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Methods

Disability and Health Data System (DHDS) contains data on Disability Status and Types, Limitation Status, and Psychological Distress Status. Data also are available for disability-associated health-care expenditures.

To see a list of indicators and how they were defined, please see the Data Guide. This guide provides detailed information for each indicator, including: definition, specific analysis criteria, years for which the data are available, and a citation if the definition was based on a publication.

Indicator definitions and the methodology for calculating estimates are specific to DHDS and might not be applicable outside of this system. Therefore, estimates in DHDS may not match those reported in other Centers for Disease Control and Prevention (CDC) data systems and reports.

Please refer to the Glossary for a description of terms commonly used throughout the site.



Data Source

Data are from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based health survey of civilian, non-institutionalized adults 18 years of age and older. The survey is conducted by all 50 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. With assistance from the Centers for Disease Control and Prevention (CDC), trained interviewers collect comprehensive demographic, health condition, health risk behavior, and preventive health data. Detailed information about BRFSS, including BRFSS questionnaires, codebooks, and methodology information, is available online at www.cdc.gov/brfss/.

Statistical Analysis

Analyses were performed using SAS (SAS Institute, Inc., Cary, North Carolina) and SAS-callable SUDAAN (Research Triangle Institute, Research Triangle Park, North Carolina) to account for the BRFSS complex survey design. Prevalence estimates were calculated, and for each prevalence estimate the following statistics were computed: Number, Weighted Number, Standard Error, Lower Limit (LL) of the 95% confidence interval (95% CI), and Upper Limit (UL) of the 95% confidence interval (95% CI). All estimates were weighted to account for the probability of selection, nonresponse, noncoverage of households without a telephone, the number of adults in a household, the number of telephones in a household, and to adjust to population totals for each state or territory. Most estimates were age-adjusted to the 2000 U.S. standard population, with the exception of estimates stratified by age.1 For each indicator, Don’t Know and Not Sure responses were set to missing. Missing data were not imputed. Respondents with missing data for an indicator were not included in analyses involving that indicator. Estimates were suppressed if the standard error was greater than or equal to 30% of the estimate or if the unweighted total population was less than 50.

Data are available for all 50 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands. Data were aggregated to produce estimates for U.S. Census divisions and regions, and the U.S. and Territories total.2,3

Estimates

Please note that not all estimates are available in all DHDS features (Maps & Data Tables, State Profiles, and Dual Area Profiles). More information on where to view specific estimates is available here.

Disability Status and Types

Disability Status and Types Estimates

The prevalences of disability status and select disability types were calculated among adults overall, and by the following demographic characteristics: age, sex, race/ethnicity, and veteran status.

Demographic and Health Topic Estimates by Disability Status

Demographic (income level, education level, marital status, and employment status) and health topic indicators in DHDS were analyzed by disability status to present prevalence estimates among adults with any disability and among adults without any disability. Disparity estimates are percentage point differences calculated as the percentage of adults with any disability with an attribute minus the percentage of adults without any disability with that attribute.4

Demographic and Health Topic Estimates by Disability Types

Demographic (income level, education level, marital status, and employment status) indicators in DHDS were analyzed by select disability types to present prevalence estimates among adults with each of the following types of disability: cognitive, mobility, vision, self-care, and independent living.

Health topic indicators in DHDS were analyzed by select disability types to present prevalence estimates among adults with each of the following types of disability: cognitive, mobility, and vision.

Health Topic Estimates by Disability Status and Demographic Groups

Health indicators in DHDS were analyzed by disability status and three demographic groups to present prevalence estimates among adults with and without any disability, and additionally by age groups (18-44, 45-64, 65+),1 sex (male, female), or race/ethnicity (white, black, Hispanic, other)5.

Limitation Status

Limitation Status Estimates

The prevalence of limitation status was calculated among adults overall, and by the following demographic characteristics: age, sex, race/ethnicity, and veteran status.

Demographic and Health Topic Estimates by Limitation Status

Demographic (income level, education level, marital status, and employment status) and health topic indicators in DHDS were analyzed by limitation status to present prevalence estimates among adults with a limitation and among adults without a limitation. Disparity estimates are percentage point differences calculated as the percentage of adults with a limitation with an attribute minus the percentage of adults without a limitation with that attribute.4

Psychological Distress Status

Psychological Distress Status Estimates

The prevalence of psychological distress status was calculated among adults overall, and by the following demographic characteristics: age, sex, race/ethnicity, and veteran status.

Demographic and Health Topic Estimates by Psychological Distress Status

Demographic (income level, education level, marital status, and employment status) and health topic indicators in DHDS were analyzed by psychological distress status to present prevalence estimates among adults with serious psychological distress, adults with mild to moderate psychological distress, and adults with no psychological distress.

Data Limitations

The estimates presented in DHDS are subject to a number of limitations. First, BRFSS is a telephone survey and may have higher levels of non-coverage than an in-person interview, as some households are unable to be reached by telephone. Second, BRFSS data are self-reported and subject to recall bias, and may be less accurate than data based on physical measurements (e.g., height, weight, and blood pressure). Third, BRFSS does not include people living in institutions or group homes. Since people residing in such facilities may be more likely to have a disability, the prevalence of disability and limitation may be underestimated. Fourth, in 2013, BRFSS began asking five of the six questions used by the Department of Health and Human Services to assess disability. The sixth question, “Are you deaf or do you have serious difficulty hearing?”, was not included on BRFSS, therefore data on the number of people who have hearing difficulties was not collected. However, BRFSS will begin collecting this information in 2016. Fifth, the questions in BRFSS used to define disability and limitation do not include information on permanence, duration or underlying medical condition.

Expenditures

Disability-Associated Health-Care Expenditures (DAHE) are health-care costs related to injury, diseases, and chronic conditions that are associated with a person’s disability, exclusive of non-disability related costs. DHDS contains data on two pieces of information related to DAHE: health-care expenditures associated with disability, and mean per capita DAHE.

Health-care expenditures associated with disability presents mean health-care expenditures that are associated with disability by four payer types: Total Expenditures, Medicare, Medicaid, and Nonpublic Source payer. Estimates represent the proportion of the total expenditures in that payer type that are DAHE. Estimates are presented in percentages and millions of 2006 dollars.

Mean DAHE per capita presents mean expenditures per person, regardless of whether they have a disability. The state total DAHE is divided by the total population in that state. Estimates are available at state-level and for the entire United States. Mean per capita expenditures are presented in 2006 dollars.

For more information, please see:
Anderson WL, Armour BS, Finkelstein EA, Wiener JM. Estimates of state-level health-care expenditures associated with disability. Public Health Rep. 2010;125:44–51.

Notes

  1. Although most indicators were age-adjusted or stratified using the following age groups: 18-44, 45-64, and 65+, these age groups do not apply to all indicators. More information on age-adjustment and additional age groups is available in Analytic considerations for DHDS estimates, available from Additional Resources (http://dhds.cdc.gov/explorer/resources/).
  2. Data are not available for all states and territories for all years. The following states or territories did not participate in the BRFSS for a given year(s): U.S. Virgin Islands (2012-2014). These states and territories appear in DHDS as NA and are not part of the divisional, regional, and total estimates for those years indicated.
  3. Psychological Distress Status data are only available for 2007 for the following 37 states and territories: Alaska, Arkansas, California, Colorado, Connecticut, District of Columbia, Georgia, Hawaii, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Texas, Vermont, Virginia, Washington, Wisconsin, Wyoming, and Puerto Rico. States and territories that do not have data for Psychological Distress appear in DHDS as NA and are not part of the divisional, regional, and total estimates.
  4. Disparity estimates were calculated before rounding the estimates and therefore may not match disparities calculated by subtracting the rounded estimates available in DHDS.
  5. All respondents identified as white, black, and other (includes Asian, Native Hawaiian or Other Pacific Islander, and American Indian or Alaska Native) were non-Hispanic. Respondents identified as Hispanic might be of any race.
 
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  • Email DHDS Team: dhds@cdc.gov

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    TTY: (888) 232-6348
  • Contact CDC–INFO
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