Health Status Change Associated with Disability Status Change

Background

People with disabilities need community access and social systems that reduce the impact of disability on their quality of life. In 2008, the US government began including disability identifiers in many large national surveys. These questions are intended to identify people with permanent, ongoing disabilities. However, Ward et al. (2017) reported that a substantial share of respondents to the Current Population Survey respond inconsistently to these items over time.  We examined the correspondence of these dichotomous items to a scaled version collected currently in a population-based survey. Across disability type, respondents were very consistent in their responses suggesting the dichotomous items are valid and that change over time in how people respond reflects real change in their disability status (RTC:Rural, 2017).

Myers et al. (2017) reported additional evidence of the validity of these disability status results by examining the correspondence of mobility impairment to other health-related outcomes such as use of mobility equipment and reports of pain. However, they did not report results for all disability types. We present these results here.

Methods

We used Dillman’s (2007) methods to construct a population-based sampling frame by mailing a recruitment letter to randomly selected households in a small western US city. We identified people with disabilities from their response to the six-question disability set used in the American Community Survey. We collected surveys from 525 people in separate households. We collected four waves of data over approximately 18 months. Click here for detailed information about the data collection methods and sample identified.

We collected measures of health status using the Health Related Quality of Life Measures (Moriarty, Kobau, Zack, & Zahran, 2005) and three items (pain, depression, andfatigue) from the Surveillance Instrument of Secondary Conditions (Seekins, Smith, McCleary, Clay, & Walsh, 1990).  Additionally, we used a checklist of disability-related supports to identify supports respondents used, like other people or equipment.

Results

In addition to results reported by Myers et al. (2017) for people with mobility impairments, Tables 1-3 provide the odds ratios from logistic regressions with individual fixed effects of health status indicators on health status or use of supports. This specification relates changes in health status to changes in other health status or support use. Overall, the odds that a respondent’s impairment report changed were positively related to their self-reported health status and use of supports for all impairments except sensory impairments. Respondents were 50-100% more likely to report a change in health status when their health status and use of supports changed at the same time.

Table 1: Odds Ratio of Change in Health Related Quality of Life (HRQoL) When Disability Status Changed

This table shows odds ratios of change in eight Health Related Quality of Life measures for the six disability types as reported in the American Community Survey.  Click the link below for a text description of the data contained in the table.
Click here for a text description of the data presented in Table 1

Table 2: Odds Ratio of Change in Secondary Conditions When Disability Status Changed

This table shows the odds ratio of change in the eight Secondary Condition Surveillance Instruments when disability status changed. Click the link below for a text description of the data contained in the table.
Click here for a text description of the data presented in Table 2

Table 3: Odds Ratio of Change in Supports Used When Disability Status Changed

This table shows odds ratios of change for each of nine categories of supports used by respondents. Click the link below for the text description of the data contained in the table.
Click here for a text description of the data presented in Table 3

Discussion

These results fill out those reported by Myers et al. (2017) to impairments beyond mobility impairment. They are important because evidence that impairment changes over time has not yet identified whether or not change is associated with hypothesized changes in other health status indicators. Further, these results add support to our assertion that the change in self-report is related to real change experienced by respondents and not simply measurement error.

It is important to estimate the size of disabled population accurately for both program and social policy development. Results we have presented previously suggest the size of the population with enduring disabilities is smaller than previously reported. However, the size of the population that experiences impairment during any time is larger than previously reported. While the needs of these two distinct populations surely overlap, current programs and policy may not adequately address the needs of those with transient impairments and slow the onset of enduring disability. Disability onset could be altered with both medical interventions that address impairment status and social interventions that provide earlier accommodations and universal design.

References

Dillman, D. (2007). Mail and internet surveys: The tailored design method. (2nd ed.) New Jersey: John Wiley & Sons, Inc.

Moriarty, D. G., Kobau, R., Zack, M. M., & Zahran, H. S. (2005). Tracking healthy days – a window on the health of older adults. Preventing Chronic Disease, 2(3).

Myers, A., Ward, B., Wong, J., & Ravesloot, C. (2017).  Health Status Change Correlates of Transient Mobility Disability Status:  Evidence that the ACS Six-Question Disability Set Measures Enduring and Transient Disability Status. Missoula, MT: Research and Training Center on Disability in Rural Communities. (Manuscript submitted for publication).

Research and Training Center on Disability in Rural Communities.  Measuring Impairment: Consistency of dichotomous and scaled responses to the six-question disability set. http://pip.ri.umt.edu/pip-home-page/person-2/measuring-impairment/ Accessed May 2, 2017.

Seekins, T., Smith, N., McCleary, T., Clay, J. A., & Walsh, J. (1990). Secondary disability prevention: Involving consumers in the development of a public health surveillance instrument. Journal of Disability Policy Studies, 1(3), 21-35.

Ward, B., Myers, A., Wong, J., & Ravesloot, C. (2017). “Disability Items From the Current Population Survey (2008–2015) and Permanent Versus Temporary Disability Status”, American Journal of Public Health 107, no. 5 (May 1, 2017): pp. 706-708.