse Survey
To rapidly monitor recent changes in health status and health care, the National Center for Health Statistics (NCHS) partnered with the Census Bureau on an experimental data system called the Household Pulse Survey. This 20-minute online survey was designed to complement the ability of the federal statistical system to rapidly respond and provide relevant information about the impact of the coronavirus pandemic in the U.S. Data collection began on April 23, 2020.
Beginning in Phase 3.1, NCHS included four of the six questions on functioning and disability from the Washington Group on Disability Statistics Short Set on Functioning (WG-SS). These questions covered four domains: vision, hearing, cognition, and mobility. Beginning in Phase 3.5, NCHS included the remaining two questions on functioning and disability covering the domains of self-care and communication.
Estimates on this page are derived from the Household Pulse Survey and show the percentage of adults aged 18 and over who experienced select health outcomes by disability status. Disability status is based on the level of difficulty in seeing, hearing, cognition, mobility, self-care, and communication, and it is defined as having a lot of difficulty or being unable to do any of the six domains of functioning. See the technical notes for more information on these measures.
Use the drop-down menus to show data for selected indicators or groups. Select the buttons at the bottom of the dashboard to view bar chart and data table. The data table may be scrolled horizontally and vertically to view additional estimates.
Adapted Washington Group Short Set on Functioning and Disability:
Seeing – Do you have difficulty seeing, even when wearing glasses? Response options: no – no difficulty, yes – some difficulty, yes – a lot of difficulty, or cannot do at all. Select only one answer.
Hearing – Do you have difficulty hearing, even when using a hearing aid? Response options: no – no difficulty, yes – some difficulty, yes – a lot of difficulty, or cannot do at all. Select only one answer.
Cognition – Do you have difficulty remembering or concentrating? Response options: no – no difficulty, yes – some difficulty, yes – a lot of difficulty, or cannot do at all. Select only one answer.
Mobility – Do you have difficulty walking or climbing stairs? Response options: no – no difficulty, yes – some difficulty, yes – a lot of difficulty, or cannot do at all. Select only one answer.
Self-Care – Do you have difficulty with self-care, such as washing all over or dressing? Response options: no – no difficulty, yes – some difficulty, yes – a lot of difficulty, or cannot do at all. Select only one answer.
Communication – Using your usual language, do you have difficulty communicating, for example understanding or being understood? Response options: no – no difficulty, yes – some difficulty, yes – a lot of difficulty, or cannot do at all. Select only one answer.
Disability – Adults reporting “a lot of difficulty” or “cannot do at all” to at least one of the six selected domains of functioning (seeing, hearing, cognition, mobility, self-care, and communication) are considered to have disability.
Adapted PHQ-2 questions (symptoms of a depressive disorder):
Over the last 7 days, how often have you been bothered by … having little interest or pleasure in doing things? Would you say not at all, several days, more than half the days, or nearly every day? Select only one answer.
Over the last 7 days, how often have you been bothered by … feeling down, depressed, or hopeless? Would you say not at all, several days, more than half the days, or nearly every day? Select only one answer.
Adapted GAD-2 questions (symptoms of an anxiety disorder):
Over the last 7 days, how often have you been bothered by the following problems … Feeling nervous, anxious, or on edge? Would you say not at all, several days, more than half the days, or nearly every day? Select only one answer.
Over the last 7 days, how often have you been bothered by the following problems … Not being able to stop or control worrying? Would you say not at all, several days, more than half the days, or nearly every day? Select only one answer.
Mental health care:
At any time in the last 4 weeks, did you take prescription medication to help you with any emotions or with your concentration, behavior, or mental health?
At any time in the last 4 weeks, did you receive counseling or therapy from a mental health professional such as a psychiatrist, psychologist, psychiatric nurse, or clinical social worker? Include counseling or therapy online or by phone.
At any time in the last 4 weeks, did you need counseling or therapy from a mental health professional, but did not get it for any reason?
These questions were removed from the Household Pulse Survey starting in Phase 3.5.
Unmet medical care need:
At any time in the last 4 weeks, did you need medical care for something other than coronavirus, but did not get it because of the coronavirus pandemic?
This question was removed from the Household Pulse Survey starting in Phase 3.2.
Adult Telemedicine Use:
At any time in the last 4 weeks, did you have an appointment with a doctor, nurse, or other health professional by video or by phone? Please only include appointments for yourself and not others in your household.
Health Insurance Coverage:
Respondents were asked, “Are you currently covered by any of the following types of health insurance or health coverage plans?” They were then provided with a list of 8 possible sources of health care coverage and asked to mark yes or no to each. The list consisted of:
- Insurance through a current or former employer or union (through yourself or another family member)
- Insurance purchased directly from an insurance company, including marketplace coverage (through yourself or another family member)
- Medicare, for people 65 and older, or people with certain disabilities
- Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability
- TRICARE or other military health care
- VA (including those who have ever used or enrolled for VA health care)
- Indian Health Service
Health insurance coverage is categorized into three categories: private, public, and uninsured. The private and public categories are not mutually exclusive. Adults can be enrolled in both. Estimates on this page are based on responses from adults aged 18-64 years.
Private health insurance coverage includes adults with a) insurance through a current or former employer or union; b) insurance purchased directly from an insurance company, including marketplace coverage; or c) TRICARE or other military health care.
Public health plan coverage includes adults with a) Medicare; b) Medicaid; or c) VA health care.
Adults were classified as uninsured if they did not report any private health insurance coverage or public health plan coverage at the time of interview. Adults were also classified as uninsured if they had only Indian Health Service coverage.
Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or laboratory test) or been told by a doctor or other health care provider that you have or had COVID-19?
Answer Choices: yes, no
How would you describe your coronavirus symptoms when they were at their worst?
Answer choices: I had no symptoms, I had mild symptoms, I had moderate symptoms, I had severe symptoms.
Did you have any symptoms lasting 3 months or longer that you did not have prior to having coronavirus or COVID-19?
Long term symptoms may include: Tiredness or fatigue, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as “brain fog”), difficulty breathing or shortness of breath, joint or muscle pain, fast-beating or pounding heart (also known as heart palpitations), chest pain, dizziness on standing, menstrual changes, changes to taste/smell, or inability to exercise.
Answer choices: yes, no
Do you have symptoms now?
Answer choices: yes, no
The U.S. Census Bureau, in collaboration with five federal agencies, launched the Household Pulse Survey to produce data on the social and economic impacts of Covid-19 on American households. The Household Pulse Survey was designed to gauge the impact of the pandemic on employment status, consumer spending, food security, housing, education disruptions, and dimensions of physical and mental wellness.
The survey was designed to meet the goal of accurate and timely weekly estimates. It was conducted by an internet questionnaire, with invitations to participate sent by email and text message. The sample frame is the Census Bureau Master Address File Data. Housing units linked to one or more email addresses or cell phone numbers were randomly selected to participate, and one respondent from each housing unit was selected to respond for him or herself. Estimates are weighted to adjust for nonresponse and to match Census Bureau estimates of the population by age, sex, race and ethnicity, and educational attainment. All estimates shown meet the NCHS Data Presentation Standards for Proportions.
The Household Pulse Survey is different from other surveys. NCHS, the Census Bureau, and other federal statistical agencies are considered the preeminent source of the nation’s most important benchmark surveys. Many of these surveys have been in production for decades and provide valuable insight on health, social, and economic trends. However, the production of benchmark data requires a relatively long lead time, and personal interviews (face-to-face or telephone) require additional time. While efforts are underway to introduce COVID-19 questions into these surveys, that process can take months, sometimes years, before data are made available.
The Household Pulse Survey is different: It was designed to go into the field quickly, to be administered via the web, and to disseminate data in near real-time, providing data users with information they can use now to help ease the burden on American households and expedite post-pandemic recovery. The Census Bureau is fielding the Household Pulse Survey as a demonstration project, with data released as part of its Experimental Statistical Products Series.
Confidence intervals included in the tables on this page only reflect the potential for sampling error. Nonsampling errors can also occur and are more likely for surveys that are implemented quickly, achieve low response rates, and rely on online response. Nonsampling errors for the Household Pulse Survey may include:
- Measurement error: The respondent provides incorrect information, or an unclear survey question is misunderstood by the respondent. The Household Pulse Survey schedule offered only limited time for testing questions.
- Coverage error: Individuals who otherwise would have been included in the survey frame were missed. The Household Pulse Survey only recruited households for which an email address or cell phone number could be identified.
- Nonresponse error: Responses are not collected from all those in the sample or the respondent is unwilling to provide information. The response rate for the Household Pulse Survey was substantially lower than most federally sponsored surveys.
- Processing error: Forms may be lost, data may be incorrectly keyed, coded, or recoded. The real-time dissemination of the Household Pulse Survey provided limited time to identify and fix processing errors.
For more information on nonresponse bias for the Household Pulse Survey, please visit https://www2.census.gov/programs-surveys/demo/technical-documentation/hhp/2020_HPS_NR_Bias_Report-final.pdf.
For more information on the Household Pulse Survey, please visit https://www.census.gov/householdpulsedata