Definition

Percentage of persons who responded yes to any of the following questions:[[br]] 1. Are you blind or do you have serious difficulty seeing, even when wearing glasses?[[br]] 2. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?[[br]] 3. Do you have serious difficulty walking or climbing stairs?[[br]] 4. Do you have difficulty dressing or bathing?[[br]] 5. Because of a physical, mental, or emotional condition, do you have any difficulty doing errands alone such as visiting a doctor's office or shopping?[[br]] 6. Are you deaf or do you have serious difficulty hearing?

Numerator

Includes survey respondents ages 18 and older who reported they had experienced any of the six disability types. Excludes those with missing, don't know, and refused answers.

Denominator

Includes survey respondents ages 18 and older. Excludes those with missing, don't know, or refused answers.

Data Interpretation Issues

Because age affects the likelihood of having many types of disability, it is beneficial to adjust for the effect of age when comparing populations. This helps determine if certain populations have factors that contribute to disability prevalence other than the effect of age. Beginning in 2011, BRFSS data included both landline and cell phone respondent data along with a new weighting methodology called iterative proportional fitting, or raking. This methodology utilizes additional demographic information (such as education, race, and marital status) in the weighting procedure. Both of these methodology changes were implemented to account for an increased number of U.S. households without landline phones and an under-representation of certain demographic groups that were not well-represented in the sample. More details about these changes can be found at: [https://ibis.health.utah.gov/pdf/opha/resource/brfss/RakingImpact2011.pdf].

Why Is This Important?

About 56.7 million people in the U.S. have a disability.^1^ Disabilities cut across the boundaries of age, race, sex, and socioeconomic status. "Although 'people with disabilities' sometimes refers to a single population, this is actually a diverse group of people with a wide range of needs. Two people with the same type of disability can be affected in very different ways. Some disabilities may be hidden or not easy to see."^2^ Until recently, it has been difficult to recognize the differences and barriers to health that people with disabilities experience due to lack of including this category in public health surveys. Data now shows that people with disabilities are more likely to experience significant differences in their health behaviors and health than those without a disability. Costly health events and chronic conditions such as, stroke, asthma, heart disease, diabetes, and cancer, are all more common for those with disabilities, and basic preventive services such as cancer screenings and dental checks are less common. While some differences in the health outcomes of people with disabilities compared to those without disabilities may be due to the nature of the disability itself, many of these differences are avoidable and societal based.^3^ As stated by Healthy People 2020, "To be healthy, all individuals with or without disabilities must have opportunities to take part in meaningful daily activities that add to their growth, development, fulfillment, and community contribution." This will require all public health programs, organizations, and communities to find ways to include people with disabilities in program activities and healthy communities. A gap in the availability and accessibility of evidence-based programs led to the development of the [https://www.nchpad.org/fppics/NCHPAD_GRAIDs_Flyer_final.pdf Guidelines, Recommendations, Adaptations, Including Disability framework] (GRAIDs) by the National Centers on Health, Physical Activity and Disability (NCHPAD). The GRAIDs are an evidence-based method to adapt programs to be more inclusive of individuals with disabilities. The GRAIDs framework is applicable across programs, settings, sectors, and organizations. Applying the five GRAIDs domains will ensure accessibility and inclusion for individuals with disabilities in communities, programs, services, and organizations.[[br]] [[br]] ---- 1. Centers for Disease Control and Prevention. National Center on Birth Defects and Developmental Disabilities. "Disability Impacts All of Us." [https://www.cdc.gov/media/releases/2015/p0730-US-disability.html].[[br]] 2. Krahn G.H., Walker D.K., Correa-De-Araujo R. Persons with disabilities as an unrecognized health disparity population. AJPH. 2015;105:S198?S206. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355692/].[[br]] 3. Utah Department of Health. Behavioral Risk Factor Surveillance System (BRFSS), Salt Lake City: Utah Department of Health, Center for Health Data.

Healthy People Objective DH-2.1:

Increase the number of State and the District of Columbia health departments that have at least one health promotion program aimed at improving the health and well-being of people with disabilities
U.S. Target: 18 States and the District of Columbia

Other Objectives

Other Healthy People 2030 Objectives include: *DH-01: Reduce the proportion of adults with disabilities aged 18 years and older who experience delays in receiving primary and periodic preventive care due to cost. *0A-01: Increase the proportion of older adults with reduced physical or cognitive function who engage in light, moderate, or vigorous leisure-time physical activities.

How Are We Doing?

Almost one in every four Utah adults reports having one or more disabilities. A disability can occur at any age and most people will experience a disability at some point in their life. The most commonly reported disability in 2019 among Utah adults was cognitive (10.9%), which means the person has difficulty concentrating, remembering, or making decisions. Mobility disability was the second most commonly reported disability (10.0%), followed by difficulty hearing/deaf (6.4%), independent living disability (i.e. inability to drive oneself to doctor appointments or run errands alone, 5.6%), difficulty seeing/blind (3.1%), and inability to care for oneself such as dressing and bathing (i.e. self-care disability, 2.6%). The likelihood of having a disability varies with social circumstances and geographic location. Hispanic adults (27.1%) were more likely than non-Hispanic adults to have a disability (22.7%). American Indian/Alaskan Native adults had the highest disability rates compared to other races. Lower incomes are correlated to higher disability rates. Among Utah adults, 42.8% of those that made less than $25,000 a year had a disability compared to only 14.7% of those that made more than $75,000 a year. Rural areas are also more likely to have a higher prevalence of disability rates than urban areas. Local health districts with higher rates of people reporting a disability included San Juan, Southeast Utah, Tooele County, TriCounty, and Weber-Morgan. See the [[a href="indicator/view/Dis.LHD.html" Local Health District data view]] for more information. Looking at smaller geographic areas, greater variation is seen in the rate of disabilities. For example, within Salt Lake County, 31.0% of adults in Glendale reported having a disability whereas 11.7% and 15.7% of adults had a disability in Draper and Sandy (Southeast), respectively. See the [[a href="indicator/view/Dis.SA.html" Utah Small Area data view]] for more information. Lastly, overall disability rates increase with age. Adults 65 years and older are much more likely to report having one or more disabilities. Among adults aged 18 to 34, women were significantly more likely than men to have a disability.

How Do We Compare With the U.S.?

The age-adjusted prevalence of disability in Utah was 24.0% in 2019, which was slightly lower than the U.S. rate of 26.6%.

What Is Being Done?

Due to the need for programmatic, policy, and environmentally based inclusion strategies, the Centers for Disease Control and Prevention awarded the Disability and Health Program at the Utah Department of Health a five-year grant to reduce disparities for people with disabilities through improving health promotion and chronic disease management inclusivity. Quarterly meetings that guide inclusion efforts occur with the Utah Disability Advisory Committee, which is comprised of people with disabilities, public health management, and organizations that specialize in and serve people with disabilities. Currently, programmatic efforts are focused on: *Training public health administration and staff to increase their programs' accessibility and inclusivity, *Raising awareness and increasing access to data on the health of people with disabilities, and *Developing and increasing the spread of inclusive health promotion programs (primarily focused on physical activity, nutrition, and diabetes).

Evidence-based Practices

^ ^ *Utah Department of Health staff are required to complete the Disability and Health 101 training developed by NACCHO. *Leaders of evidence-based programs, such as National Diabetes Prevention Program and Chronic Disease Self-management Education are also receiving training on inclusive practices. *Teaching Obesity Prevention (TOP) Star is an intervention to help adult day program providers develop policies for inclusive nutrition and physical activity environments. This program was piloted in 2018-2019 and finalized in 2020. *Quit Line vendors offering evidence-based cessation services will be trained in inclusive practices. Efforts to refer people with disabilities to and promote the Quit Line are also occurring.[[br]] [[br]] Public Health leaders and staff can use the [https://www.nchpad.org/fppics/NCHPAD_GRAIDs_Flyer_final.pdf GRAIDs framework], developed by the National Center on Health, Physical Activity and Disability (NCHPAD), to increase the inclusivity and accessibility of health promotion programs and services.

Available Services

Services include: *[https://livingwell.utah.gov/program.php?grp=alzh Alzheimer's Disease and Related Dementias] *[https://health.utah.gov/cshcn/programs/babywatch.html Baby Watch Early Intervention] provides support and services to families with children from birth to age three years who have developmental delays or disabilities *[https://health.utah.gov/cshcn/ Children with Special Health Care Needs] provides a variety of services and education for families with children with special health care needs *[https://health.utah.gov/cshcn/programs/ehdi.html Early Hearing Detection and Intervention] resources include the [https://health.utah.gov/cshcn/programs/chap.html Children's Hearing Aid Program, Hearing Aid Recycling Program], newborn hearing screening, CMV education, and other audiology services *[http://www.livingwell.utah.gov Living Well] lists a variety of evidence-based programs and workshops in the community that can help you manage health problems such as asthma, diabetes, arthritis, tobacco use, pain management, injury prevention, etc. Alternatively, you can call the Health Resource Line at 1-888-222-2542 to find and register for a class near you. *[https://medicaid.utah.gov/ Medicaid] and [https://medicaid.utah.gov/ltc/ Medicaid Waiver Services] are sources of health care coverage for people with disabilities; available waivers include Acquired Brain Injury Waiver, Aging Waiver, Community Supports Waiver for Individuals with Intellectual Disabilities or Other Related Conditions, Medicaid Autism Waiver, Medically Complex Children's Waiver, New Choices Waiver, Physical Disabilities Waiver, and Waiver for Technology Dependent Children *[https://health.utah.gov/cshcn/programs/ubdn.html The Utah Birth Defect Network] is a statewide, population-based surveillance system that identifies birth defects in children born in Utah and provides education to families on the prevention of birth defects *[http://health.utah.gov/tbi/tbi-fund.html Utah Traumatic Brain Injury Fund] *[http://health.utah.gov/vipp/topics/traumatic-brain-injury/sci-fund.html Utah Traumatic Spinal Cord (SCI) and Brain Injury Rehabilitation (TBI) Fund]

Relevant Population Characteristics

As the Utah population ages, a greater percentage of Utahns will report experiencing a disability. Disability is also negatively correlated with education and income. This means as a person's income or education decrease, disability rates increase. This is likely partially due to disability limiting educational and income opportunities. Disability rates vary by ethnicity, with the Hispanic population being the more likely to report a disability in Utah, and race, with the American Indian/Alaskan Native population reporting disability at higher rates.

Health Care System Factors

The aging population in Utah is likely to lead to an increase in the prevalence of disabilities that can have dramatic consequences in terms of health care expenditures. Access to health care is still a problem for many Utahns. Individuals who cannot obtain needed health care tend to have higher rates of death and disability from chronic disease. Cost is the most commonly reported barrier to getting needed health care. Adults with a disability were much more likely to report that they were unable to get needed medical care due to cost compared to those without a disability (27.7% compared to 9.2%, respectively). People with disabilities are significantly less likely to report receiving preventive screenings or to have visited a dentist in the past year. See [https://www.cdc.gov/ncbddd/disabilityandhealth/dhds/index.html] for data on people with disabilities in Utah.

Risk Factors

Utah adults with a disability are more likely to report engaging in behaviors that are harmful to their health, such as smoking. They also report eating less fruits and vegetables on a daily basis and getting less exercise than adults without a disability.

Health Status Outcomes

Utah adults with disabilities are more likely to report a variety of poor health outcomes at higher rates than the those without disabilities, such as, arthritis, asthma, cancer, diabetes, heart disease, and stroke. Due to the nature of disability, these conditions can be outcomes of as well as precursors to disability.

Nearly one in every four Utah adults has as disability (24.0% age-adjusted rate or 23.9% crude rate). The most common type of disability is cognitive followed by mobility disability at nearly 10% each.

Data Notes

Disability status is self-reported and not confirmed by a health-care provider; however, such self-reports have been shown to be acceptable for surveillance purposes. For purposes of this report, "disability" is defined as someone who said "yes" to one or more of the following questions:[[br]] 1. Are you blind or do you have serious difficulty seeing, even when wearing glasses?[[br]] 2. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?[[br]] 3. Do you have serious difficulty walking or climbing stairs?[[br]] 4. Do you have difficulty dressing or bathing?[[br]] 5. Because of a physical, mental, or emotional condition, do you have any difficulty doing errands alone such as visiting a doctor's office or shopping?[[br]] 6. Are you deaf or do you have serious difficulty hearing?

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Among Utah adults, Hispanic persons are significantly more likely to report having a disability than non-Hispanic persons.

Data Notes

Disability status is self-reported and not confirmed by a health-care provider; however, such self-reports have been shown to be acceptable for surveillance purposes. For purposes of this report, "disability" is defined as someone who said "yes" to one or more of the following questions:[[br]] 1. Are you blind or do you have serious difficulty seeing, even when wearing glasses?[[br]] 2. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?[[br]] 3. Do you have serious difficulty walking or climbing stairs?[[br]] 4. Do you have difficulty dressing or bathing?[[br]] 5. Because of a physical, mental, or emotional condition, do you have any difficulty doing errands alone such as visiting a doctor's office or shopping?[[br]] 6. Are you deaf or do you have serious difficulty hearing?

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

The percentage of adults with disabilities among American Indian/Native Alaskan populations was significantly higher than the state rate of 22.3%. Note: American Indian/Alaskan Native persons are often underrepresented and oversampled in surveys.

Data Notes

Disability status is self-reported and not confirmed by a health-care provider; however, such self-reports have been shown to be acceptable for surveillance purposes. For purposes of this report, "disability" is defined as someone who said "yes" to one or more of the following questions:[[br]] 1. Are you blind or do you have serious difficulty seeing, even when wearing glasses?[[br]] 2. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?[[br]] 3. Do you have serious difficulty walking or climbing stairs?[[br]] 4. Do you have difficulty dressing or bathing?[[br]] 5. Because of a physical, mental, or emotional condition, do you have any difficulty doing errands alone such as visiting a doctor's office or shopping?[[br]] 6. Are you deaf or do you have serious difficulty hearing?

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Significant differences exist between income brackets. Those with a lower annual income were more likely to report having a disability.

Data Notes

Disability status is self-reported and not confirmed by a health-care provider; however, such self-reports have been shown to be acceptable for surveillance purposes. For purposes of this report, "disability" is defined as someone who said "yes" to one or more of the following questions:[[br]] 1. Are you blind or do you have serious difficulty seeing, even when wearing glasses?[[br]] 2. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?[[br]] 3. Do you have serious difficulty walking or climbing stairs?[[br]] 4. Do you have difficulty dressing or bathing?[[br]] 5. Because of a physical, mental, or emotional condition, do you have any difficulty doing errands alone such as visiting a doctor's office or shopping?[[br]] 6. Are you deaf or do you have serious difficulty hearing?

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Local health districts (LHDs) with a significantly higher disability prevalence than the state include: *San Juan *Southeast Utah *Tooele County LHD *TriCounty LHD *Weber-Morgan LHD[[br]] [[br]] LHDs with a significantly lower prevalence of adults reporting having a disability included: *Summit County *Utah County[[br]] [[br]] Bear River, Central Utah, Davis County, Salt Lake County, Southwest Utah, and Wasatch County LHDs were considered equal to the state percentage of people living with a disability.

Data Notes

Disability status is self-reported and not confirmed by a health-care provider; however, such self-reports have been shown to be acceptable for surveillance purposes. For purposes of this report, "disability" is defined as someone who said "yes" to one or more of the following questions:[[br]] 1. Are you blind or do you have serious difficulty seeing, even when wearing glasses?[[br]] 2. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?[[br]] 3. Do you have serious difficulty walking or climbing stairs?[[br]] 4. Do you have difficulty dressing or bathing?[[br]] 5. Because of a physical, mental, or emotional condition, do you have any difficulty doing errands alone such as visiting a doctor's office or shopping?[[br]] 6. Are you deaf or do you have serious difficulty hearing?

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

Data Notes

Disability status is self-reported and not confirmed by a health-care provider; however, such self-reports have been shown to be acceptable for surveillance purposes. For purposes of this report, "disability" is defined as someone who said "yes" to one or more of the following questions:[[br]] 1. Are you blind or do you have serious difficulty seeing, even when wearing glasses?[[br]] 2. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?[[br]] 3. Do you have serious difficulty walking or climbing stairs?[[br]] 4. Do you have difficulty dressing or bathing?[[br]] 5. Because of a physical, mental, or emotional condition, do you have any difficulty doing errands alone such as visiting a doctor's office or shopping?[[br]] 6. Are you deaf or do you have serious difficulty hearing?

Data Source

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health

In general, the likelihood of having a disability increases as people age. For ages 18 to 34, women were significantly more likely than men to have a disability.

Data Notes

Disability status is self-reported and not confirmed by a health-care provider; however, such self-reports have been shown to be acceptable for surveillance purposes. For purposes of this report, "disability" is defined as someone who said "yes" to one or more of the following questions:[[br]] 1. Are you blind or do you have serious difficulty seeing, even when wearing glasses?[[br]] 2. Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?[[br]] 3. Do you have serious difficulty walking or climbing stairs?[[br]] 4. Do you have difficulty dressing or bathing?[[br]] 5. Because of a physical, mental, or emotional condition, do you have any difficulty doing errands alone such as visiting a doctor's office or shopping?[[br]] 6. Are you deaf or do you have serious difficulty hearing?

References and Community Resources

^ ^ *NACCHO trainings and fact sheets, such as "Five Steps for Inclusive Communication: Engaging People with Disabilities" and "Health and Disability 101--Health Department Employee Training"([https://www.naccho.org/programs/community-health/disability]) *[https://livingwell.utah.gov/ Livingwell.utah.gov] lists Utah Department of Health evidence-based programs available in Utah communities. *GRAIDs: a framework for closing the gap in the availability of health promotion programs and interventions for people with disabilities. ([https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4148531/])[[br]] [[br]] *[https://health.utah.gov/wp-content/uploads/DHP-report-2020.pdf Disabilities and Health in Utah 2020 report] delves further into data related to disabilities and health and practical examples to increase accessibility and inclusivity for people with disabilities in health programs and services. 1. Centers for Disease Control and Prevention. National Center on Birth Defects and Developmental Disabilities. "Disability Impacts All of Us." [https://www.cdc.gov/media/releases/2015/p0730-US-disability.html].[[br]] 2. Krahn G.H., Walker D.K., Correa-De-Araujo R. Persons with disabilities as an unrecognized health disparity population. AJPH. 2015;105:S198?S206. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355692/].[[br]] 3. Utah Department of Health. Behavioral Risk Factor Surveillance System (BRFSS), Salt Lake City: Utah Department of Health, Center for Health Data.