Nastassia Vaitsiakhovich

Introduction: Current disability questions used in many US federal surveys exclusively measure disability as having 1 or more of 6 functional limitations. This strategy is at odds with who is disabled as some disabled people do not experience these limitations. Methods: Using data from a nationally representative survey of 2169 adults, this study describes the potential of a comprehensive disability status question to improve the measurement of disability. Results: Results from this study demonstrate that a comprehensive disability status question successfully identifies disabled people who both do, and do not, experience limitations. Conclusion: These findings suggest that a single comprehensive disability status question may provide a viable and more inclusive alternative to identifying the disabled population in US federal surveys.

Researchers and federal agencies are currently discussing the best way to measure disability in US federal surveys. One idea being discussed is expanding/supplementing the question sets commonly used to capture disability status in order to better capture a broader segment of the disabled population. We used data from the 2010–2018 National Health Interview Survey to examine the performance of questions commonly used to measure disability in the US–the ACS-6 and Washington Group Short Set questions–in capturing intellectual and developmental disabilities, mental health disabilities, and physical health disabilities. We found that neither set of disability questions was sufficient to fully capture these disability statuses. We contend that current disability questions used in US population surveys must be expanded/supplemented in order to increase the inclusiveness of disability measurement, and thereby, improve efforts to reduce disparities experienced by the disabled population.

Subjective wellbeing (SWB) - being happy or perceiving one’s life has meaning, is critical to good physical health. People who are happier and who report that their lives have meaning are healthier and live longer. In general, individuals with disabilities have worse SWB compared to those without disabilities. This brief summarizes findings from a study that used data from the National Wellbeing Survey collected in early-2021 to examine differences in happiness and perceived meaning in life between U.S. working-age adults (ages 18-64) with versus without a self-care disability (such as difficulty eating, using the toilet, or dressing without assistance) and the role social support plays in improving happiness and meaning in life between these groups. Results show that adults with a self-care disability are less likely to be happy, less likely to feel their lives have meaning, and less likely to receive social support compared to adults without a self-care disability. The authors recommend policy changes to improve the SWB of adults with a self-care disability, such as removing barriers to moving for work and education and promoting disability awareness in social networks.

Background and Objective.: The objective of the National Health Interview Survey (NHIS) is to provide data that can be used to monitor the health of the US population. In this study, we evaluate whether the disability questions currently used in the NHIS – the Washington Group questions – threaten the ability of this survey to fulfil its stated objective for disabled people. Methods.: Data were from the 2011-2012 NHIS with linkage to mortality status through 2019. We examined the percentage and characteristics of people reporting a disability in the American Community Survey (ACS) disability questions who were documented as such in the Washington Group (WG) disability questions. We then examined the consequence of use of the WG, as opposed to the ACS questions, on estimates of disability prevalence and comparative mortality risk. Results.: We find that when compared to their predecessor, the American Community Survey disability questions, the Washington Group questions account for less than half of disabled people, primarily documenting disabled people with a more than one disability status, but excluding many disabled people with only one disability status. As a result of these exclusions, disability prevalence rates based on the Washington Group questions underestimate the size of the disabled population in the US, and overestimate the comparatively higher mortality risk associated with disability status. Conclusions.: These results underscore the need to re-evaluate the disability questions used in the NHIS, and invest in the development of improved and expanded disability questionnaires for use in national surveys.

Background: Historically, US adults with intellectual disability (ID) experience worse healthcare access than the general population. However, the implementation of the Patient Protection and Affordable Care Act (ACA) may have reduced disparities in healthcare access.Methods: Using a pre‐ACA 2011–2013 sample and a post‐ACA implementation 2014–2016 sample from the National Health Interview Survey data, we examined the association between the ACA's introduction and healthcare access among adults with ID (N = 623). Negative binomial regression models were used to test the association between the ACA and the total number of foregone healthcare services. Binary logistic regression was used to explore whether the ACA's implementation was associated with the increased likelihood of possessing health insurance as well as the decreased likelihood of any and particular measures of foregone healthcare services due to cost.Results: The study provides evidence that the ACA's implementation was associated with the decreased likelihood of the total number and any foregone care services owing to cost. Findings also revealed that the ACA's implementation was associated with expansion of health insurance coverage and decreasing instances of foregone care services for medical care, dental care, specialist visit and mental care among adults with ID. However, persons with ID were still at a higher risk of foregone prescription medicines, follow‐up medical care and eyeglasses due to cost in the post‐ACA years.Conclusions: The study provides evidence that healthcare access among Americans with ID improved after the ACA's implementation. However, challenges in access to follow‐up care, eyeglasses and prescription medicines persist and require policy solutions, which extend beyond the ACA's provisions.