U.S. Department of Health and Human Services

Task I: Population Profile of Disability

Executive Summary

Pat Doyle

Mathematica Policy Research, Inc.

October 1989

This report was prepared under contract #HHS-88-0047 between the U.S. Department of Health and Human Services (HHS) and Mathematica Policy Research. SysteMetrics/McGraw-Hill was a subcontractor for the project. For additional information about the study, you may visit the DALTCP home page at http://aspe.hhs.gov/daltcp/home.htm or contact the Office of Disability, Aging and Long-Term Care Policy at HHS/ASPE/DALTCP, Room 424E, H.H. Humphrey Building, 200 Independence Avenue, SW, Washington, DC 20201. The e-mail address is: webmaster.DALTCP@hhs.gov. The DALTCP Project Officer was Michele Adler.

Research on the number and characteristics of persons with disabilities has generated widely divergent estimates of the size of the disabled population. Differences abound because no single concept of disability is appropriate for all concerns and policy issues. Accommodating the diverse needs for data on this population group requires multiple definitions that deal both with the types of limitations and with the severity of the limitations.

This report presents estimates of the size and characteristics of the noninstitutionalized population of persons with disabilities, derived from the Survey of Income and Program Participation (SIPP). It is organized by age group (persons under age 18, working-age adults and persons age 65 and older) to accommodate the variation in methods of measuring disability status.

The disability status of children is based on the presence of physical and mental or emotional limitations with 2.3 million defined as disabled (4 percent of the population younger than age 18).

The disability status of the working-age population is based on three different definitions of disability (limitations in functioning, limitations in work, and the receipt of disability benefits) and, within the first two, the extent to which individuals are limited. The functional limitations definition is presented first as it has a parallel among the elderly population (see Table 1). The prevalence of functional limitations ranges from 1.2 million working-age adults who need assistance with Activities of Daily Living (ADLs) to 10.1 million working-age adults who have difficulty only in one function. Thus, 1 percent of the working-age population can be classified as having the most severe impairments while 7 percent have the least severe level of functional limitations.

The disability status of the elderly is based on the presence of limitations in functioning. Estimates of the percentage of elderly with functional limitations are larger in magnitude than corresponding estimates of the working-age population but exhibit the same increasing pattern as the level of the severity declines (6-15 percent, or 1.7-3.9 million persons).

For certain purposes including comparability to many of the estimates of the size of the disabled population in the literature, it is useful to aggregate the data in Table 1. For example:

• 7.7 million persons ages 18 and older (or 5 percent of the adult population) need assistance with ADLs or Instrumental Activities of Daily Living (IADLs).

• 25.6 million persons (or 11 percent of the total population) can be classified as having a substantial limitation in functioning. This figure includes all adults with limitations classified as Levels I-IV and children with physical, mental, or emotional limitations.

• 37.1 million adults (or 22 percent of those ages 18 and older) have at least some limitation in functioning.

• 41.6 million persons have at least some limitation in functioning including as estimated 2.2 million persons with disabilities who reside in facilities not covered in SIPP and 2.3 million children under 18 with limitations.

Switching to the second concept based on limitations in work, the size of the working-age population with disabilities ranges from 8 million persons who are prevented form working altogether to 18 million persons who have at least some work limitation (the sum of Levels I-III in Table 2). Thus 6 percent of the working-age population is prevented from work while 13 percent have at least some work limitation. On the other hand, 4.4 million, or 3 percent, of the working-age population receive disability benefits under the Social Security, Supplemental Security, or Veterans' programs.

We summarize the characteristics of the noninstitutionalized population after we provide an overview of the purpose of this report and the project to which it belongs.

A. PURPOSE

This report is the first in a series of four reports prepared for the Department of Health and Human Services to gather information on the population of persons with disabilities. This project provides a profile of the disabled population based primarily on SIPP, a nationally representative, ongoing survey of the noninstitutionalized population. SIPP provides a rich source of information on limitations in functioning and in work, combined with detailed sociodemographic and economic characteristics, such as income, assets, earnings and work history, welfare participation, family composition, and health insurance characteristics. The objectives of the four reports in this series, beginning with this report, are as follows:

• To describe the prevalence of disabilities under three alternative definitions--limitations in functioning, work limitations, and the receipt of disability benefits--and to develop statistics on the demographic and economic characteristics of persons with disabilities and on their health insurance coverage and health status.

• To develop a handbook of Federal programs that serve the disabled population.

• To investigate the extent to which persons with disabilities participate in federally sponsored programs, such as Social Security and Supplement Security Income, and the interaction among Federal programs targeted toward persons with disabilities.

• To analyze the work efforts and activities of persons with disabilities.

B. THE CHARACTERISTICS OF THE DISABLED POPULATION

The information on demographic characteristics of the disabled population in SIPP indicates that:

• The prevalence of disability increases with age. If we count children with physical or mental/emotional limitations as having substantial limitations in functioning, then nearly three or four persons with a substantial limitation in functioning are older than 49 years of age, and 45 percent are older than age 64. Among persons without a substantial limitation in functioning, these percentages are 20 and 7, respectively.

• Over 60 percent of the population with a substantial limitation in functioning are women, due to the higher presence of women (2 of 3) among the elderly. However, among children, boys account for nearly 60 percent of the children with disabilities. In addition, women are no more likely than men to receive disability benefits.

• Except among the elderly, blacks are disproportionately represented among persons with substantial limitations in functioning.

• Adults without a high school diploma account for almost 60 percent of adults with substantial limitations in functioning, while they represent only 22 percent of those without substantial limitations in functioning.

• Most of the individuals in the disabled population live with others, but a significant number (one-tenth of the working-age population and about one-third of the elderly) live alone. It is interesting to note, however, that adults who need assistance with ADLs are less likely to live alone than are adults with less severe limitations in functioning.

• Children with limitations are more likely than children without limitations to live with other persons who have disabilities, and almost one-third live in single female-headed households.

SIPP also provides detailed information for determining the economic well-being of persons with and without disabilities. The data reveal that:

• Adults with substantial limitations in functioning and children with limitations are at greater risk of living in poverty than are persons without substantial limitations in functioning. They also tend to reside in households whose mean and median income is lower.

• Children with disabilities live in households that receive a higher percentage of their income from means-tested government programs than do children without disabilities.

• Working-age adults with limitations in functioning live in households which receive a greater share of their income from Social Security and means-tested transfer programs than do persons without limitations in functioning.

• Persons who receive disability benefits live in households that, on average, depend primarily on Social Security and to a lesser extent on earnings and means-tested transfers. Persons who cannot work live in households which rely almost equally on earnings and Social Security income. In contrast, persons with the most severe limitations in functioning live in households that rely substantially more on earnings.

• While Social Security is a major source of income for all elderly persons, those with severe limitations in functioning tend to live in households which depend more on means-tested transfers than do the households of those without limitations in functioning.

• Working-age adults with limitations in functioning are less likely to work than are working-age adults without limitations. Working-age adults who receive disability benefits and working-age adults limited in work but able to work part-time are less likely to work than are persons in the same age range with the most severe limitations in functioning. This pattern is reversed among those with less severe work limitations and limitations in functioning.

The SIPP data show some interesting patterns of health insurance coverage and health status:

• Over one-fifth of children with mental or emotional limitations lack health insurance coverage through private plans or through Medicaid. In contrast, 12 percent of children with physical limitations and 17 percent of children without limitations have no coverage. Children in households whose monthly income is below the poverty level are less likely than children in nonpoor households to have health insurance, due primarily to the receipt of private insurance among nonpoor children.

• Although working-age adults with limitations in functioning are reported to be in poorer health than are persons without limitations in functioning, they are not necessarily less protected by health insurance. The lack of health insurance is more pronounced for persons with mild limitations in functioning than it is for those with severe limitations in functioning or with no impairments. Furthermore, proportionately more people below than above the poverty level lack health insurance.

• Working-age adults with limitations in functioning are more likely to be covered under health insurance from the Federal government in the form of Medicare or Medicaid than they are to be covered under private insurance. Public sources of health insurance are particularly important for poor persons with severe limitations in functioning. For example, over half of the poor persons who need assistance with ADLs or IADLs are covered under Medicaid or Medicare and have no private sources of insurance.

• Medicaid and Medicare play a substantially larger role in providing health insurance coverage to persons who receive disability benefits and to persons who are unable to work than they do for persons with substantial limitations in functioning. Four-fifths of individuals who receive disability benefits and over half of those who are unable to work have Medicaid or Medicare either singly or in combination with another insurance program. In contrast, less than one-third of those with a substantial limitation in functioning have Medicaid or Medicare.

• Virtually all elderly persons, with or without limitations in functioning, are covered by some form of health insurance, due largely to the role played by Medicare and Medicaid.