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DISABILITY AMONG VIRGINIANS:
AN ANALYSIS OF BRFSS DATA
2000, 2001, 2002
JANUARY
2004
Prepared for:
Virginia Department of Health
Health Promotion for People with Disabilities (HPPD) Project
Division of Chronic Disease Prevention and Control
Prepared by:
Kirsten Barrett, PhD
Senior Research Associate
Survey and Evaluation Research Laboratory
Virginia Commonwealth University
This publication was supported by Grant/Cooperative Agreement Number U50/CCU321219 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the author and do not necessarily represent the official views of the CDC.
Table of Contents
Page
Acknowledgements 3
Executive Summary 4
Overview of Project 7
Overview of BRFSS 7
Disability Determination
Determining Disability Status 8
Determining Disability Severity 9
Determining Disability Type 10
Results
Demographic Profile based on Disability 11
Demographic Profile based on Severity of Disability 12
Health Status 14
Health Care Access 16
Cholesterol and Blood Pressure 18
Diet and Heart Disease and Stroke 19
Cancer Screening 20
Dental Care 21
Immunizations 22
Smoking 24
Diabetes 25
Arthritis 25
Weight Control and Physical Activity 26
Relationship of BRFSS Findings to Healthy People 2010 27
Differences based on Perceived Health, Gender, Age, and Race 29
Summary 34
Limitations 37
Page
List of Tables
Table 1 Type of Impairment (detailed) 10
Table 2 Type of Impairment (grouped) 10
Table 3 Demographic Profile of Respondents based on Disability 11
Table 4 Demographic Profile of Respondents based on Severity of Disability 13
Table 5 Cancer Screening by Disability 21
Table 6 Summary of BRFSS Data Compared to HP 2010 Goals 28
List of Figures
Figure 1 BRFSS Respondents and Disability 8
Figure 2 Severity of Disability 9
Figure 3 General Health by Presence of Disability 14
Figure 4 General Health by Severity of Disability 14
Figure 5 Days of Poor Physical Health by Severity of Disability 15
Figure 6 Days of Poor Mental Health by Severity of Disability 16
Figure 7 Health Care Coverage by Severity of Disability 16
Figure 8 Lack of Health Care Coverage by Severity of Disability 17
Figure 9 Usual Source of Care by Severity of Disability 17
Figure 10 Unmet Health Care Needs by Disability 18
Figure 11 Unmet Health Care Needs by Severity of Disability 18
Figure 12 Blood Cholesterol by Severity of Disability 19
Figure 13 Blood Pressure by Severity of Disability 19
Figure 14 Eating Fewer High Fat or High Cholesterol Foods by Severity of Disability 20
Figure 15 Dental Insurance by Severity of Disability 21
Figure 16 Teeth Cleaning by Severity of Disability 22
Figure 17 Influenza Vaccine by Severity of Disability 23
Figure 18 Pneumonia Vaccine by Severity of Disability 23
Figure 19 Smoking by Disability 24
Figure 20 Smoking by Severity of Disability 24
Figure 21 Diabetes by Severity of Disability 25
Figure 22 Arthritis by Severity of Disability 25
Figure 23 Weight Control by Severity of Disability 26
Figure 24 Weight Loss by Severity of Disability 26
Figure 25 Physical Activity by Severity of Disability 27
Appendix 1 Virginia BRFSS Content 39
Appendix 2 Disability Comparisons (detailed tables) 41
Acknowledgements
The following individuals and groups deserve special thanks for their contributions which made this project possible:
· Virginia Commonwealth University’s Survey and Evaluation Research Laboratory (SERL) Technical Division for their ongoing excellence in conducting Virginia’s Behavioral Risk Factor Surveillance Survey.
· James Ellis, Director, SERL Technical Division, for his assistance with data file management.
· India Foy, Virginia Department of Health (VDH), Project Manager, Health Promotion for People with Disabilities, and Virginia’s Health Promotion for People with Disabilities Task Force for their availability and ongoing feedback and dialogue throughout the course of the project.
Executive Summary
The Virginia Department of Health (VDH), as part of their federal grant Preventing Secondary Conditions and Promoting the Health of People with Disabilities, contracted with the Survey and Evaluation Research Laboratory (SERL) at Virginia Commonwealth University to conduct an analysis of 2000-2002 Behavioral Risk Factor Surveillance Survey (BRFSS)[1] data to determine if disparities in health status and health risk behaviors exist among Virginians based on the presence of disability. Efforts were also made to determine if disparities existed based on the degree of disability.
Disability Status. Sixteen percent of BRFSS respondents, across years, reported having a disability (n=1,561).[2],[3] The remaining 84% (n=7,313) reported no disability. Across years, 29% of those with disabilities reported receiving help with either routine or personal care.
Demographics. Individuals with disabilities tended to be older than their non-disabled counterparts; 42% were 55 years of age or older as compared to 24% of those without disabilities. Sixteen percent of individuals with disabilities had less than a high school education as compared to 10% of those without disabilities. Individuals with disabilities were more likely to earn less than $20,000 per year. Only 44% of individuals with disabilities were employed as compared to 68% of those without disabilities.
Health Care Coverage and Access. Despite similarities in health insurance coverage and despite a greater likelihood of having a usual source of care, individuals with disabilities were twice as likely to have had a time within the past twelve months when they needed medical care but could not get it. When comparing those requiring assistance to those without disabilities, the likelihood of having unmet health care needs was three times as great.
Dental Care. As compared to those without disabilities, individuals with disabilities were less likely to have insurance coverage for routine dental care and were less likely to have had their teeth cleaned by a dental hygienist within the past two years.
Perceived Health. Those with disabilities reported fair to poor health more frequently than their counterparts without disabilities, 42% versus 8%. Only 38% of individuals requiring assistance reported good to excellent health as compared to 66% of those with disabilities not requiring assistance and 92% of those with no disabilities.
Physical and Mental Health. Those with disabilities reported, on average, 11 days in which their physical health was not good and 7 days in which their mental health was not good as compared to 2 days and 3 days respectively for those without disabilities. Respondents with disabilities requiring assistance reported the greatest number of days in which physical health and mental health were not good.
Blood Cholesterol and Blood Pressure. Although individuals with and without disabilities were similar with regard to their frequency of blood cholesterol and blood pressure checks, those with disabilities were more likely to have been told, at some point in time, that they have high blood cholesterol and high blood pressure.
Weight Control. Individuals with disabilities were more likely to be overweight than their counterparts without disabilities, according to their body mass index (BMI). Although those with disabilities were more likely to report that they were currently trying to lose weight, they were less likely to have engaged in physical activity within the past month as compared to those without disabilities.
Cancer Screening. With the exception of having a Pap smear within the past three years, those with disabilities, across cancer types, were more likely to have been screened.
Immunizations. Individuals with disabilities were more likely to have received the influenza vaccine within the past year and the pneumonia shot at some point in the past. Those requiring assistance were most likely to have received vaccinations.
Smoking. Individuals with disabilities were slightly more likely to be current smokers than those without disabilities, 27% versus 22%. Individuals requiring assistance were the most likely to smoke.
Limitations
BRFSS data can provide valuable insights into the health status and health risk behaviors of individuals. It can also be used to explore differences between those with and without disabilities. However, BRFSS is not without limitations. First, as a telephone survey of one adult in each randomly selected household, there is a chance that a second adult in the household has a disability but, because he/she was not selected for participation, his/her information would go unreported. Second, as a telephone survey, BRFSS will likely underrepresent those that are least well off. Third, as an adult survey, BRFSS generates no information about the health status of children. Fourth, given the available response categories, nearly one-quarter of BRFSS respondents with disabilities reported “other” as their major impairment. This lack of specificity makes it difficult to determine which disability sub-groups are doing well and which are struggling. Finally, BRFSS data is self-reported; there are no formal clinical examinations to determine if disease conditions truly exist.
Recommendations
The analysis of the BRFSS data has generated many interesting findings that can be used by Virginia’s Health Promotion for People with Disabilities Task Force as it plans future activities related to disability. The following recommendations are made based on the results:
· Individuals with disabilities were equally as likely to have health care coverage and more likely to have a usual source of care. However, they were more likely to have needed medical care in the past 12 months and had not been able to get it. Additional research should be done to determine what factors beyond health insurance coverage and a usual source of care impact receipt of medical care.
Recommendations (con’t)
· Disability impacts not only the individual but also his/her family and/or caregiver(s). The majority of individuals with disabilities that require assistance perceive their health as poor to fair. The impact of the care recipient’s perceived health on the caregiver’s physical and mental health and well-being should be explored. In other words, how does the health and well-being of the caregiver vary as a result of the care recipient’s perceived health?
· Individuals with disabilities were more likely to have less than a high school education. The educational approach used by providers in the health care system should be sensitive to the educational level of people with disabilities. Also, many individuals with disabilities are unemployed and living on limited incomes. This raises concern about access to care that is typically driven by employment-based health insurance; dental care is a good example.
· Individuals with disabilities were less likely to have insurance coverage for routine dental care and were less likely to have had their teeth cleaned by a dental hygienist within the past two years. Efforts should be taken to ensure that the oral health needs of individuals with disabilities are being met. This may require consumer and provider education as well as policy-level decisions that provide individuals with disabilities the financial resources necessary to receive dental care.
· There is little difference between those with and without disabilities with regard to preventive screening activities for blood pressure and blood cholesterol. However, those with disabilities were more likely to have high blood pressure and high blood cholesterol. In the future, emphasis should be placed on underlying health behaviors that lead to chronic conditions; nutritional habits and exercise are two examples.
· The relationship between chronic health conditions, weight control, and exercise should be considered. Individuals with disabilities were more likely to have high blood pressure, high blood cholesterol, diabetes, and arthritis. Also, individuals with disabilities were more likely to be overweight, according to their body mass index (BMI). Individuals with disabilities were more likely to report that they were currently trying to lose weight, but they were less likely to have engaged in physical activity within the past month as compared to those without disabilities. Efforts should be made to determine why individuals with disabilities are less likely to be physically active and to then create responsive programs that allow them to participate in physical activity.
· Some methodological limitations of BRFSS have been identified. The findings from this study can be used as justification for future research that focuses specifically on the disability community. Survey content could be expanded to gather more information across a range of health conditions. Also, disproportionate sampling strategies could be used so that valid subgroup comparisons could be made.
· Individuals requiring TTY or other alternative forms of survey completion are unable to participate in BRFSS. SERL, on other disability-related projects, offers TTY as an option for respondents. This should be incorporated into any future research involving the disability community.
Overview of Project
The Virginia Department of Health (VDH), as part of their federal grant Preventing Secondary Conditions and Promoting the Health of People with Disabilities, contracted with the Survey and Evaluation Research Laboratory (SERL) at Virginia Commonwealth University to conduct an analysis of Behavioral Risk Factor Surveillance Survey (BRFSS) data. The purpose of the analysis was to determine if disparities in health status and health risk behaviors exist among Virginians based on the presence of disability. Further, efforts were made to determine if there were disparities based on the degree of disability. Finally, preliminary analyses were done to determine if perceived health, gender, age, and/or race impacts health care access, health status, and/or health risk behaviors among those with disabilities.
Overview of BRFSS
This study uses data from Virginia’s 2000, 2001, and 2002 BRFSS, a population-based telephone survey. BRFSS, a collaborative project of the Centers for Disease Control and Prevention and states and territories, measures behavioral risk factors in the adult population 18 years of age or older living in households.[4] SERL has conducted BRFSS on behalf of VDH since 1989.
BRFSS consists of three sections. The core is a standard set of questions asked by all states. From year to year, core sections may change. For sections that remain in the core from year to year, question wording or response categories may change. In some cases, sections remain in the core from year-to-year with no changes at all. Optional modules contain topic-specific questions that states can add at their discretion. Like the core sections, optional modules can change from year-to-year. Finally, state-added questions are, as the name implies, questions that are created by or acquired by the state and added to the state BRFSS. Appendix 1 contains a list of core sections and optional modules on Virginia’s BRFSS in 2000, 2001, and 2002.