Chartbook on Disability in New York State, 1998 - 2000
Disability is a major public health problem in the United States, resulting in reductions in quality of life and increasing dependence on the health-care system by the nation’s population. About one in seven Americans has a disabling condition that interferes with his or her life activities. Nearly one in four persons with disabilities have functional limitations so severe that they cannot work, attend school, or maintain a household.1 Disabilities are disproportionately represented among minorities, the elderly, and lower socioeconomic populations.1 As the number of people who survive life-threatening conditions increases, and as the population continues to age, quality of life issues associated with disability become of greater public health concern. In the mid-1980s, there were about 28 million people in the United States aged 65 years and older. The U.S. Bureau of the Census has predicted about twice as many, 59 million, by the year 2025.2
In New York State (NYS), 2000 Census figures show nearly 2.4 million residents to be aged 65 years and older. By the year 2025, this total is projected to increase by nearly one-third to over 3.2 million. This growth in the numbers of elderly people, as well as in the proportion of the population they comprise, is due to both declines in fertility rates and increased life expectancy. The aging of the state’s population and its accompanying burden of disease and disability have profound public health implications for the utilization of medical care, and for the need for supportive and long-term 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.
The growing recognition of the impact of disability and associated secondary conditions on public health is evidenced in Healthy People 2010,3 a set of health objectives for the nation to achieve over the first decade of the 21st century. A separate chapter establishes health objectives specifically for persons with disabilities, with the goal of promoting health, preventing secondary conditions, and eliminating disparities in health status between people with and without disabilities in the U. S. population.
Assessment of Disability
Disability is usually assessed through self-report of difficulty or need for help in performing basic self-care activities. A measurable aspect of the prevalence of disability in a given population is that of limitation in activity caused by chronic health conditions, injuries, and impairments. The primary source for state-level prevalence estimates has been the Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey limited to the noninstitutionalized, civilian adult (aged 18 years and older) population. The system monitors modifiable risk behaviors and other factors contributing to the leading causes of morbidity and mortality in the population.
The definition of "disability" for the purposes of this chartbook relied on responses to four items that were part of the New York BRFSS Disability Module in 1998, 1999, and 2000:
- "Are you limited in the kind or amount of work you can do because of any impairment or health problem?"
- "Because of any impairment or health problem, do you have any trouble learning, remembering, or concentrating?"
- "If you use special equipment or help from others to get around, what type do you use?"
- "Are you limited in any way in any activities because of any impairment or health problem?"
A negative response to all four items assigned the respondent to the group of persons with no disabilities (No Disability). An affirmative response to at least one of these four items identified the respondent as a person with a disability, and follow-up questions were asked to further assess the respondent’s limitation status:
- "Because of any impairment or health problem, do you need the help of other persons with your personal care needs, such as eating, bathing, dressing, or getting around the house?"
- "Because of any impairment or health problem, do you need the help of other persons in handling your routine needs, such as everyday household chores, doing necessary business, shopping, or getting around for other purposes?"
An affirmative response to either or both of these items classified the respondent as a person with a greater degree of disability (Disability/Help), whereas a negative response to both questions identified the respondent as having a lesser degree of disability (Disability/No Help). These three categories of disability status (Disability/Help, Disability/No Help, No Disability) serve as the comparison groups throughout this chartbook. [See Appendix A for more detail on methods.]