Chartbook on Disability in New York State, 1998 - 2000
Disability is a major public health problem in the United States. About one in seven Americans has a disabling condition that interferes with his or her life activities. Disabilities are disproportionately represented among minorities, the elderly, and lower socioeconomic populations. In New York State, as in the rest of the nation, the aging of the population and its accompanying burden of disease and disability have profound public health implications for the utilization of medical care and the need for supportive care. In this context, the measurement and surveillance of the indicators of disability are critical to monitoring the impact of this important public health issue.
Disability is usually assessed through self-report of difficulty or need for help in performing basic self-care activities. This profile reports results from the New York State Behavioral Risk Factor Surveillance System (NYS BRFSS) survey for the period 1998 to 2000. During this three-year period, the NYS BRFSS questionnaire, administered by the NYS Department of Health, included a special Disability Module, which permitted assessment of the disability status of the state's noninstitutionalized, civilian adult population through responses to six items on activity limitations and use of special equipment. Three comparison groups were formed based on responses and are used throughout the chartbook: 1) disability requiring assistance in daily activities; 2) disability, but no assistance required; and 3) no disability.
Demographic Characteristics by Disability Status
In comparison to the population who reported no disabilities, those with disabilities were proportionately older, had a lower level of educational attainment, reported lower annual household income, and were less likely to be employed. Additionally, those with a greater degree of disability, i.e., those requiring assistance in daily life activities, were comprised of a higher proportion of females and lower proportion of non-Hispanic whites than either those needing no assistance or those with no disabilities.
Prevalence of Disability
Overall, an estimated 22.5% of adult New Yorkers reported having a disability. Of this total, 5.8% were those requiring assistance in daily activities and 16.7% were those needing no assistance. In general, the prevalence of disability increased with age and decreased with reported levels of educational attainment and household income. Females with disabilities were twice as likely as males with disabilities to report the need for assistance in performing daily activities (7.6% vs. 3.8%, respectively).
Cause of Disability
Of those reporting disabilities, the most frequently identified cause of activity limitation among those aged 18-64 years was back or neck problems. Among those aged 65 years and older, the most frequently identified cause was arthritis or rheumatism.
Health Care Coverage, Access, and Utilization
Among working-age adults (aged 18-64 years), those with disabilities requiring assistance were more likely than the rest of the population to have some form of health care coverage. Coverage for persons with disabilities, however, was more likely to be under a public, government-funded plan. Although working-age adults with disabilities were as least as likely as, if not more likely than, the rest of the population to be insured, they were more likely to report this coverage as being inadequate; that is, they were more likely to report a time during the prior 12 months when they could not afford a needed doctor visit. Persons with disabilities, however, were more likely than those with no disabilities to have had a routine checkup during the previous year. Also, people aged 50 years and older with disabilities requiring assistance were generally more likely to have had recommended screening procedures for colorectal cancer, i.e., a blood stool test in the previous 12 months and a sigmoidoscopy or colonoscopy at some prior time. Moreover, women with disabilities were essentially as likely as the rest of the population to have had a recent (past 3 years) Pap smear and a recent age-appropriate clinical breast exam. Women aged 40-64 years with disabilities were also as likely as those without disabilities to have had a recent (past 12 months) mammogram. The subgroup of women aged 65 years and older and needing assistance, however, were less likely than those with no disabilities to report having had a mammogram in the prior 12 months. Persons with disabilities were as likely as the rest of the population to have had their blood cholesterol checked within the previous 2 years. People under the age of 65 years with disabilities requiring assistance were more likely than the rest of the population to report having gotten a flu shot within the previous 12 months. Moreover, among those aged 45-64 years, persons with disabilities requiring assistance were more likely than the rest of the population to have ever gotten a pneumonia vaccination. With regard to oral health, persons with disabilities were less likely than those with no disabilities to have had a dental visit within the previous 12 months.
In summary, these survey results suggest that, with exceptions among certain subgroups, health care coverage and utilization among the population of persons with disabilities may be generally no worse than that among the rest of the adult population. Compared to those with no disabilities, persons with disabilities were at least as likely to have reported having insurance coverage, getting routine physical checkups, undergoing recommended cancer screenings, and getting recommended vaccinations. Persons with disabilities were, however, more likely to report occasions in which their health coverage was not adequate to meet the costs of needed doctor visits.
Health Status and Quality of Life
Health-related quality-of-life (HRQoL) information on the BRFSS consisted of both subjective ratings of health and perceptions of recent health. The rating items requested that respondents give their perceptions of emotional support, satisfaction with life, and self-rated health. HRQoL questions on recent health elicited information on respondents' estimates of impaired health days during the prior month by asking respondents to estimate the number of days in the past 30 that they had experienced a number of adverse health events.
Compared to those without disabilities, persons with disabilities were less likely to report getting sufficient emotional support and more likely to report being dissatisfied with life. Moreover, persons with disabilities were far more likely to rate their health status as fair or poor than were those with no disabilities. Over half (57.9%) of those requiring assistance reported fair or poor health, compared to only 6.7% of those with no disabilities.
When compared to the population with no disabilities, persons with disabilities were more likely to report more days of impaired health in the previous month on every measure, including poor physical health, poor mental health, activity limitation due to poor physical or mental health, activity-limiting pain, depressed mood, worry or anxiety, and insufficient rest or sleep. Persons with disabilities were also less likely to report days of feeling very healthy and full of energy. On all measures, the number of reported symptom days was directly related to the degree of disability (i.e., requiring no assistance [lesser degree] vs. needing assistance [greater degree]).
Chronic Health Conditions
Persons with disabilities are generally more likely than the rest of the population to be burdened with chronic health conditions. Conversely, chronic health conditions are the most common reason people have a disability. This report summarizes the prevalence of seven chronic health problems by disability status. When compared to those without disabilities, persons with disabilities, especially those needing assistance, were more likely to report arthritis. In addition, persons with disabilities were more likely to report having diabetes, asthma, hypertension, and high blood cholesterol. Persons with disabilities were also more likely to report a history of heart attack and stroke.
Health Risk Factors
Compared to those without disabilities, persons with disabilities under the age of 65 years were more likely to report being current smokers. The difference was especially notable among those aged 18-44 years, as an estimated 45.1% of those requiring assistance were current smokers compared to 26.4% of those with no disabilities. Persons with disabilities were also more likely to be overweight or obese (body mass index [BMI] of 25.0 or greater) than were those with no disabilities. The difference was again most evident in the 18-44 years age group, as 62.6% of those needing assistance reported being overweight or obese compared to 46.0% of those with no disabilities. In an assessment of obesity (BMI ≥ 30.0) alone, persons with disabilities, especially those needing assistance, were more likely than those without disabilities to be obese. In particular, among those aged 45-64 years, 41.4% of those needing assistance were obese compared to 17.0% of those without disabilities. Recent leisure-time exercise or physical activity also varied by disability status, as those needing assistance were more likely than the rest of the population to report getting no exercise in the previous month, regardless of age. There were essentially no differences by disability status, however, in the daily consumption of five or more servings of fruits and vegetables.