Iezzoni Lisa I, Kurtz Stephen G, Rao Sowmya R
Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, USA; Department of Medicine, Harvard Medical School, Boston, USA.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
Disabil Health J. 2014 Oct;7(4):402-12. doi: 10.1016/j.dhjo.2014.05.007. Epub 2014 Jun 10.
Trends in the patterns and prevalence of chronic disability among U.S. residents carry important implications for public health and public policies across multiple societal sectors.
To examine trends in U.S. adult population rates of chronic disability from 1998 to 2011 using 7 different disability measures and examining the implications of trends in population age, race and ethnicity, and body mass index (BMI).
We used National Health Interview Survey data on civilian, non-institutionalized U.S. residents ages ≥ 18 from selected years between 1998 and 2011. We used self-reported information on functional impairments, activity/participation limitations, and expected duration to create 7 chronic disability measures. We used direct standardization to account for changes in age, race/ethnicity, and BMI distributions over time. Multivariable logistic regression models identified associations of disability with sociodemographic characteristics.
Without adjustment, population rates of all 7 disabilities increased significantly (p < 0.0001) from 1998 to 2011. The absolute percentage change was greatest for movement difficulties: 19.3% in 1998 and 23.3% in 2011. After separate adjustments for trends in age, race/ethnicity, and BMI distributions, 6 disability types continued to show increased rates over time (p < 0.01), except for sensory disabilities. Over time, poor education, poverty, and unemployment remained significantly associated with disability.
If these trends continue, the numbers and proportions of U.S. residents with various disabilities will continue rising in coming years. In particular, the prevalence of movement difficulties and work limitations will increase. Furthermore, disability will remain strongly associated with low levels of education, employment, and income.
美国居民慢性残疾的模式和患病率趋势对多个社会部门的公共卫生和公共政策具有重要影响。
使用7种不同的残疾衡量标准，研究1998年至2011年美国成年人口慢性残疾率的趋势，并探讨人口年龄、种族和民族以及体重指数（BMI）趋势的影响。
我们使用了1998年至2011年选定年份中年龄≥18岁的美国平民、非机构化居民的国家健康访谈调查数据。我们使用了关于功能障碍、活动/参与限制和预期持续时间的自我报告信息来创建7种慢性残疾衡量标准。我们使用直接标准化来考虑年龄、种族/民族和BMI分布随时间的变化。多变量逻辑回归模型确定了残疾与社会人口学特征之间的关联。
未经调整时，从1998年到2011年，所有7种残疾的人口患病率均显著上升（p<0.0001）。运动困难的绝对百分比变化最大：1998年为19.3%，2011年为23.3%。在分别对年龄、种族/民族和BMI分布趋势进行调整后，除感觉残疾外，6种残疾类型的患病率仍随时间增加（p<0.01）。随着时间的推移，教育程度低、贫困和失业仍然与残疾显著相关。
如果这些趋势持续下去，未来几年美国各类残疾居民的数量和比例将继续上升。特别是，运动困难和工作限制的患病率将会增加。此外，残疾仍将与低教育水平、低就业和低收入密切相关。
