Disability Statistics at NCHS:
An Update
Julie D. Weeks, Ph.D.
National Center for Health Statistics
Annual Compendium of Disability Statistics Release
Capitol Visitor Center, Washington, DC
November 2, 2011
A number of ongoing disabilityrelated activities…
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ACA Section 4302 meetings
Health, U.S. content
Healthy People 2020 work groups
Washington Group on Disability Statistics
National Health Interview Survey content
Future directions for measurement and research
ACA Section 4302
2010 Patient Protection and Affordable Care Act:
Mandates the collection of data on disability status
Requires a standard disability measure
Acknowledges disability as a demographic
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ACA Disability Subcommittee:
NCHS member
Recommended the 6-question ACS measure as the minimum
standard
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Current status:
DHHS solicited public comments on draft standards
10/31/2011: Secretary announced final standards
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Health, U.S. and Healthy People
Health, U.S.:
• Historically, used “limitation of activity due to a chronic condition”
• In 2009, moved to Basic Actions Difficulties and Complex Activity
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Limitation (disability measures consistent with current disability models
and legislation)
Disability used as a demographic in 20+ tables (pain, SRH, alcohol use,
no usual source of care, health care visits, insurance, etc.)
HP Change in Operational Definition:
Include in the core of all applicable Healthy People 2020 population data
systems a standardized set of questions that identify “people with
disabilities.”
Adopted ACS as the standard measure of disability for 2020 work
HP Objectives tables have disability as a demographic
Where possible ACS set used
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Washington Group: Purpose
Purpose: The promotion and coordination of international cooperation in the area
of health statistics by focusing on disability measures suitable for censuses and
national surveys which will provide basic necessary disability information
throughout the world.
Measures must be developed within the framework of a model, culturally
comparable, and accepted for use across many countries.
Short Set Measure (6 questions):
• Adopted in 2006 (Uganda meeting)
• Approx 20 countries planning to/using the SS in census
Extended Set Measure (additional functional domains):
• Adopted in 2010 (Luxembourg meeting)
• Added to 2010 NHIS
Possible Domains and Activities
Mobility
Walking
Climbing stairs
Bending or stooping
Reaching or lifting
Using hands
Sensory
Seeing
Hearing
Communicating
Understanding
Speaking
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Cognitive functions
Learning
Remembering
Making decisions
Concentrating
Emotional functioning
Interpersonal interactions
Psychological well-being
Other
Affect
Pain
Fatigue
Self care
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WG Disability Short Set
1-5. How much difficulty do you have:
seeing even if wearing glasses?
hearing even if using a hearing aid?
remembering or concentrating?
walking or climbing stairs?
with self-care, such as washing all over or dressing?
6. Because of a physical, mental or health condition, how much
difficulty do you have communicating, for example understanding
or being understood by others?
a) No, no difficulty
b) Yes – some difficulty
c) Yes – a lot of difficulty
d) Cannot do at all
National Health Interview Survey
Disability Content
Basic Actions Difficulties
Movement
Sensory
Emotional
Cognitive
Complex Activity Limitations
Social and leisure
activities
Perceived ability to
work
Maintaining
independence, including
self care and HH chores
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American Community Survey Set
Washington Group Short Set
Washington Group Extended Set
Upper body movement
Learning
Affect (anxiety & depression)
Pain
Fatigue
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Participation & QOL Measures
Location of NHIS Disability
Questions: ACS and WG
2008 (4th quarter) -2009
FDB: ACS questions – ½ sample “person” and ½ “family” style
2010
FDB: ACS questions – “person” style
QOL: WG questions, plus some quality of life / participation
measures
2011
FDB: ACS questions – “person” style
CDB: ACS questions
ADB: ACS questions
AFD: WG questions, plus some quality of life / participation
measures
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What Are We Learning About
Disability Questions from the NHIS?
2008 (4th quarter) -2009
FDB: ACS questions – ½ sample “person” and ½ “family” style
Do disability estimates vary by administration style? How?
Do NHIS estimates vary from the ACS and CPS? How?
2010
FDB: ACS questions – “person” style
QOL: WG questions, plus some quality of life / participation measures
Do different question sets yield varying estimates of disability? How?
How does participation vary by disability status?
2011
FDB: ACS questions – “person” style
CDB and ADB: ACS questions
AFD: WG questions , plus some quality of life / participation measures
How do disability estimates vary when asked in the family section vs. the sample
adult/child sections?
How do extended questions on disability operate in a national survey?
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Prevalence of Disability by Survey: 2009
NHIS
Ages
CPS
ASEC†
(%)
FamilyStyle
(%)
PersonStyle
(%)
ACS
(%)
Vision difficulty
1+
1.7
2.1
2.4
2.2
Hearing difficulty
1+
3.1
3.9
4.1
3.4
Mobility difficulty
5+
6.9
6.6
7.2
6.9
Cognitive difficulty
5+
3.5
3.9
4.7
4.8
Self-care difficulty
5+
2.0
1.8
2.2
2.6
Independent living diff
15+
4.0
4.7
5.1
5.4
Any disability
1+
11.6
12.0
13.1
12.1
Disability Item
†NOTE:
CPS data are for population 16 years and over.
Prevalence of Any Disability
by Survey and Employment Status*: 2009
30%
24.5
25%
22.1
20.3
20%
16.5
15%
10%
5%
3.4
4.7
5.7
5.0
0%
Employed
Not employed
* CPS and ACS cover persons 16-64; NHIS covers persons 18-64.
CPS ASEC
NHIS, FS
NHIS, PS
ACS
Where Does the ACS Fit In?
Basic Action Measures
31.7%
Source: NCHS, 2010 NHIS, ages 18+
Where Does the ACS Fit In?
Basic Action Measures
31.7%
Complex
Activity
Limitation
15.3%
10.8% Non-Overlap
Source: NCHS, 2010 NHIS, ages 18+
Where Does the ACS Fit In?
ACS Questions
19.7%
Basic Action Measures
31.7%
Complex
Activity
Limitation
15.3%
9.0% Non-Overlap
10.8% Non-Overlap
Source: NCHS, 2010 NHIS, ages 18+
Relationship of ACS to Basic Action
and Complex Activity Measures
100
90
Movement Difficulty
Seeing
Hearing
Emotional Difficulty
Cognitive Difficulty
Self Care
Social
Work
80
70
60
50
40
30
20
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10
0
ACS Questions
Source: NCHS, 2010 NHIS Sample Adult File, Ages 18+
Next Steps in Disability Measurement
• Incorporating disability measures in more national surveys.
• Which standard should be adopted – ACS or WG?
• Adding other functioning domains that are not currently
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included, for example learning and mental health.
Development of measures of participation (other than work).
Development of measures of the environment.
Conduct longitudinal surveys.
Conduct disability supplements on single-policy issues.
Washington Group/Budapest Initiative/UNESCAP Activities and Workplan
Basic Activity Domains
Questionnaire
Topic/Type
Row
Communi- Cognition/
Vision (1) Hearing (1) Mobility
cation remembering
Capacity
Short Set
Single Questions (1)
Extended Set
Multiple Questions (1)
Performance
Use of Assistive Devices
Micro-E (2)
5
Age at Onset
6
Cause
7
Duration
8
Impact
9
Meso-Environment
(3)
10
Macro-Environment
(4)
Complex Activity Domains
Upper
Body
Learning/
understanding
d
a
c
Affect
Pain
Fatigue
ADL/
IADL
Getting
Life
Participation
Along with
Activities in Society
People
d
c
c
c
b
Functioning with
Assistance, Micro-E (2)
ICF Chapter Reference Activities/Participation
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ICF-7
ICF-8
ICF-9
To be obtained through other sources, not personal survey data collections
ICF-1
ICF-1
ICF-4
ICF-3
ICF-1,2
ICF-4
ICF-1
ICF-2
(5) See Note below
ICF-5,6
Thank you!
Questions?
The ACS Disability Measures
For sample persons 1 year of age and older:
1. Is this person deaf or does he/she have serious difficulty hearing?
2. Is this person blind or does he/she have serious difficulty seeing?
For sample persons 5 years of age and older:
3. Because of a physical, mental, or emotional condition, does this person have
serious difficulty concentrating, remembering or making decisions?
4. Does this person have serious difficulty walking or climbing stairs?
5. Does this person have difficulty dressing or bathing?
For sample persons 15 years of age and older:
6. Because of a physical, mental, or emotional condition, does this person have
difficulty doing errands alone such as visiting a doctor’s office or shopping?
Response Categories:
1. Yes
2. No
Equalization of Opportunities
Disability used as a
demographic.
Employed (%)
90
Proportion (%)
Seeks to identify all
those at greater risk than
the general population
for limitations in
participation.
60
30
0
Nondisabled
Disabled