Here is an electronic text version of the Disability Chartbook, published in 1996 by InfoUse (http://www.infouse.com/disabilitydata), with funding from the National Institute on Disability and Rehabilitation Research. As authoritative as possible, it provides answers to common empirical questions about disability in the United States. Jamal Mazrui National Council on Disability Email: 74444.1076@compuserve.com ---------- Chartbook on Disability in the United States, 1996 Prepared by: Lewis E. Kraus Susan Stoddard, Ph.D. David Gilmartin InfoUse 2560 Ninth Avenue, Suite 216 Berkeley, CA 94710 (510) 549-6520 Email: disabilitydata@infouse.com Prepared for: U.S. Department of Education # H133D50017 National Institute on Disability and Rehabilitation Research Washington, DC Suggested Citation Kraus, Lewis E., Stoddard, Susan, and Gilmartin, David (1996). Chartbook on Disability in the United States, 1996. An InfoUse Report. Washington, DC: U.S. National Institute on Disability and Rehabilitation Research. Foreword Our statutory charge at the National Institute on Disability and Rehabilitation Research (NIDRR) is to support research in order to maximize the self-sufficiency of individuals with disabilities of all ages. NIDRR has a leadership role in improving federal disability data, and in making the data more available. Demographic data and statistical information on disability contribute to the understanding of the scope of disability issues in the United States, developing disability policy, and planning, conducting, and evaluating services for individuals with disabilities. But the variety of statutory authorities for the collection of public data sets, and an inconsistently applied definition of disability have resulted in fragmented, incomplete, and inconsistent data sets about individuals with disabilities. Legislators, policymakers, service providers, the press, manufacturers, retailers, and advocates require information on the incidence and prevalence of disability conditions, the distribution of disability conditions among the population, and the characteristics of individuals with disabilities. To address the need for better use of disability statistics, NIDRR has identified the need for presentation of data in meaningful, understandable, and accessible formats usable by persons with a range of educational levels and technical skills, sensory disabilities, languages, and cognitive disabilities. This Chartbook on Disability in the United States, 1996, a product of NIDRR's new Center on Improving Access to Disability Data at InfoUse, is designed to provide current data in answer to many frequently asked questions about disability. The Chartbook is also available in print from InfoUse. Katherine D. Seelman, Ph.D., Director National Institute on Disability and Rehabilitation Research Preface The Chartbook on Disability in the United States, 1996, is a reference on disability in the U.S. population. We have created it for use by nontechnical and technical audiences alike. The book is a resource for agencies, organizations, employers, researchers, and others needing to know about those people in the population who have a disability. Each page contains a topic question, explanatory text on the topic, and an explanatory graphic (or table) that provides data in an easy-to-read form. The source of the information and the survey used to collect the data appear at the bottom of the page. The surveys have a technical summary located in the appendix. In the text, key terms are shown in boldface and are defined in the glossary at the end of the book. Graphic: Display of sample page with key features noted. Contents Foreword i Preface iii Contents iv Introduction 1 SECTION 1 - Prevalence of Disabilities 3 How many people have a disability? 4 How many people are severely limited in physical functions? 6 How many people need assistance in daily activities? 7 How many people have mental retardation? 8 How many people have a mental disorder? 9 SECTION 2 - Characteristics of People With Disabilities 11 Where do people with activity limitations live? 12 How many people use assistive technology devices? 13 How many people use home accessibility features? 14 How do activity limitations differ by age? 15 How do the levels of disabilities change with age? 16 How does activity limitation differ for males and females? 17 How do disability rates differ for males and females? 18 How does disability differ for races and ethnicities? 19 How does the need for assistance differ by race and ethnicity? 20 How do activity limitations differ by family income? 21 How do functional limitations differ by income? 22 How do activity limitations differ by educational level? 23 How does the need for assistance differ by educational level? 24 SECTION 3 - Causes and Medical Cost of Disabilities 25 Which chronic health conditions cause activity limitation most often? 26 In a year, which conditions causing activity limitations are reported most often? 27 How much do people with disabilities spend for medical care? 28 SECTION 4 - Disability, the Elderly, Children and Youth 29 How many elderly persons have disabilities? 30 How many older people need assistance with activities of daily living? 31 How many children have limitations in activity? 32 What are the differences in race and income for children with limitations? 33 How many children and youth receive special education? 34 Where do children and youth receive special education? 35 SECTION 5 - Work and Disabilities 37 How many people are considered to be work disabled? 38 How many disabled persons are in the labor force? 39 How many work disabled persons are working full-time? 40 How has the number of disabled people in the labor force changed over time? 41 How do the states differ in numbers of people with a work disability? 42 How many persons have a severe work disability? 43 How many people are limited or unable to work because of a health condition? 44 What chronic health conditions are the most frequent causes of work limitation? 45 How do occupational injuries and illnesses affect work disability? 46 What are the earnings of someone with a work disability? 47 How many people does the Vocational Rehabilitation system help? 48 Glossary 49 Bibliography 54 Appendix 59 Acknowledgments 64 Introduction This 1996 edition of the Chartbook updates basic and current disability statistics. The presentation is nontechnical and meant for people who are interested in data on disability in the United States, but who are not familiar with the statistical sources. The document is intended for distribution in print and on the "Web." This book's approach uses the most generalizable data possible from national survey and program data. These data are considered by experts to provide the best estimates of disability nationally. In the Chartbook, we report analyses from more than one survey, since surveys use different definitions of disability. All charts are prepared from published tables and documents. Each term which is uniquely defined by the surveys is bold-faced on the page and is defined in the Glossary. Each page notes the survey and source of analysis. A Bibliography provides references for the sources consulted. Detailed information covering technical issues of each survey is provided in the Appendix. Section 1 provides estimates of people with disabilities in the United States. Section 2 reviews the data on characteristics (age, sex, race, ethnicity, income, education, geographic location) of people with disabilities as reported by national surveys. Causes of disabilities, and medical costs, are covered in Section 3. Section 4 examines aspects of two particularly important disability populations, the elderly and children. Finally, work disability is reviewed in Section 5. ---------- Section 1: Prevalence of Disabilities This first section provides numbers to answer the most basic question on disability: "How many people have disabilities?" The best estimates come from two main national surveys using different definitions of "disability." The Survey of Income and Program Participation (SIPP) uses a definition of disability which considers limitations in specific functional activities, activities of daily living (ADLs) and instrumental acitivities of daily living (IADLs), the use of special aids, the presence of certain conditions reklated to mental functioning and the ability to work. Furthermore, the SIPP includes program participation data in its estimates. The National Health Interview Survey (NHIS) defines disability as being limited in activity caused by chronic health conditions. It also looks at limitations in terms of major activities associated with a person's age group. Levels of severity are presented for both surveys also. In the SIPP, an inability to perform physical functions is the measure of severity, while in the NHIS it is the need for assistance in daily activities. These surveys are better at measuring physical limitations than mental limitations. Other data sources are presentedin this section for estimating the prevalence of mental retardation and mental disorders. Topic Questions: How many people have a disability? How many people are severely limited in physical functions? How many people need assistance in daily activities? How many people have mental retardation? How many people have a mental disorder? ---------- How many people have a disability? An estimated 19.4% of noninstitutionalized civilians in the United States, totaling 48.9 million people, have a disability. Almost half of these people (an estimated 24.1 million people ) can be considered to have a severe disability. Almost one in five people has a disability. Graphic: Pie chart. Source: McNeil, 1993 Survey: SIPP, 1992 An estimated 15.0% or 37.7 million noninstitutionalized United States residents have an activity limitation. Of these, 11.5 million people are unable to perform their major activity, 14.3 million people are limited in the kind or amount of major activity they can perform, and 11.9 million are limited in activities other than their major activity. Activities considered to be major are: * children under age 5: playing; * persons 5-17: attending school; * persons 18-69: working or keeping house; * people age 70 and over: ability to care for oneself (bathing, eating, dressing, or getting around the home) and one's home (doing household chores, doing necessary business, shopping, or getting around for other purposes) without another person's assistance. Almost one out of every seven people has an activity limitation. Graphic: Pie chart. Source: LaPlante, 1995 Survey: NHIS, 1992 ---------- How many people are severely limited in physical functions? Of all noninstitutionalized persons age 15 and over in the United States, 17.5% have a functional limitation (34.2 million people). Many people have more than one limitation. For 17.5 million, it is going up a flight of stairs without resting; for 17.3 million people the limitation is in walking a quarter of a mile; for 16.2 million it is lifting or carrying something as heavy as a bag of groceries; for 10.9 million, it is hearing what is said in normal conversation; for 9.7 million, it is seeing words or letters in ordinary newsprint, even when wearing glasses or contact lenses; for 7.8 million, it is getting around outside the home; for 5.3 million, it is getting into and out of bed; for 3.7 million, it is getting around inside the home; and for 2.3 million, it is having one's own speech understood. People have a physically severe functional limitation if they are unable to perform a physical function or if they need the help of another person to perform the function. An estimated 7.8% of those age 15 and older (15.2 million people) are severely limited in the functions of seeing, hearing, having speech understood, lifting or carrying, walking, or using stairs. A quarter of the population over 15 years old has some functional limitation, and nearly one-third of them has a severe limitation. Graphic: Pie chart. Source: McNeil, 1993 Survey: SIPP, 1992 ---------- How many people need assistance in daily activities? An estimated 4.0% (9.2 million) of the noninstitutionalized population age 5 and over in the United States need personal assistance with one or more activities. Over 5.8 million people need assistance in "instrumental activities of daily living" (IADL), while 3.4 million need assistance in "activities of daily living" (ADL). ADL includes bathing, dressing, eating, walking, and other personal functioning activities. IADL covers preparing meals, shopping, using the phone, doing laundry, and other measures of living independently. If someone has a need for assistance in ADL, it is assumed that they will have a need for assistance in IADL also. One in 25 people age 5 and over needs assistance in daily activities. Graphic: Stacked column chart. Source: LaPlante, 1996 Survey: NHIS, 1992 ---------- How many people have mental retardation? Because it is difficult to measure in the population, there is only general agreement on how many people have mental retardation. While estimates of the percent in the U.S. population range from .67% to 3%, the most accepted estimates find approximately 1% of the noninstitutionalized population has mental retardation. This translates to about 2.5 million noninstitutionalized people having mental retardation. Estimates vary by age and definition used. Additionally, in 1995, there were an estimated 346,659 people with mental retardation in residential settings and institutions: 33,943 are in nursing homes; 62,028 are in state institutions; 37,311 reside in private institutions with 16 or more residents; and 213,377 live in other community facilities. Another estimated 1,400 persons with mental retardation are in the non-mental retardation/developmental disabilities units of psychiatric hospitals. In 1995, there were an estimated 1.3 million people of all ages reporting mental retardation as a cause of activity limitation (NHIS). People, age 15 and over, reporting mental retardation as a cause of disability in the SIPP in 1992 totaled 501,000. The number of people with mental retardation causing an activity limitation goes down with age. Graphic: Column chart. Source: LaPlante 1995; McNeil 1993; Prouty and Lakin, 1996 Survey: NHIS, 1992; SIPP, 1992 ---------- How many people have a mental disorder? The Epidemiologic Catchment Area Survey (ECA) estimated 28.1%, or 51.3 million people in the community and in institutional settings in the United States had a mental disorder in any given 1-year period. About 2.8% of the adult population (or 5 million people) experience severe mental disorders in a 1-year period. The 1989 NHIS estimates that 1.8% (3.3 million people) have a serious mental illness. It also found that 78.8% (2.6 million) are currently limited by this serious mental illness. Technical Notes: 1) The ECA used diagnoses based on the NIMH Diagnostics Interview Schedule, which is a structured psychiatric diagnostic schedule suitable for administration by lay interviewers in community populations. The NHIS used self-reports of illness. 2) The ECA was conducted in five sites: New Haven, CT; Durham, NC; Baltimore, MD; St. Louis, MO; and Los Angeles, CA. More than one in four people has a mental disorder in any year. Graphic: Column chart. Source: Bourdon, et al, 1994; National Advisory Mental Health Council, 1993; Barker, et al, 1992 Survey: ECA, 1980-1985; NHIS 1989 ---------- Section 2: Characteristics of People With Disabilities This section provides data collected in national surveys on the demographics of people with disabilities. Subjects covered in this section include age, sex, ethnicity, income, educational level, geographic location, and residence of people with disabilities (including those in institutions). As with Section 1, the information is based predominantly on the NHIS and the SIPP, which have the broadest definitions of disabilities (limitation of activity and limitation of function). There are also pages on the demographics of severely disabled persons, as measured in these surveys (including those who need assistance in activities of daily living). Topic Questions: Where do people with activity limitations live? How many people use assistive technology devices? How many people use home accessibility features? How do activity limitations change with age? How do the levels of disabilities change with age? How does activity limitation differ for males and females? How do disability rates differ for males and females? How does disability differ for races and ethnicities? How does the need for assistance differ by race or ethnicity? How do activity limitations differ by family income? How do functional limitations differ by income? How do activity limitations differ by educational level? How does the need for assistance differ with educational level? ---------- Where do people with activity limitations live? People with activity limitations live in all parts of the United States, but a slightly higher levels of activity limitations in the population is found in the South (16.1%) than in the West (14.7%), Midwest (14.6%), and Northeast (14.3%). People living in rural areas (not MSAs) have the highest levels of activity limitation (17.6%). Centeral city residents report 15.8% have limitations and those living in MSAs outside of the central cities report the lowest activity limitation levels (13.4%). Technical Note: Geographic regions include the following states: Midwest - Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin. Northeast - Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and Vermont. South - Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia. West - Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming. People living in rural areas have the highest activity limitations. Graphic: Stacked column chart. Source: NCHS, 1995 Survey: NHIS, 1994 ---------- How many people use assistive technology devices? There are an estimated 13.1 million persons using assistive technology devices in the United States for anatomical, mobility, hearing, vision, speech, or other purposes. The most common devices are canes or walking sticks (4.4 million), hearing aids (3.8 million), walkers (1.7 million), wheelchairs (1.4 million), and back braces (1.2 million). Just as disability increases with age, so do the number of assistive technology devices, rising from 1.0 million for those 24 years and under to 4.1 million for people 75 and over. Use of canes, hearing aids, and walkers rises sharply with age. Graphic: Line chart. Source: LaPlante, et al., 1992 Survey: NHIS, 1990 ---------- How many people use home accessibility features? There are over 7.1 million persons using home accessibility features in the United States. The most common features are hand rails (3.4 million people), ramps (2.1 million), extra wide doors (1.7 million), other home accessibility features (1.6 million), and raised toilets (1.3 million). (Other features include adapted door locks, lowered counters, and slip-resistant floors.) Unlike assistive devices, most home accessibility features do not show much increase with older populations, fluctuating between 1.4 million for those 24 and under to 1.7 million for those 75 and over. Hand rails, the most common home accessibility feature, is one of the only features that are used increasingly with age. Graphic: Line chart. Source: LaPlante, et al., 1992 Survey: NHIS, 1990 ---------- How do activity limitations change with age? Activity limitation increases with age. For the 66.5 million noninstitutionalized persons in the U.S. under age 18, where the major activity is playing or attending school, 6.1% have activity limitations: 0.6% are unable to play or attend school, 3.9% are limited in the amount or kind of play or school they can participate in, and 1.6% are limited in a nonmajor activity. In contrast, for the 20.8 million people over age 70, where the major activity is housekeeping and self-care, a total of 39.7% are limited: 8.3% are unable to keep house or do self-care, 12.3% are limited in the amount or kind of housekeeping or self-care they can do, and 19.1% are limited in a non-major activity. Technical Note: The definition of major activity changes after age 69, to self-care and housekeeping from work, and percentage rates for age groups above 69 years drop initially, but then increase. Activity limitation increases with age. Graphic: Stacked column chart. Source: LaPlante, 1996 Survey: NHIS, 1992 ---------- How do the levels of disabilities change with age? The proportions of people with disabilities and of people with severe disabilities both increase with age. Of the 34.8 million 15 to 24 year olds, there are 3.5 million (10.0%) with a disability and 1.2 million (3.3%) are classified as severely disabled. Among the 9.9 million persons, 75 to 84 years old, 6.3 million (63.7%) have disabilities; of those, 4.1 million or 41.5% report having severe disabilities. Disability increases in severity with age. Graphic: Stacked column chart. Source: McNeil, 1993 Survey: SIPP, 1992 ---------- How does activity limitation differ for males and females? In general, women are more likely to have activity limitations than men. Of the 129.3 million noninstitutionalized females in the U.S., 15.4% are limited in activity compared to 14.6% of the 122.2 million males. Women are less likely to be unable to perform their major activity than men (4.3% compared to 4.9%) but are more likely to be limited in the amount or kind of major activity they can perform (6.1% to 5.3%) or to be limited in activities other than their major activity (5.0% to 4.4%). Under the age of 25, men are more likely than women to report being limited in amount or kind of their major activity; however, at ages 25 and older, women are more likely to report a limitation. Technical Note: Since keeping house and working are the major activities for ages 18-69, people whose major activity is keeping house and are not limited in this activity are classified as being limited in a non-major activity if they report a work limitation. In youth, males report more limitations, while in old age, females report more limitations. Graphic: Multiple stacked bar charts. Source: LaPlante, 1996 Survey: NHIS, 1992 ---------- How do disability rates differ for males and females? Of the noninstitutionalized population in the United States over the age of 15, 25.0 million females (24.6%) report disabilities compared to 21.0 million males (22.4%). Furthermore, 14.0 million females report severe disabilities (13.8%), while only 9.6 million males report severe disabilities (10.2%). Disability rates for both sexes increase as age increases. For some age groups, males report higher percentages of disabilities than women, and, in others, women have higher percentages than men. Disability rates are higher for females at older ages. Graphic: Line chart. Technical Note: The midpoints of the groups have been used to create a continuous line. Source: McNeil, 1993 Survey: SIPP, 1992 ---------- How does disability differ for races and ethnicities? The rate of disability reported by individuals in different ethnic groups varies from a low of 9.9% for Asian and Pacific Islanders to a high of 21.9% for Native Americans. Asian and Pacific Islanders have the lowest percentages of severe disability (4.9%). Blacks have the highest proportion of those with a severe disability (12.2%). Approximately 41 million white persons report a disability, with 19.7 million of those being severely disabled. An estimated 6.3 million blacks report a disability, with 3.8 million of those having a severe disability. An estimated 361,000 Amercian Indians, Eskimos, or Aleuts report a disability, with 162,000 being severe. Asian Americans report 777,000 people with a disability and 384,000 with a severe disability. Of those with a Hispanic origin (who can be of any race), 3.4 million rported a disability and 1.8 million reported a severe disability. Disability rates range from about 1 in 10 for Asians/Pacific Islanders to 1 in 4 for Native Americans. Graphic: Stacked bar chart. Source: McNeil, 1993 Survey: SIPP, 1992 ---------- How does need for assistance differ by race or ethnicity? Native Americans report the highest proportion of their population age 5 and over needing assistance in activities of daily living (ADL), 2.6%. Native Americans and black non-Hispanics report 3.0% of their population needing assistance in instrumental activities of daily living (IADL), the highest of all races/ethnicities. Over 4.5 million white non-Hispanic people are estimated to need assistance in IADL only and another 2.5 million in ADL. Of black non-Hispanics, 819,000 need assistance in IADL only and another 553,000 in ADL. Technical Note: Persons of Hispanic origin may be of any race. Native Americans and Blcak non-Hispanics have the highest rates of need for assistance. Graphic: Stacked bar chart. Technical Note: The standard error for the values listed for Black Hispanics is too great to be a statistically reliable estimate. Source: LaPlante, 1992 Survey: SIPP, 1992 ---------- How do activity limitations differ by family income? There is a clear link between activity limitation and family income. Income loss often occurs as a result of disability. An estimated 6.5 million of the 23.3 million people who are members of low-income families (less than $10,000 income annually) have activity limitations (28.0%). An estimated 1.6 million of these low-income family members are limited in nonmajor activity (6.9% of low-income family members), another 2.3 million are limited in amount or kind of major activity (9.9%), and 2.6 million are unable to carry out their major activity (11.2%). On the contrary, only 9.4 million people (9.4%) of members of families with an annual income of $35,000 or more have activity limitations; 3.6 million (3.6%) are limited in a nonmajor activity, 3.9 million (3.9%) are limited in amount or kind of major activity, and only 1.9 million (1.9%) are unable to carry out their major activity. Technical Note: Incomes are in 1994 dollars. Activity limitations decrease steadily with increasing family incomes. Graphic: Stacked column chart. Source: NCHS, 1995 Survey: NHIS, 1994 ---------- How do functional limitations differ by income? People over age 15 with functional limitations tend to be members of lower income households. Almost one out of five persons (19.8%) over age 15 with functional limitations have adjusted incomes of less than the poverty threshold (translating to over 6.8 million people), while only 12.2% of people with no functional limitations receive less than the poverty threshold amount. On the other hand, 34.1% of people with no functional limitations have monthly household incomes of more than four times the poverty threshold, but only 18.4% of people with limitations receive that amount. Note, however, that older people, who have higher rates of limitations, have lower incomes, explaining some of the relationship of income and limitations. Technical Note: Income information was collected in the last three months of 1991 and the first month of 1992. The poverty threshold for a family of four in 1991, which is when most of this data was collected, was $13,924. In 1992, the poverty threshold for a family of four was $14,335. People with lower incomes report higher levels of functional limitations. Graphic: Bar chart. Source: McNeil, 1993 Survey: SIPP, 1992 ---------- How do activity limitations differ by educational level? People age 18 and over who have completed 8 years or fewer of school are more likely to have activity limitations than are people with more education. In fact, the higher the educational level, the less likely one is to be limited in activity; 61.6% of the 16.4 million people with 8 years or less education are not limited in activity, compared to 88.5% of the 32.8 million people with 16 years or more education. The pattern of increasing limitations for people with lower levels of education holds for persons limited in nonmajor activity (5.3% to 10.0%), those limited in kind or amount of major activity (3.9% to 11.9%), and those unable to perform major activity (2.3% to 16.5%). Technical Note: It should be noted that higher levels of education may place someone in a desk job that is less likely to pose an on-the-job hazard. It should also be noted that older people, who have higher rates of limitations, also have lower amounts of education, and were more likely to have physically dangerous occupations than today's adult. People with lower education levels report higher levels of activity limitations. Graphic: Bar chart. Source: LaPlante, 1996 Survey: NHIS, 1992 ---------- How does the need for assistance differ with education level? The percent of those needing assistance in IADL only (instrumental activities of daily living) drops off quickly as level of education rises - 10.0% (1.6 million) for those with 8 years or less of education compared to 1.3% (481,000) for those with 16 or more years of education. The same trend occurs for those needing assistance in ADL (activities of daily living), dropping from 6.1% (1,002,000) to 0.7% (265,000), respectively. It should be recognized that there is a lower probability of advanced education in older citizens at this time. Therefore, some of the difference can be attributed to the influence of age. More than one in six people with 8 years of education or less have a need for assistance. Graphic: Stacked bar chart. Source: LaPlante, 1996 Survey: NHIS, 1992 ---------- Section 3: Causes and Costs of Disabilities Chronic health conditions are the most common reason people have a disability. This section presents the data on the most prevalent chronic health conditions, how much activity limitation is caused by those conditions, and which conditions include the highest percentage of persons with limitations. In addition, there is information on the costs and sources of payment for medical care. Topic Questions: Which chronic health conditions cause activity limitations most often? In a year, which conditions causing activity limitations are reported most often? How much do people with disabilities spend for medical care? ---------- Which chronic health conditions cause activity limitations most often? Chronic health conditions can cause activity limitations. Chronic health conditions cause activity limitations an estimated 61,047,000 times in the U.S. population. The five conditions causing the most limitations are: heart disease (7,932,000); back problems (7,672,000); arthritis (5,721,000); asthma (2,592,000); and diabetes (2,569,000). The conditions causing people to have activity limitations in major activity most often are: mental retardation (87.5 percent of people with the condition have a limitation); multiple sclerosis (69.4% ); malignant neoplasm of the stomach, intestine, colon, and rectum (62.1%); complete and partial paralysis of extremities (60.7%); malignant neoplasm of the lung, bronchus, and other respiratory sites (60.6%); and blindness in both eyes (60.3%). The top ten chronic conditions that cause activity limitations... Chronic condition Number of conditions causing limitations Heart disease 7,932,000 Back problems 7,672,000 Arthritis 5,721,000 Asthma 2,592,000 Diabetes 2,569,000 Mental disorders 2,035,000 Disorders of the eye 1,577,000 Learning disabilities and Mental retardation 1,575,000 Cancer 1,342,000 Visual impairments 1,294,000 and the top ten most frequently limiting conditions. Chronic condition Percent of conditions causing major limitations Mental retardation 87.5% Multiple sclerosis 69.4% Malignant neoplasm of stomach, intestine, colon, and rectum 62.1% Paralysis of extremities, complete or partial 60.7% Malignant neoplasm of lung, bronchus, and other respiratory sites 60.6% Blindness, both eyes 60.3% Other deformity or orthopedic impairment 54.4% Paralysis of other sites, complete or partial 48.0% Other diseases of the heart, excluding hypertension 47.8% Epilepsy 44.4% Source: LaPlante, 1996; NCHS, 1996 Survey: NHIS 1990-1992 ---------- In a year, which conditions causing activity limitations are reported most often? The highest percents of chronic health conditions that cause activity limitations and onset in the year 1991 were: malignant neoplasms of other and ill-defined sites within the digestive organs and peritoneum (40.7 percent of all reports of the condition); visual disturbances (40.7%); malignant neoplasms of respiratory and intrathoracic organs (40.5%); malignant neoplasms of male genital organs (38.9%); malignant neoplasms of other and unspecified sites (37.7%); and malignant neoplasms of other and unspecified female genital organs (32.9%). Technical Note: Groupings of the conditions can affect the percents and rates. For example, malignant neoplasms could be grouped together as cancer, giving a different rate. Listed conditions are significantly different from all conditions at p<.05 confidence at a minimum. Of the top 15 conditions causing an activity limitation that onset in the past year, many were cancers. Chronic condition Percent of conditions causing limitations with onset in past year Malignant neoplasm of other and ill-defined sites within the digestive organs and peritoneum 40.7% Visual disturbances 40.7% Malignant neoplasm of respiratory and intrathoracic organs 40.5% Malignant neoplasm of male genital organs 38.9% Malignant neoplasm of other and unspecified sites 37.7% Malignant neoplasm of other and unspecified female genital organs 32.9% Chronic injuries or late effects of injuries 29.2% Other digestive diseases 27.1% Heart failure 23.9% Dyspnea and respiratory abnormalities 23.6% Peripheral enteropathies and other allied disorders 22.0% Malignant neoplasm of female breast 21.6% Orthopedic impairment of shoulder and /or upper extremity 18.5% Other chronic ischemic heart disease 15.5% Orthopedic impairment of lower extremity 14.5% Source: LaPlante, 1996 Survey: NHIS 1992 ---------- How much do people with disabilities spend for medical care? In 1987, people with an activity limitation spent an estimated $156,949,000 on medical expenditures. By 1993, it was an estimated $282,832,000. For a group which comprised 17% of the total population, people with a limitation accounted for 47% of medical expenditures nationally. In 1987, people with an activity limitation due to a chronic condition spent over four times more on medical care than nondisabled individuals (an estimated $4,692 per person per year for those with limitations compared to $1,086 for those with no limitations). This was true for males, females, and all age groups. People with disabilities pay via public coverage most (Medicare - 30% and Medicaid - 10%). In comparison, people with no disabilities turn to private coverage most - 46%. Half of those with a disability are covered by private insurance from ages 1-17. Private insurance coverage drops to 38% between age 18 and 64 and only 14% over age 65. In comparison, 48% of those between ages 1 and 17 with no disabilities are covered by private insurance, 53% between ages 18 and 64, and 18% over 65. Those with activity limitations report more medical expenditures. Graphic: Multiple bar charts. Source: Trupin, et al., 1996 Survey: NHIS, 1987 and 1993 ---------- Section 4: Disability, the Elderly, Children and Youth Although people with disabilities exist throughout the population, two groups are especially important to look at: the elderly and children and youth. Surveys have been designed specifically for collecting data about these two subpopulations. This section reports the specifics of disability as related to elderly persons, and as related to children and youth, especially how the groups differ from the rest of the population. Again, disability is represented by limitations in activity, limitations in physical functions, and needing assistance in daily activities. In addition, there are data on numbers of special education students and types of special education environments. Topics covered: How many elderly persons have disabilities? How many older people need assistance with activities of daily living? How many children have limitations in activity? What are the differences in race and income for children with limitations? How many children and youth receive special education? Where do children and youth receive special education? ---------- How many elderly persons have disabilities? Elderly persons are particularly affected by activity limitations. In contrast to people between 18 and 45, where fewer than 8.6% report activity limitations, 38.8% of people age 65 and older report being limited in their activity. Similarly, those aged 65 and older report higher rates of disability in the SIPP (53.9%) than people between 18 and 45 (13.6%). Over half of those over age 65 have a disability and almost 40% report having an activity limitation. Graphic: Multiple pie charts. Source: McNeil, 1993, LaPlante, 1995 Survey: SIPP, 1992; NHIS, 1992 ---------- How many older people need assistance with activities of daily living? Over 5 million people age 65 and older need assistance in IADL (instrumental activities of daily living) or ADL (activities of daily living). The percentage of people in any given age range needing help with ADL (activities of daily living) doesn't rise above 10% until age 85, when it jumps to 20.0%. Similarly, the percentage of those needing assistance in IADL (instrumental activities of daily living) only doesn't rise above 10% until age 75 (13.9% for 75-84; 22.3% for 85 and over). The numbers of people who need assistance, however, is not insignificant in younger age groups. Over 1.0 million 25-44 year olds need assistance in IADL only and another 477,000 need assistance in ADL. Almost 1.6 million 45-64 year olds need assistance in IADL only, and 684,000 more in ADL. The need for assistance increases later in life. Graphic: Bar chart. Source: LaPlante, 1996 Survey: NHIS, 1992 ---------- How many children have limitations in activity? Over 4.7 million children under age 18 have activity limitations (6.7% of all children). An estimated 1.8% of children (1.3 million children) are limited in an activity other than playing or attending school, 4.2% (2.9 million) are limited in kind or amount of play or school they can attend, and 0.7% (519,000) are unable to play or attend school at all. An estimated 7.9% of boys under age 18 have an activity limitation (2.8 million) compared to 5.6% of girls of the same age (1.9 million). Age breakdowns can be seen in the chart below. Technical Note: Major activity for children changes from playing for those under age 5 to attending school from age 5-17. Graphic: Bar chart. The percent of children limited in their major activity ranges from 5% for those ages 5-13 to 1.4% for children under age 5. Source: NCHS, 1995; LaPlante , Disability Abstract #15, 1995 Survey: NHIS 1994, 1992 ---------- What are the differences in race and income for children with limitations? An estimated 8.8% (996,000) black children under age 18 have activity limitations compared to 6.4% of white children of the same age (3.6 million). For children in families with incomes under $10,000 annually, 11.1% (779,000) have activity limitations. For those children in families receiving $10,000 to $19,999 annually, 8.4% (850,000) have limitations. An estimated 6.5% (936,000) children in families with incomes of between $20,000 and $34,999 have limitations. Finally, children in families with incomes of $35,000 or more, 5.3% (1.5 million) have limitations. As family income rises, the percentage of those under age 18 with activity limitations goes down. Graphic: Bar chart. Source: NCHS, 1995 Survey: NHIS, 1994 ---------- How many children and youth receive special education? In the United States, District of Columbia and Puerto Rico, 5.4 million children and youth age 3 to 21 with disabling conditions are served under of the Elementary and Secondary Education Act (ESEA), Chapter 1- State Operated Programs (SOP) and Individuals with Disabilities Education Act (IDEA), Part B. These two federal programs provide special education funding for disabled children and youth from birth through age 21. Of children ages 6-21, 51.1% have specific learning disabilities, 21.1% have speech or language impairments, 11.6% have mental retardation, and 8.7% have serious emotional disturbance. These rates vary by age. The largest groups for 6 to 11 year olds are learning disability (41.4%) and speech impairment (36.3%). Learning disability is by far the largest category for the 12 to 17 year olds (62.6%). The largest groups for ages 18 to 21 years old are learning disabilities (50.2%) and mental retardation (26.5%). More than half of special education students have specific learning disabilities. Graphic: Pie chart. Source: Office of Special Education and Rehabilitative Services, 1995 Survey: OSEP state reported data, 1993-94 school year ---------- Where do children and youth receive special education? The majority of students with disabilities age 6-21 receive special education and related services in settings with nonhandicapped peers. Nearly 40% receive special education in regular classes, while over 31% are served primarily in resource rooms. Just under 24% were served in separate classes in regular education buildings. The remaining 5% of the special education population were served in separate, residential, or homebound hospital facilities. There is variation, however, across handicapping conditions. Students with speech impairments (82%), visual impairments (45%), other health impairments (40%), orthopedic impairments (35%) and learning disabilities (35%) are served primarily in regular classes. In contrast, 57% of students with mental retardation, 50% of those with autism, and 45% of those with multiple disabilities are in separate classes. Four of ten special education students are served in regular classrooms. Graphic: Pie chart. Source: Office of Special Education and Rehabilitative Services, 1995 Survey: OSEP state reported data, 1992-93 school year ---------- Section 5: Work and Disabilities Attempting to count people who have a work disability is somewhat easier than trying to estimate the number of all people with disabilities. In work disability there is an easy-to-survey age group (the working ages - 16-64 or 18-69 depending on the survey) and a specific activity in which to measure ability (work). The Bureau of the Census produces yearly data on work disability from its annual March Income Supplement to the Current Population Survey (CPS). It also asks work disability questions in the SIPP. Both ask questions about being prevented or limited in work, retiring or leaving a job because of health or disability. The surveys also ask questions about receipt of Medicare, SSI, or veteran's disability compensation. Another definition of work and disability is provided by the NHIS in its measurement of work limitation, which is also based on the respondent reporting being limited or prevented from work due to a chronic health condition. Topic Questions: How many people are considered to be work disabled? How many disabled persons are in the labor force? How many work disabled persons are working full time? How has the number of disabled people in the labor force changed over time? How do the states differ in numbers of people with work disabilities? How many persons have a severe work disability? How many people are limited or unable to work because of a health condition? What chronic health conditions are the most frequent causes of work limitation? How do occupational injuries and illnesses affect work disability? What are the earnings of someone with a work disability? How many people with disabilities does the Vocational Rehabilitation system help? ---------- How many people are considered to be work disabled? The number of noninstitutionalized people in the United States with a work disability is estimated to be 16.9 million, which represents 10.1% of the working age population (16 to 64 years old). Higher percentages of blacks are work disabled than whites or Hispanics: 15.4% of blacks have a work disability (3.2 million people) compared to 9.6% for people of Hispanic origin (1.6 million), 9.4% of whites (13 million) and 8.5% of other races (700,000). Work disability increases in frequency with age. At 16-24 years, 4.2% are work disabled; for 25-34 years, the proportion rises to 6.4%; for 35-44 years, 9.4%; from 45-54 years, 13.3%; and for 55-64 years, 22.9% are work disabled. Technical Note: The Hispanic category can include people of any race. Blacks report the highest rates of work disability. Graphic: Bar chart. Source: LaPlante, Disability Abstract #11 Survey: CPS 1995 ---------- How many disabled persons are in the labor force? The labor force is made up of people who are employed, those just laid off, and those who are actively looking for a job. It does not include people who are not working and not looking for a job. Of the 158.6 million between the ages of 18-64 in 1994, 124.6 million were in the labor force, a labor force participation rate of 78.6%. However, labor force participation rates are quite different for those with activity limitations (51.8%) compared to those without (83.0%). The difference is consistent when looking at men and women in the labor force(58.8% of limited men versus 91.4% of nonlimited men; 45.6% of limited women compared to 74.9% of nonlimited women). Graphic: Bar chart. A far lower percentage of of both men and women with activity limitations are in the labor force. Source: Trupin, 1996 Survey: NHIS, 1994 ---------- How many work disabled persons are working full-time? Another way to look at employment of people with a work disability is through full-time employment rates. Only 18.4% of the 16.9 million people with a work disability are employed full time. In comparison, 62.0% of the 150 million nonwork disabled people are employed full-time. The difference is true regardless of sex, race, or ethnicity. People with a work disability are far less likely to work full time, year round than those with no work disability. Graphic: Multiple bar charts. Source: McNeil, 1996 Survey: CPS, 1995 ---------- How has the number of disabled people in the labor force changed over time? The long term trend is toward higher rates of participation in the labor force, for both those with a disability and those with no disability. In 1983, 79.1% of persons with no disability were part of the labor force; in 1994, that figure had risen to 83.0%. Of those with disabilities, 48.6% were part of the labor force in 1983; in 1994, the proportion had risen to 51.8%. However, the majority of that change is due to the change in labor force participation of women. The rate of men with a disability has stayed fairly constant - 60% in 1983, 58.8% in 1994. The same rate for women, however, increased from 38% in 1983 to 45.6% in 1994. The rate of participation in the labor force has increased for women with a disability but dropped for men with a disability. Graphic: Line chart. Source: Trupin, 1996 Survey: NHIS 1983-1994 ---------- How do the states differ in numbers of people with work disabilities? States where the proportion of persons aged 16-64 with work disabilities is the highest are concentrated in the southern United States. The top 10 states (and District of Columbia) in percentage of disabled working age persons are: 1) West Virginia 12.6% 2) Kentucky 11.4% 3) Arkansas 11.1% 4) Mississippi 11.0% 5) Louisiana 10.3% 6) Oklahoma 10.2% 7) Maine 10.2% 8) Oregon 10.0% 9) Tennessee 9.7% 10) Montana and Alabama 9.7% The states (and District of Columbia) with the lowest proportions of work disabilities are: 51) New Jersey 6.2% 50) Connecticut 6.4% 49) Hawaii 6.6% 48) Alaska 6.6% 47) Illinois 6.9% 46) North Dakota 7.0% 45 & 44) Nebraska and Maryland 7.1% 43 & 42) Kansas and Massachusetts 7.2% States with the largest increases in this rate from 1980 to 1990 are Alaska (up 22.0% from 5.4% in 1980 to 6.6% in 1990), Montana (up 19.3%), Wyoming (up 18.4%), Hawaii (up 11.4%) and Colorado (up 8.3%). States with the largest decreases in work disability from 1980 to 1990 are District of Columbia (down 15.0%), Florida (down 12.8%), Arkansas (down 12.2%), Maryland (down 11.9%) and Virginia (down 10.6%). The highest rates of disability occur in the South. Graphic: Shaded map of the limited States. Source: LaPlante and Cyril, Disability Statistics Abstract #6, 1993 Survey: 1990 Census of Population and Housing ---------- How many persons have a severe work disability? There are an estimated 10.4 million people of working age (16-64) who have a severe work disability. Of this number, 5.1 million are males and 5.3 million are females. Seven and a half (7.5) million are whites (5.4% of all whites of working age), 2.5 million are blacks (11.8% of all blacks of working age), and the remaining 400,000 are of other races. There are 1.2 million persons of Hispanic origin with severe work disabilities who are 7.0% of the 17.1 million Hispanics of working age. The proportion of working age blacks who have severe work disabilities is higher than for whites or Hispanics. Graphic: Bar chart. Source: McNeil, 1996 Survey: CPS, 1995 ---------- How many people are limited or unable to work because of a health condition? For people between 18 and 69 years of age, work is considered to be the major activity. Measuring work limitations due to a chronic health condition, an estimated 10.9 million of these people are unable to work (6.6%), while another 8.1 million are limited in amount or kind of work activity (5.0%). For females, 6.6% are unable to work while an additional 4.8% are limited, compared to 6.7% of males unable to work and 5.1% who are limited. As age increases, so does the impact of chronic conditions on ability to work. Only 1.9% of 18-24 year olds are unable to work, but the rate rises to 18.6% for 65-69 year olds. Similarly, 2.6% of 18-24 year olds are limited in amount or kind of work activity which rises to 10.0% for 65-69 year olds. Technical Note: These data are from the National Health Interview Survey (NHIS), while the previous pages on work disability are from the March supplement of the Current Population Survey(CPS). As noted earlier, the two surveys have different definitions of work and disability (see glossary under work limitation and work disability). Asians and Pacific Islanders report the fewest limitations in work activity. Graphic: Stacked bar chart. Source: LaPlante, 1995 Survey: NHIS 1992 ---------- What chronic health conditions are the most frequent causes of work limitation? The chronic health condition most frequently reported to cause work limitation is heart disease at 2.1 million conditions (10.9% of all conditions cited as causing work limitation), followed by orthopedic impairment of the back or neck at 2.0 million (10.5%), intervertebral disk disorders at 1.5 million (7.8%), osteoarthritis and allied disorders at 1.3 million (6.8%), and orthopedic impairment of the lower extremities at 861,000 (4.5%). Technical Note: Chronic condition groups are based on the International Classification of Diseases (ICD-9) codes as adapted by National Center for Health Statistics. The top five chronic conditions causing work limitation. Graphic: Bar chart. Source: LaPlante, 1995 Survey: NHIS 1992 ---------- How do occupational injuries and illnesses affect work disability? Occupational injuries and illnesses also contribute to work disability. Over the past 20 years, the number of reported occupational injuries and illnesses has generally decreased, but the impact of these injuries and illnesses has greatly increased. In 1972, 10.9 cases of occupational injury or illness were recorded for every 100 full-time workers. By 1994, that incidence rate had dropped to 8.4 cases per 100 workers. In 1972, occupational injuries and illnesses caused 47.9 lost work days per 100 workers, whereas by 1991, the rate had increased to 86.5 lost workdays per 100 workers. The effect of occupational illnesses and injuries has increased over the last 15 years. Graphic: Line chart. Source: Bureau of Labor Statistics, 1995 Survey: ASOII, 1972-1994 ---------- What are the earnings of someone with a disability? The mean monthly earnings of persons of all ages with a disability which is not severe is $1,771. A person with a severe disability has monthly earnings of $1,422. By comparison, mean monthly earnings of people with no disability are $1,962. Technical Note: Earnings are in 1991-1992 dollars. The figures reported for age groups in the chart below should be interpreted cautiously, as high standard error rates were reported in several categories, particularly among men with severe disabilities. The difference between the earnings of people with and without disabilities is slight for year round full-time workers. Graphic: Column chart. Source: McNeil, 1995 Survey: SIPP, 1992 ---------- How many people with disabilities does the Vocational Rehabilitation system help? The state-federal vocational rehabilitation (VR) program provides services for individuals with disabilities, assisting them in obtaining employment. The program, authorized by the Rehabilitation Act of 1973, as amended, served 1,250,314 persons in FY 1995, including 940,177 with severe disabilities. That year, 209,509 individuals, including 159,138 with severe disabilities, were rehabilitated, or successfully completed their VR services and found work in a variety of jobs. Types of conditions and impairments that people served by VR have are shown below. Vocational rehabilitation serves people with varying types of disabilities. Graphic: Bar chart. Source: Rehabilitation Services Administration, 1996 Survey: Tabulations based on FY 1995 quarterly cumulative case load report, Form RSA-133. ---------- Glossary This list provides explanation of terms used in the book that may require clarification. Each of these terms is referenced on the page(s) upon which it is used. The definitions are taken from the survey or footnoted publication as closely as possible in order to convey the original authorsı perspectives. Activity limitation: In the NHIS, each person is classified into one of four categories: (a) unable to perform the major activity, (b) able to perform the major activity but limited in the kind or amount of this activity, (c) not limited in the major activity but limited in the kind or amount of other activities, and (d) not limited in any way. The NHIS classifies people as limited (groups a-c) or not limited (group d). Persons are not classified as limited in activity unless one or more chronic health conditions are reported as the cause of the activity limitation (see also chronic health condition and major activity). ADL: The NHIS probes for information on persons who need the help of others in performing activities of daily living (ADL). The ADLs are bathing, dressing, eating, and getting around the home (see also IADL). Assistive technology devices: As used in the Assistive Devices Supplement to the 1990 NHIS, the operational definition of assistive technology includes devices that enhance the ability of an individual with a disability to engage in major life activities, actions, and tasks. These devices assist people with deficits in physical, medical, or emotional functioning. Chronic health condition: A condition that a respondent described as having persisted for three or more months is considered to be chronic, as is any condition that is on a list of conditions always classified as chronic no matter how long the person has had the condition (NHIS). Earnings: The sum of wages and/or salary and net income from farm and nonfarm self-employment. ESEA (SOP): Chapter 1 of the Elementary and Secondary Education Act - State Operated Programs, one of two programs that have provided states with financial assistance to educate school-age children and youth with disabilities (see also IDEA). Family income: The income recorded by the NHIS is the total of all income received by members of the family in the 12 month period preceding the week of the interview. Income from all sources is included. Sources can be wages, salaries, rents from property, pensions, government payments, and help from relatives. Full-time employment: A full-time employed worker, according to the CPS, is one who worked primarily at full-time civilian jobs 50 weeks or more during the preceding calendar year. Functional limitation: The SIPP asked respondents about their ability to perform the following specific sensory and physical activities: (1) seeing ordinary newspaper print (with glasses or contacts if normally used); (2) hearing normal conversation (using aid if normally used); (3) having speech understood; (4) lifting or carrying 10 lbs.; (5) walking a quarter of a mile without resting; (6) climbing a flight of stairs without resting; (7) getting around outside; (8) getting around inside; or (9) getting into and out of bed. Difficulty in performing any of these activities is classified as a functional limitation in the SIPP. Home accessibility features: The Assistive Devices Supplement to the 1990 National Health Interview Survey (NHIS) asked whether the respondent's home was equipped with any special features designed for disabled people including: ramps; extra-wide doors or passages; elevators or stairlifts (not counting public elevators); hand rails or grab bars (other than normal hand rails on stairs); raised toilets; levers, push bars, or special knobs on doors; lowered counters; slip-resistant floors; and other special features designed for disabled people. The presence of any of these features in the home is considered a "home accessibility feature." IADL: The NHIS collected information on the respondent's need for assistance in performing instrumental activities of daily living (IADL). The IADls include: doing household chores, doing necessary business, shopping, and getting around for other purposes. People who need assistance in ADL were not asked about IADL (see also ADL). IDEA: The Individuals with Disabilities Education Act, Part B State Program is one of two major Federal programs that have provided states with financial assistance to educate school-age children and youth with disabilities (see also ESEA). Incidence: The number or rate of conditions that onset in any one year. Labor force: As used by the Bureau of the Census in the March Supplement of the Current Population Survey (CPS), the labor force includes people employed as civilians, unemployed, or in the Armed Forces during the survey week (see also Unemployment rate). People who are neither employed nor seeking employment are not included in the labor force (people engaged in housework, attending school, unable to work because of long-term physical or mental illness, persons who are retired or too old to work, seasonal workers in an off season, and voluntarily idle people). Labor force participation rate: The number of people employed divided by the number of people in the labor force ( used by teh CPS and the SIPP). Major activity: In the NHIS, persons are classified in terms of the major activity usually associated with their particular age group. The major activities for the age groups are (a) ordinary play for children under 5 years of age, (b) attending school for those 5-17 years of age, (c) working or keeping house for persons 18-69 years of age, and (d) capacity for independent living (e.g., the ability to bathe, shop, eat, dress, and so forth, without needing the help of another person) for those 70 and over People aged 18-69 years who are classified as keepiong house are also classified by their ability to work at a job or business (see activity limitation). Mean annual income: The CPS measures the mean annual income by dividing the total income of individuals by the total number of individuals. Income includes wages or salary, interest, dividends, Social Security retirement, Supplemental Security Income, public assistance or welfare, veterans payments, unemployment, workerıs compensation, private or public pensions, alimony, child support, regular contributions from persons not living in the household, and other periodic income. Medical expenditures: The NMES measures costs for medical care by totaling costs for hospital care, physician services, emergency room, dental services, vision aids, prescription drugs, medical equipment, and home care. MSA: The Metropolitan Statistical Area has been defined by the U.S. Office of Management and Budget with help from the Federal Committee on Metropolitan Staistical Areas generally as a county or a group of counties containing at least one city having a population of 50,000 or more plus adjacent counties that are metropolitan in character and are economically and socially integrated with the central city. Occupational illnesses and injuries: From the Recordkeeping Guidelines for Occupational Injuries and Illnesses, the definition used by the Annual Survey of Occupational Illnesses and Injuries (ASOII) for occupational injury is any injury such as a cut, fracture, sprain, etc., which results from a work accident or from exposure involving a single incident in the work environment. Occupational illness is any abnormal condition, acute or chronic illness, disease, or disorder (other than occupational injury) caused by exposure to environmental factors (inhalation, absorption, ingestion, or direct contact). Poverty level: Poverty statistics presented in this report are based on a definition developed by the Social Security Administration in 1964 and revised by Federal Interagency Committees in 1969 and 1980. The poverty index provides a range of income cutoffs adjusted by such factors as family size and number of children under 18 years old. Prevalence: The number or rate of conditions that exist in the population at any time. Rehabilitated: The successful placement of a client of a state Vocational Rehabilitation (VR) agency into competitive, sheltered, or self-employment, or homemaking and unpaid family work for a minimum of 60 days after the completion of all necessary rehabilitation services (see Vocational Rehabilitation). Severe functional limitation: The Survey of Income and Program Participation (SIPP) regards a person who is unable to perform or needs th help of another person to perform one or more of a list of physical functional activities as having a severe functional limitation (see Functional limitation for list of activities). Severe work disability: The Current Population Survey (CPS) classifies persons as having a severe work disability if (1) they did not work in the survey week because of a long-term physical or mental illness that prevents the performance of any kind of work, (2) they did not work at all in the previous year because of illness or disability, (3) they are under 65 years of age and covered by Medicare, and (4) they are under 65 years of age and a recipient of Supplemental Security Income (SSI) (see also Work disability). Special education: Free appropriate public education and related services provided for children and youth with disabilities from birth through age 21. Assisted through funding by federal legislation IDEA -part B and Chapter 1 of ESEA (SOP) (see IDEA and ESEA). Unemployed: Unemployed people include those who, during the CPS survey week, had no employment but were available for work and (1) had engaged in a specific job seeking activity within the past 4 weeks, (2) were waiting to be called back to a job from which they had been laid off, or (3) were waiting to report to a new wage or salary job within 30 days (see Labor force participation rate). The number of unemployed persons divided by the number of people in the labor force is the unemployment rate. Vocational Rehabilitation: This refers to programs conducted by state Vocational Rehabilitation agencies operating under the Rehabilitation Act of 1973 to provide or arrange for a wide array of training, educational, medical, and other services individualized to the needs of persons with disabilities. The services are intended to help these persons acquire, reacquire, or maintain gainful employment. Most of the funding is provided by the federal government. Work disability: Persons were classified as having a work disability by the Current Population Survey (CPS) if they met any of the following criteria: (1) had a health problem or disability which prevents them from working or which limits the kind or amount of work they can do, (2) ever retired or left a job for health reasons, (3) did not work in survey week because of a long-term physical or mental illness or disability which prevents the performance of any kind of work, (4) did not work at all in 1986 because of illness or disability, (5) under 65 years of age and covered by Medicare, (6) under 65 years of age and a recipient of SSI (Supplemental Security Income), or (7) received veteran's disability compensation (see also Severe work disability). Work limitation: In the NHIS, a person can be described as having a work limitation if he or she describes a chronic health condition that prevents performance of work at all, allows only certain types of work to be performed, or prevents him or her from working regularly. Bibliography Federal Data Sources: Subheader 2: Bureau of the Census Bowe, Frank. U.S. Census and disabled adults: The 50 states and the District of Columbia. Arkansas Research and Training Center in Vocational Rehabilitation, University of Arkansas, Arkansas Rehabilitation Services. Hot Springs: April 1984. Bureau of the Census. Current Population Reports, Series P-23, No. 160, Labor force status and other characteristics of persons with a work disability: 1981 to 1988. Special Studies, Washington, D.C.: U.S. Department of Commerce, July 1989. Bureau of the Census. 1990 Census of Population and Housing. Bureau of the Census, Statistical Abstract of the United States: 1995 (115th edition.) Washington, DC, 1995. McNeil, J. M., Americans with Disabilities: 1991-92 U.S. Bureau of the Census. Current Population Reports, P70-33, U.S. Government Printing Office, Washington, DC, 1993. McNeil, J. M., ³Household Survey Data on Employment and Disability,² unpublished memorandum, May, 1996. Subheader 2: Department of Education Ficke, Robert C. Digest of data on persons with disabilities. Washington, D.C.: National Institute on Disability and Rehabilitation Research, 1991. Ing, Christine D. and Tewey, Betsy P. Summary of data on children and youth with disabilities. Washington, D.C.: National Institute on Disability and Rehabilitation Research, 1994. Kraus, Lewis E. and Stoddard, Susan. Chartbook on Work Disability in the United States. An InfoUse Report. Washington, D.C.: National Institute on Disability and Rehabilitation Research, 1991. Kraus, Lewis E. and Stoddard, Susan. Chartbook on Disability in the United States. An InfoUse Report. Washington, D.C.: National Institute on Disability and Rehabilitation Research, 1989. LaPlante, Mitchell P., Kennedy, Jae, Kaye, H., S., and Wenger, Barbara L. Disability and Employment, Disability Statistics Abstract #11. Disability Statistics Rehabilitation Research and Training Center. Washington, D.C.: National Institute on Disability and Rehabilitation Research 1996. LaPlante, Mitchell P. and Carlson, Dawn. Disability in The United States: Prevalence and Causes, 1992, Disability Statistics Rehabilitation Research and Training Center, Institute for Health and Aging, University of California, San Francisco, CA, 1995 LaPlante, Mitchell P. and Cyril, Julianna. Disability in the States, Disability Statistics Abstract #6. Disability Statistics Program. Washington, D.C.: National Institute on Disability and Rehabilitation Research 1993 LaPlante, Mitchell P. Disability risks of chronic illnesses and impairments, Disability Statistics Report. No. 2. A publication of the Disability Statistics Program, San Francisco, CA: National Institute on Disability and Rehabilitation Research, 1989. LaPlante, Mitchell P. Data on disability from the National Health Interview Survey, 1983-85. An InfoUse Report. Washington, D.C.: National Institute on Disability and Rehabilitation Research, 1988. Prouty, R. and Lakin, K. C. Eds. ³Status and trends through 1995² Residential services for persons with developmental disabilities. Minneapolis: University of Minnesota Research and Training Center on Community Living, 1996 Rehabilitation Services Administration, Tabulations based on FY 1995 quarterly cumulative case load report, Form RSA-133, 1996 Trupin, Laura. Unpublished tables on trends in work disability. 1996 Trupin, Laura, Rice, Dorothy P., and Max, Wendy. Medical expenditures for people with disabilities in the United States, 1987. Washington, DC: National Institute on Disability and Rehabilitation Research, 1995. U.S. Office of Special Education and Rehabilitative Services. Seventeenth annual report to Congress on the implementation of the Individuals with Disabilities Education Act. Washington, DC: U.S. Government Printing Office, 399-652/20003, 1995 Wenger, Barbara L., Kaye, H., S., and LaPlante, Mitchell P. Disability Among Children, Disability Statistics Abstract #15. Disability Statistics Rehabilitation Research and Training Center. Washington, D.C.: National Institute on Disability and Rehabilitation Research 1995. Subheader 2: Department of Labor Bureau of Labor Statistics. News release '94, USDL-95-508 Workplace injuries and illnesses in 1994. World Wide Web Site http://www.bls.gov, 1995. Bureau of Labor Statistics, Occupational injuries and illnesses in the United States, by industry, 1987, U.S. Department of Labor, Bulletin 2328, Washington D.C.: U.S. Government Printing Office, 1989 - 237-199/00345, May 1989. Subheader 2: National Center for Health Statistics Barker, P.R., Mandersheid, R.W., Hendershot, G.E., et al. ³Serious mental illness and disability in the adult household population: United States 1989.² advance data from Vital and Health Statistics; no. 218. Hyattsville, Maryland: National Center for Health Statistics, 1992. LaPlante, MP, Hendershot, GE, Moss, AJ. Assistive technology devices and home accessibility features: prevalence, payment, need, and trends. Advance data from vital and health statistics; no. 217. Hyattsville, Maryland: National Center for Health Statistics, 1992. National Center for Health Statistics, ³Prevalence of chronic conditions in the United States (in manuscript - 1996). National Center for Health Statistics, Current estimates from the National Health Interview Survey, United States, 1994. Vital & Health Statistics: Series 10, No. 193. DHHS Pub. No. (PHS) 96-1521. Public Health Service, Hyattsville, MD. National Center for Health Statistics. Health of our nation's children. Vital & Health Statistics: Series 10, No. 191. DHHS Pub. No. (PHS) 95-1519. Public Health Service, Hyattsville, MD, December 1994. National Center for Health Statistics, Current estimates from the National Health Interview Survey, United States, 1993. Vital & Health Statistics: Series 10, No. 190. DHHS Pub. No. (PHS) 95-1518. Public Health Service, Hyattsville, MD. National Center for Health Statistics. Types of injuries and impairments due to injuries, United States. Vital & Health Statistics: Series 10, No. 159. DHHS Pub. No. (PHS) 87-1587. Public Health Service, Hyattsville, MD, November 1986. Subheader 2: National Institute of Mental Health Bourdon, K.H., Rae, D.S., Narrow, W.E., Manderdscheid, R.W., and Regier, D.A. ³National Prevalence and Treatment of Mental and Addictive Disorders² in Mental Health, United States, 1994. Manderscheid, R.W. and Sonnenschein, M.A. (eds.). Center for Mental Health Services, DHHS Pub. No. (SMA) 94-3000. Washington D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1994. National Advisory Mental Health Council. ³Health care reform for severe mental illnesses.² American Journal of Psychiatry; 150:10, October 1993. Subheader 2: Social Security Administration Social Security Administration. Security Bulletin Annual Statistical Supplement, 1995. Baltimore, MD: U.S. Department of Health and Human Services, August 1995. Non-federal Data Sources: Nagi, S. Z. (1991). Disability concepts revisited: Implications for prevention. In A,M. Pope and A.R. Tarlov (Eds.), Disability in America: Toward a National Agenda for Prevention (Appendix A, pp. 309-327). Washington, DC: National Academy Press. N.O.D./Harris survey of Americans with disabilities. Louis Harris and Associates, Inc. New York, N.Y. 1994. Stucki, Barbara. Living in the community with a disability. A publication of the Public Policy Institute. American Association of Retired Persons, 1995. World Health Organization (1980). International classification of impairments, disabilities and handicaps: A manual of classification relating to the consequences of disease. Geneva. Appendix In this appendix, information on the sources and limitations of the data is presented. The major surveys covered in this publication are the Current Population Survey (CPS), the National Health Interview Survey (NHIS), the Survey of Income and Program Participation (SIPP), the Annual Survey of Occupational Injuries and Illnesses (ASOII), and the Census. These surveys provide the most current national numbers and estimates from respondent-based information. Estimates from surveys are within the past 7 years. The following summaries will cover the surveys, their sampling formats, the respondent size, and definitions of terms used in the surveys concerning work disability and how it is measured. More details can be found in the original publications. NHIS - The National Health Interview Survey is a nationwide sample of households done by the National Center for Health Statistics (NCHS). It queries the civilian, noninstitutionalized population of the United States on its health. For disability purposes, it is concerned with activity limitations and chronic conditions. Sampling - A multistage probability design permitting a continuous sampling of the civilian noninstitutionalized population living in the United States. Each weekly sample is representative of the target population and is additive with other weekly samples. Sampling is done throughout the year thus preventing seasonal bias. The samples are grouped in four major geographic regions: Northeast, Midwest, South, and West. Surveys after 1985 use a redesign of the sampling which reduces sampling units by half and oversamples the black population. Respondents - The following samples were reached: 1993 - 109,671 persons and in 1994 - 116,179 persons. Response rate was approximately 95.6% in 1993 and 94.1% in 1994. Definitions - Chronic condition is one noticed for three months or more, or being on the NCHS list of chronic conditions. Disability refers to any long or short-term reduction of a personıs activity as a result of an acute or chronic condition. Limitation of activity is a long-term reduction in a personıs capacity to perform the average kind or amount of activities associated with his or her age group. SIPP - The Survey of Income and Program Participation is a longitudinal survey conducted by the Bureau of the Census. The data in this publication come from the third wave of the 1991 panel and the sixth wave of the 1990 panels of the SIPP. For the 1991-92 report, the topical modules included questions on disability status. The SIPP covers the noninstitutionalized population of residents living in the U.S. Sampling - The same households are interviewed every four months. A cycle of four interviews covering the entire sample, using the same questionnaire, is called a wave. The 1990 panel contains an oversample of Black headed households, Hispanic headed households and female headed family households with no spouse present and living with relatives. Respondents - The sample size for October 1991 to January 1992 was 34,000 households. While no numbers are given on number of individuals interviewed (because it is a household survey) , a rough estimate would be 85,000 (using an estimated 2.5 persons per household). The response rate ranged from 81.7% in October to 82.3% in November. Definitions - Functional limitations are defined from the questions asked about the difficulty in performing basic functional activities (seeing, hearing, having one's speech understood, walking, carrying or lifting 10 lbs., and walking up a flight of stairs). A person age 15 and over was considered to have a Disability if they met the following criteria: (a) used a wheelchair; (b) had used a cane or similar aid for 6 months or longer; (c) had difficulty with a functional activity; (d) had difficulty with an ADL; (e) had difficulty with an IADL; or (f) was identified as having a developmental disability or a mental or emotional disability. A person also was considered to have a disability if: (g) the person were 16 years and over and had a condition that made it difficult to do housework; (h) the person were between 16 and 67 years old and had a condition that limited the amount or kind of work the person could do at a job; (i) the person were under 21 years old and their parents responded on the survey about receipt of developmental services, and limitations in usual activities, the ability to do regular schoolwork, or the ability to walk, run, or use stairs; and (j) the person were under age 65 and covered by Medicare or received SSI. Activities of daily living (ADLs) cover getting around inside the home, getting into and out of bed or a chair, bathing, dressing, eating, and toileting. Instrumental activities of daily living (IADLs) cover going outside the home, keeping track of money or bills, preparing meals, doing light housework, and using the telephone. CPS - The Current Population Survey is a monthly survey done by the Bureau of the Census which deals mainly with labor force data for the civilian noninstitutional population. The part of the survey with which we are concerned for this publication is the March Income Supplement. Questions relating to labor force participation are asked of all members who are 14 or older in a household. In March, supplementary questions are asked about income thereby supplying the data for characteristics of noninstitutionalized persons with a work disability. Sampling - The CPS sample was selected from the 1970 Census files covering all 50 states and the District of Columbia. The sample is continuously updated to reflect new construction. Respondents - 60,500 households were eligible, but 2,500 were nonresponses (95.8% response rate). This translates into approximately 120,000 persons (assuming 2.5 people per household and lowering the estimate because the sample only includes ages 14 and above). Definitions - Work disability is the only disability measured by the CPS. People are classified as having a work disability if they (1) have a health problem or disability which prevents them from working or limits the kind or amount of work they can do; or (2) ever retired or left a job for health reasons; or (3) did not work in the survey week because of long-term physical or mental illness or disability that prevents the performance of any kind of work; or (4) did not work at all in previous year because of illness or disability; or (5) are under 65 years of age and are covered by Medicare; or (6) are under 65 years of age and a recipient of SSI (Supplemental Security Income); or (7) received veteran's disability compensation. ASOII - The Annual Survey of Occupational Injuries and Illnesses collects data on work-related injuries, illnesses, and fatalities for the Bureau of Labor Statistics from a random sample of private establishments. Sampling - An independent sample is selected for each state. The sample design is based on the total recorded case incidence rate. The sample is stratified on the Standard Industrial Classification (SIC) code and employment. Respondents - The survey covered 280,000 private establishments and represents about 83 million workers in the private sector. ECA - The National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Survey is a multisite epidemiologic and health services research study that assesses mental disorder prevalence, incidence, and service use rates. The five sites for the study and the participating universities which carried it out were New Haven, CT (Yale); Baltimore, MD (Johns Hopkins); St.Louis, MO (Washington University); Durham, NC (Duke); and Los Angeles, CA (UCLA). Sampling - Population sizes in the five sites ranged from 270,000 to 420,000 with mixes of urban, rural, and suburban locations as well as ethnic and age compositions. One adult age 18 or over was surveyed in each of a probability sample of households in an area. Oversamples were done for elderly in New Haven and Durham, and blacks in St. Louis; and in Los Angeles, one area was predominantly Hispanics. Respondents - A total of 18,571 persons were interviewed, ranging from 3,004 to 5,034 completed interviews at each site. Definitions - The ECA diagnosed mental disorders according to the diagnostic criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders - Third Edition (DSM-III) of the American Psychiatric Association. NMES - The National Medical Expenditures Survey is a national probability sample of households done for the Agency for Health Care Policy and Research (AHCPR). It asked the civilian, noninstitutionalized population of the United States and medical providers about medical service use and expenditures, source of payments for health care, and health insurance coverage. It measured disability at two levels: activity limitations and activities of daily living (ADLs) limitations. Sampling - The NMES has a stratified multistage area probability sample design . The survey oversamples for poor and low income families, the elderly, persons with functional limitations, blacks, and Hispanics. Participants were interviewed five times between February 1987 and July 1988. Respondents - The screener interview occurred in 35,600 households. The resulting sample consists of approximately 35,00 persons in 14,000 households. Definitions - Activity limitation is defined by age group. For those age 18 and over - if their health keeps them from working at a job, doing work around the house, or going to school; and being unable to do certain types of work, housework, or schoolwork because of health. For people age 5-17 - if the child attends or needs to attend special schools or classes because of an impairment or health problem; if the child is limited in school attendance or unable to attend school because of health; and if the child is limited in any way in any activities because of impairment or health. For children under age 5 - if the child was unable to take part in at all in the usual kind of play activities done by most children at this age; and if the child is limited in any way because of an impairment or health problem. Activities of daily living (ADLs) cover getting around inside the home, getting into and out of bed or a chair, bathing, dressing, eating, and toileting. Acknowledgments This chartbook on Disability, 1996 relies on the published data from several federal agencies and organizations. We are very thankful to all the people and agencies who have collected, maintained, and analyzed this data. The following people were very gracious and helpful by providing their most current information to us and reviewing our text and graphics: Jack McNeil, Bureau of the Census Gerry Hendershot, National Center for Health Statistics Gary Collins, National Center for Health Statistics Karen Bourdon, National Institute for Mental Health Cille Kennedy, National Institute for Mental Health Daryl Regier, National Institute for Mental Health Dora Teimouri, Rehabilitation Services Administration Laura Trupin, Research and Training Center on Disability Statistics Mitchell LaPlante, Research and Training Center on Disability Statistics K. Charles Lakin, University of Minnesota Research and Training Center on Community Living Julia Bradsher identified statistical sources and contributed to the development of the chartbook. Sean Sweeney, NIDRR Project Officer, has provided statistical materials and advice. This Chartbook is one product of the InfoUse Center on "Improving Access to Disability Data," a grant supported by the National Institute on Disability and Rehabilitation Research. This is one of a series of products and activities intended to make information on disability and on disability statistics available to wider audiences