ODDC- Plenary Sessions on the Changing Demography at the Physical Disabilities through the Lifespan Conference

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TITLE:Plenary Sessions on the Changing Demography at the Physical Disabilities through the Lifespan Conference- July 21-22, 2003

Speakers: Mary Chamie, Ph.D., Demographics and Social Statistics, United Nations; Mitchell LaPlante, Ph.D., Director of Disability Statistics Center, University of California; Richard Burkhauser, Ph.D., Department of Policy Analysis and Management, Cornell University; Agustin Escalante, M.D, Division of Rheumatology and Clinical Immunology; University of Texas Health Science Center. (Katherine Cargill-Willis 2/27/04)

Global Disability: The United Nations Statistics Division (UNSD) recommends that measurement of disability be done within the conceptual framework of the WHO International Classification of Functioning, Disability and Health (ICF). The ICF conceptual framework provides standardized concepts and terminology that can be used in disability measurement. The use of a common framework also contributes to greater comparability of data at the national and international levels, thereby increasing the relevance of the data to a wide set of users. ICF represents a conceptual model of disability capturing contextual factors; environment can limit or facilitate participation. Information about disability came from censuses, surveys and administrative records.

Disability increase as age increase and the strongest relationship seems to be in Australia, but how does age influence human function and activity?

Principles of official statistics:

Public trust in official statistical information
Respect for fundamental values of society and the rights of its members
Need for citizen participation
Established standards and concepts
Disability statistics are covered under the regular principles of official statistics and are an integral part of population, housing, economic, social and health planning
Disability covers many aspects of human activity and participation, but there is not one prevalence rate that can capture it all

Definitions: In the past disability has been defined as a difficulty or inability to perform human function or to engage in human activities in interaction with the physical and social environment. Alternative ways of looking at disability and its impact is to look at how people do things differently including problematic social interactions or poor health and stamina. It is important to integrate disability into regular statistics of programs of economics, demography, social planning, housing, environment and health.

A physical disability is a disability caused by any thing other than a mental disorder. Most disabilities are caused by physical conditions and most mental health disabilities co-occurs with a physical disability

Physical Disability Vs. Mental Disability:

About twelve percent of people with physical disabilities have a mental health disability
About sixty percent of people with a mental health disability have a physical disability and the both increase with age

Economics and Disability: In the U.S. there are three definitions or questions to measure disability:

The Current Population Survey’s (CPS) work limitation question was: does anyone in the household have a health problem or a disability that prevents from working or limits the work he or she can do?

National Health Interview Survey’s (NHI) Work limitation question was: does any impairment or health problem NOW keep the person from working at a job or a business? Is the person limited in the kind or amount of work the person can do because of the impairment?

The U.S. Census Bureau’s Survey of Income and Program Participation (SIPP) work limitation question was: does the person have a physical or mental, or other health condition that limits the kind or the amount of work they can do?

According to all three measurements, employment for people with disabilities has increased. When using the SIPP work limitation question, employment is up to 75%, but when using other questions, employment is down to 30 %.

Problems with the CPS Data: Are the CPS data "valid" for measuring the employment population trends of persons with disabilities? The Federal Government should not encourage or support the dissemination of employment data until a methodology for assessing employment rates among people with disabilities that is acceptable to leading researchers and demographers in the field and credible to persons with disabilities can be developed.

Incidence of Disability in the U.S. Varies by Region: When using a measurement of disability that includes functional and activity limitations, the Appalachian and Mississippi Valley states persistently have the highest rates of disability.

Changing Demographics and Epidemiology of Disability: The population is aging in all developing countries is the most important demographic change in the 21st century and as age increase both functional and activity increase. The reasons for the age increase are:

Low rate of fertility
Low rate of mortality at advance ages
More people surviving to advance ages
Baby Boomers are now 39 to 57 years old
The decrease in cardiovascular mortality
Lower disability rate as a result of circulartory disease

Age and Disability:

Disability from circulartory disease is the most prevalent cause of activity in people 45 and over, but this number has decreased.

In the U.S. both men and women are living longer, especially women and the elderly share of population is increasing

The percentage of seniors who need attendant care has remained constant since 1997

Changing Epidemiology in the Working Ages:

Heart disease has declined as a cause of disability in the working ages
Mental illness has increased, a trend also observed in SSDI/SSI awards
A large decline in back disorders as a cause of disability in working ages after 1990
Both men and women with disabilities make less than people without but the difference is greater between women with disabilities and women without them.

Changes in Population by Disability: Life expectancy of certain populations with early onset disability, such as MR/DD, birth defects and juvenile diabetes are increasing. But the low prevalence makes this decrease hard to measure. Other facts include:

People with mental retardation are living longer
Spina Bifida rates are declining drastically

Employment by Disability:

42.4% of people with cerebral palsy are working
39.1% of people who are blind in both eyes are working
68% of people who are deaf in both ears are working
25.1% of people with paraplegia or quadriplegia are working

Minorities with Disabilities: In the U.S. the minority population, especially the Hispanic population, is increasing. Minorities are at greater risk of acquiring a disability causing conditions, like osteoarthritis, and they are less likely to receive disability-relieving treatment, like knee or joint replacements. The data on minorities and disabilities is sparse which makes solutions hard to find. The fact known are:

More Hispanics have arthritis and activity limitations from arthritis than whites especially women
Knee replacements have increased especially in the southwest
More Hispanics use Medicaid according to surname data

The Need for Future Research:

Changes in incidence and duration of disability need to be studied as well as prevalence.
Is the decline in cardiovascular disease due to the reduce incidence, or enhanced survival, or both?
What can be done to better see how people with disability are aging? Follow-up studies on specific populations are needed?
Disability is associated with low education. If educational attainment were improved, would disability decline and would regional disparities in disability diminish?
Research is also need to be focus on environmental contributions to disability, including physical and social factors.

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