Prevalence of Disabilities and Health Care Access by Disability Status and Type Among Adults — United States, 2016

Abstract

Persons with disabilities face greater barriers to health care than do those without disabilities (1). To identify characteristics of noninstitutionalized adults with six specific disability types (hearing, vision, cognition, mobility, self-care, and independent living),* and to assess disability-specific disparities in health care access, CDC analyzed 2016 Behavioral Risk Factor Surveillance System (BRFSS) data. The prevalences of disability overall and by disability type, and access to health care by disability type, were estimated. Analyses were stratified by three age groups: 18-44 years (young adults), 45-64 years (middle-aged adults), and ≥65 years (older adults). Among young adults, cognitive disability (10.6%) was the most prevalent type. Mobility disability was most prevalent among middle-aged (18.1%) and older adults (26.9%). Generally, disability prevalences were higher among women, American Indians/Alaska Natives (AI/AN), adults with income below the federal poverty level (FPL), and persons in the South U.S. Census region. Disability-specific disparities in health care access were prevalent, particularly among young and middle-aged adults. These data might inform public health programs of the sociodemographic characteristics and disparities in health care access associated with age and specific disability types and guide efforts to improve access to care for persons with disabilities. BRFSS is an ongoing state-based, random-digit-dialed telephone survey of noninstitutionalized U.S. adults aged ≥18 years. † The median survey response rate among the 50 states and the District of Columbia in 2016 was 47.0%. § The 2016 BRFSS survey included questions about six disability types (hearing, vision, cognition, mobility, self-care, and independent living). ¶ Respondents were identified as * Based on Section 4302 of the Affordable Care Act, the U.S. Department of Health and Human Services issued data collection standard guidance to include a standard set of disability identifiers in all national population health surveys. https://aspe.hhs.gov/datacncl/standards/aca/4302/index.pdf. † https://www.cdc.gov/brfss/. § Response rates for BRFSS are calculated using the standard set by the American Association for Public Opinion Research response rate formula 4 (http://www.aapor. org/AAPOR_Main/media/publications/Standard-Definitions20169theditionfinal. pdf). The response rate is the number of respondents who completed the survey as a proportion of all eligible and likely eligible persons. https://www.cdc.gov/brfss/ annual_data/2016/pdf/2016-sdqr.pdf. ¶ The interviewer first reads a preamble to the telephone survey respondent ("The following questions are about health problems or impairments you may have. Some people who are deaf or have serious difficulty hearing may or may not use equipment to communicate by phone."), followed by the six specific disability type questions. The questions are "Are you deaf or do you have serious difficulty hearing?" (hearing); "Are you blind or do you have serious difficulty seeing, even when wearing glasses?" (vision); "Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?" (cognition); "Do you have serious difficulty walking or climbing stairs?" (mobility); "Do you have difficulty dressing or bathing?" (self-care); and "Because of a physical, mental, or emotional condition, do you have difficulty doing errands alone such as visiting a doctor's office or shopping?" (independent living). having one of the disability types if they answered "yes" to the relevant question. Persons who responded "yes" to at least one disability question were identified as having any disability. Persons who responded "no" to all six questions were identified as having no disability. Missing responses and respondents who answered "don't know" or who declined to answer were excluded. Four health care access measures (i.e., health insurance coverage, having a usual health care provider, receipt of a routine checkup within the past year, and having an unmet health care need because of cost) were included.** Prevalences (with 95% confidence intervals) were calculated for any disability and disability type by sex, race/ethnicity, † † FPL, § § and U.S. Census region, and for health care access measures, by disability status and types. All analyses were stratified by age group (18-44, 45-64, and ≥65 years). Analyses accounted for the complex sampling design. One in four noninstitutionalized U.S. adults (25.7%, representing an estimated 61.4 million persons) reported any disability (Table 1) (Figure). Mobility was the most prevalent disability type (13.7%), followed by cognition (10.8%), independent living (6.8%), hearing (5.9%), vision (4.6%), and self-care (3.7%). Prevalences of any disability, hearing, mobility, and independent living disabilities were higher among older adults, whereas prevalence of cognitive disability was highest ** Health insurance coverage was ascertained by a "yes" response to the question "Do you have any kind of health care coverage, including health insurance, prepaid plans such as health maintenance organizations, government plans such as Medicare, or Indian Health Service?" Having a usual health care provider was assessed first with the question "Do you have one person you think of as your personal doctor or health care provider?" Persons who responded "no" were asked the question "Is there more than one, or is there no person who you think of as your personal doctor or health care provider?" Responses for having a usual health care provider were dichotomized into one or more and none. Receipt of a routine checkup was assessed with the question "About how long has it been since you last visited a doctor for a routine checkup? A routine checkup is a general physical exam, not an exam for a specific injury, illness, or condition." Responses for having had a routine checkup within the preceding 12 months were dichotomized into within the past year or not within the past year. Unmet health care need because of cost was ascertained by a "yes" response to the question "Was there a time in the past 12 months when you needed to see a doctor but could not because of cost?" † † Persons in all racial groups were non-Hispanic. Persons who self-identified as Hispanic might have been of any race. § § Poverty categories are based on the ratio of the respondent's annual household income to the appropriate simplified 2015 federal poverty threshold (given family size: number of adults (1-14) in the household and number of children (≥0) in the household) defined by the U.S. Census Bureau. This ratio is multiplied by 100 to be expressed as a percentage, and federal poverty thresholds were then used to categorize respondents into four FPL categories: 1) <100% of FPL (poor), 2) ≥100%-<200% of FPL (near poor), 3) ≥200% of FPL (not poor), and 4) unknown.