Californians with Activity Limitations: Data from the California Health Interview Survey 2001

Galatea King, M.P.H.

| Background | Methods | Results | Discussion | Limitations | Conclusion | References |

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Background

Disability is one of the greatest public health concerns, because it eventually affects everybody, directly or indirectly. About 19 percent of Californians over the age of five, or 5.9 million people, have some disability, according to the United States Census (1). A priority of the Office on Disability and Health in the California Department of Health Services (DHS) is to provide accurate information about disability, for example, by describing the population experiencing disabilities in California. This information will be useful to citizens and policy makers who want to understand disability and how people with disabilities can be helped or hurt by public policies.

Nationally, research consistently shows that different parts of the population, such as women, the elderly, and certain race/ethnic groups, are more likely to experience disabilities (2, 3, 4). People who are unemployed, less educated, and of lower income are also more likely to have a disability (3, 4, 5, 6). Although much research has been done on the national level, not much is known about people with disabilities in California.

In this report, we use data from the 2001 California Health Interview Survey (CHIS) to give a basic description of one particular type of disability—activity limitation.  We explore two issues:

• How many adults in California are limited in activity or use special equipment?
• What can we say about Californians who report activity limitations? How do they differ from other Californians in age, sex, race/ethnicity, employment, income, and education?

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Methods and Data

A collaboration between the University of California, Los Angeles, DHS, and the Public Health Institute, CHIS interviewed California adults between November 2000 and September 2001. CHIS covers information on a variety of health issues and behaviors of Californians. CHIS is a random-digit dial telephone survey administered to 55,428 households. Not every household is reached or responds to a telephone survey (see Limitations, below). CHIS uses statistical methods to adjust for these “nonresponse biases.” Statistical adjustment procedures ensure that survey estimates reflect California’s adult population by weighting the data to match the 2000 population on age, race/ethnicity, and sex.

Definition of Disability

Disability is a rather general concept that covers a variety of conditions and an even greater variety of ways of living with them. The Americans with Disability Act (ADA) of 1990, puts forth this definition: a person with a disability has “a physical or mental impairment that substantially limits one or more of the major life activities of such individual (7).” Major life activities include such things as attending school and going to work, and even eating, bathing, and going to the bathroom. Thus, it is not the condition itself that is the disability, rather the inability to perform an activity, such as walking or carrying things.

The rather broad ADA definition of disability is useful for policy purposes but is too general to use in research, especially statewide surveys. Because of the particular questions used in CHIS, we can only identify a portion of this population—people who report certain activity limitations—based on responses to the following questions:

1. Does your health limit you a lot, a little, or not at all in doing moderate activities, such as moving a table, pushing a vacuum cleaner, or playing golf?
2. And how much does your health limit you when climbing several flights of stairs?
3. Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?

Someone who responded “limited a lot” or “yes” to any (or all) of these questions was considered to have an activity limitation. Thus, we are able to estimate how many Californians report one or more activity limitations and which population segments are most likely to report limitations. We assumed that people who report all three limitations face more challenges than people who report fewer or none. The proportion of those who report one, two, or three limitations is shown in the table, along with the estimated number of Californians. In this report, we will simply compare respondents who report no limitations with those who gave an affirmative answer to any of the three questions.

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Results

Approximately 3.4 million or 14 percent of the California adult population report being limited in activity or using special equipment. This total consists of about 1.9 million Californians (eight percent) reporting one limitation, 970,000 (four percent) reporting two limitations, and 580,000 (two percent) reporting three limitations.

Who in California is most likely to report limitations? (See Figure)

Gender. The Figure shows that women are more likely to report a limitation (16 percent) than are men (12 percent).

Age. Older adults are much more likely to report a limitation than the younger adults. The proportion reporting limitations among those 70 years of age and older is five times the proportion of those 18-29 years old (39 percent versus seven percent).

Race/Ethnicity. The proportion of people who report limitations varies by race/ethnicity. African Americans and American Indian/Alaskan natives have the largest proportions who report limitations, 22 percent and 26 percent respectively. Latinos and Asian/Pacific Islanders have the smallest proportions who report limitations; 12 percent of Latinos, and 11 percent of Asian/Pacific Islanders. Whites and the Other category are in the middle with 15 percent and 16 percent, respectively.

Marital Status. Married people are less likely to report limitations than those widowed/separated/divorced; 13 percent of married people report at least one limitation versus 22 percent of those widowed/separated/ divorced. Those never married had the lowest rate of limitations at nine percent.

Education. The proportion who report limitations differs by the level of education. For example, those with less than a high school education have the highest proportion of people who report having at least one limitation (20 percent). This proportion decreases as the level of education increases such that those with the highest level of education, graduate school level, have the lowest proportion who report at least one limitation (eight percent).

Employment. Respondents not currently working are four times more likely to report at least one limitation than those who are working. More specifically, 29 percent of those not working report a limitation versus seven percent of those currently working.

Household Income. As annual household income increases, the proportion of those reporting at least one limitation decreases. More than one-forth (29 percent) of those with an income less than $10,000 a year report a limitation, whereas only eight percent of those with an annual household income of at least $50,000 report a limitation.

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Discussion

Who has disabilities?

Californians most likely to report limitations are women; people age 50 years and older; people of African American or American Indian/Alaskan native descent; and people who are separated, widowed, or divorced. People with a high school education or lower, those who are unemployed, and those with a household income less than $20,000 are also more likely to report limitations.

These findings raise important questions for further investigation. For example, is a low income a cause of disability or does disability cause a person to have a low income? It is also interesting to note that Latinos and Asian/Pacific Islanders both have proportions reporting limitations below the state average, 12 percent and 11 percent respectively. This is no doubt partly due to the fact that these populations have a smaller percentage of older people, but cultural or social differences could also play a role in how they experience or even report activity limitations. All in all, we clearly need more studies to better understand Californians who cope with activity limitations and other disabilities.

Although much research documents the health risks faced by women, the elderly, the unemployed, etc., not much research has been done to show the health risks experienced by Californians with disabilities. In addition to experiencing limitations, people with disabilities belong to segments in society vulnerable to discrimination and poor health outcomes. To the extent that people experiencing limitations tend to be older, poorer, less educated, and more often unemployed, they will lack the resources to reach and maintain a high quality of life.

Little is known about disparities in health-related outcomes and barriers to accessing health care faced by people with disabilities. For example, research is needed that looks at the rates of reproductive health screening among women with disabilities and compares that to the rates of screening among women without disabilities. There is also a need for information on quality of life indicators, such as days of pain, anxiousness, or sadness, and how the population with disabilities compares to those without disabilities. Having this information would help us understand the population and identify ways to meet their needs.

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Limitations of this analysis

CHIS represents Californians available by phone living in non-institutional residences. Since many people with disabilities have low household incomes, they may be without a phone and thus may not be included. People with limitations who are in care facilities at the time of the survey would also be excluded. Similarly, people with a hearing impairment, cognitive impairment, or with a health condition that prevents them from answering the phone, are, unfortunately, excluded from the survey.

The disability questions focused on physical limitations and did not address mental or emotional health as a disability. Some of the reported limitations may be transitory conditions (e.g., a sprained ankle or broken leg), although research has shown they comprise a small proportion of the population. Overall, we assume that the data underestimate the number of people with activity limitations, and surely they underestimate the number of people with disabilities.  We are collaborating with other researchers and people with disabilities to develop more efficient survey questions.

Not surprisingly, older persons are much more likely to report limitations than are younger persons. Age is also related to all of the other variables that proved to be important in the figure. That is, older persons are more like to have low incomes, be unemployed, etc. Future studies should look carefully at how aging affects all the patterns revealed in the present analysis.

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Conclusions

About 3.4 million California adults report at least one limitation, roughly 14 percent of the population.

• Californians most likely to report a limitation are more often women; people aged 50 and older; of African-American or American Indian/Alaskan native descent; and those separated, divorced, or widowed.
• Californians with a high school education or less, those who are unemployed, and those with a household income less than $20,000 are most likely to report limitations.
• Californians reporting activity limitations are especially likely to belong to segments of the population that lack the resources to deal with activity limitations and other health-related conditions.

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References

1. Waldrop J., Stern S. Census 2000 Brief: Disability Status 2000. U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, March 2003. Available at http://www.census.gov/prod/2003pubs/c2kbr-17.pdf
2. Bradsher, J.E. (1996). Disability Among Racial and Ethnic Groups. Disability Statistics Abstract (10). Washington, DC: U.S. Department of Education, National Institute on Disability and Rehabilitation Research.
3. Jans, L., Stoddard, S. (1999) Chartbook on Women and Disability in the United States. An InfoUse Report. Washington, D.C.: U.S. National Institute on Disability and Rehabilitation Research.
4. LaPlante, M.P., Carlson, D. (1996). Disability in the United States: prevalence and causes, 1992. Disability Statistics Report (7). Washington, DC: U.S. Department of Education, National Institute on Disability and Rehabilitation Research.
5. LaPlante, M.P., Carlson, D., Kaye, H.S., Bradsher, J.E. (1996). Families with Disabilities in the United States. Disability Statistics Report, (8). Washington, DC: U.S. Department of Education, National Institute on Disability and Rehabilitation Research.
6. LaPlante, M.P., Kennedy, J., Kaye, H.S., Wenger, B.L. (1996). Disability and Employment. Disability Statistics Abstract (11). Washington, DC: U.S. Department of Education, National Institute on Disability and Rehabilitation Research.
7. Americans with Disabilities Act, 3 (2)(A), 42 U.S.C. §12102 (2)(A).

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The California Department of Health Services, Epidemiology and Prevention for Injury Control (EPIC) Branch publishes EPICgram to inform the public about injury patterns, prevention programs, and opportunities to protect the lives and health of all Californians.

This EPICgram was supported by a Cooperative Agreement #U59/CCU921228-02 with the Centers for Disease Control and Prevention (CDC) to EPIC’s Office on Disability and Health. The author, a Fellow of the California Epidemiologic Investigation Service, is grateful to members of the Living Healthy with a Disability Program Advisory Committee who provided invaluable suggestions on early drafts. The EPICgram contents are solely the responsibility of the author and do not necessarily represent CDC’s official views. If you have any comments or questions regarding this EPICgram, please contact Roger Trent, Ph.D. Chief, Injury Surveillance and Epidemiology Section, at (916) 552-9858, or e-mail rtrent@dhs.ca.gov.

Arnold Schwarzenegger, Governor, State of California
S. Kimberly Belshé, Secretary, Health and Human Services Agency
Diana M. Bontá, R.N., Dr.P.H., Director, Department of Health Services
Alexander Kelter, M.D., Chief, EPIC Branch
Roger B. Trent, Ph.D., Chief, Injury Surveillance and Epidemiology Section
Barbara Alberson, M.P.H., Chief, State and Local Injury Control Section
Lisa Hershey, M.P.H., Program Manager, Living Healthy with a Disability

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