Important Facts for Disability Prevalence

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.