** Employment by Occupation and Industry
As Table T shows, the CPS also provides information on work disability
according to the person's occupation (e.g., managerial, sales, etc.) and
industry (e.g., manufacturing, professional services, etc.). As
distinguished from earlier work disability tables, these figures, by
definition, exclude persons who are unemployed or not part of the labor
force. Distinctions in employment by work disability status were far more
prevalent for occupations than for industries, and certain occupation groups
exhibited a much greater variation than others. For example, persons with a
work disability were far less likely to be employed in managerial and
professional specialty positions than their counterparts without a work
disability. While 18.2 percent of males and 16.0 percent of females with a
work disability held these positions, the rates rose to 26.3 percent and 25.6
percent, respectively, for males and females with no work disability.
Table T: Percent Distribution of Employed Persons 16 to 64 by
Work Disability Status, by Occupation and Industry, 1988
With a Without a
Occupation and Industry Work Disability Work Disability
Male Female Male Female
Occupation Group 100.0% 100.0% 100.0% 100.0%
Managerial and professional specialty 18.2% 16.0% 26.3% 25.6%
Technical, sales, and administrative 17.5% 39.5% 19.9% 45.3%
support
Service 12.5% 27.3% 9.2% 17.0%
Farm, forestry, and fishing 4.6% 1.4% 3.7% 0.8%
Precision, production, craft, and 19.6% 2.2% 19.8% 2.2%
repair
Operators, laborers, and fabricators 27.4% 13.3% 20.9% 8.7%
Industry Group 100.0% 100.0% 100.0% 100.0%
Agriculture 3.9% 1.9% 3.3% 1.1%
Forestry and fishing 0.2% 0.1% 0.1% -
Mining 1.1% - 0.9% 0.3%
Construction 12.6% 1.1% 10.2% 1.1%
Manufacturing 21.0% 12.2% 23.5% 13.7%
Transportation, Communications, and 9.2% 3.8% 9.3% 4.2%
other public utilities
Wholesale trade 5.2% 1.8% 5.3% 2.4%
Retail Trade 11.4% 19.3% 14.7% 18.9%
Finance, insurance, and real estate 4.5% 7.2% 4.7% 9.5%
Services 25.7% 47.3% 22.4% 43.7%
Public administration 4.7% 4.8% 5.0% 4.5%
Source: U.S. Bureau of the Census, 1988 Current Population Survey, Current
Population Reports, Series P-23, No. 160, Table 6.
Men with a work disability were more likely to work as operators, laborers,
and fabricators (27.4 percent) and in service occupations (12.5 percent) than
their counterparts with no work disability (20.9 and 9.2 percent,
respectively). Men with a work disability were somewhat less likely to be
employed in technical, sales, and administrative support positions (17.5
percent) than those with no work disability (19.9 percent).
Women with a work disability were more likely to be employed in service
occupations (27.3 percent) and as operators, laborers, and fabricators (13.3
percent) than those without a work disability (17.0 and 8.7 percent,
respectively). Women with a work disability were less likely to be employed
in technical, sales, and administrative support positions (39.5 percent) than
those without a work disability (45.3 percent).
Work disability data according to occupation and industry also come from the
National Health Interview survey, measured as an activity limitation, when
the major activity is work. In addition to confirming the types of
relationships in the CPS, the National Center for Health Statistics in its
analysis of data for the years 1983-1985 found that employment patterns among
the individual occupations and industries vary little by work disability
status for persons with family incomes at or above $25,000.
Health Insurance Coverage: Related to the issue of work disability is
coverage by employer-provided health insurance. As shown earlier, physician
visits and hospitalization rates are higher for persons with a functional
limitation, which makes health coverage an extremely important issue for
persons with a disability. While nearly two-thirds (65.9 percent) of males
with no work disability were covered by employer-provided health insurance,
only about half (52.1 percent) of those with a work disability had such
coverage. This distinction held for females, blacks and whites, except for
those of Hispanic origin, where there was little distinction in coverage
based on work disability status. The latter is possibly explained by the low
overall rate of coverage by employer health insurance plans for Hispanics.
** Work Disability by Functional Limitation Status
The 1984 SIPP collected data on both functional limitations and work
disability status among respondents, and for this reason comparisons are
possible between these two domains. As previously stated, disability is
multi-dimensional, and persons with a functional limitations such as walking
or hearing may not have a work disability, depending on job requirements and
an employer's accommodation, as well as training, education, work history,
and other factors. For example, of the 8.9 million working persons 16 to 64
years of age who had a non-severe functional limitation, less than one-third
(30.2 percent) had a work disability. Of the 1.5 million working persons
with a severe functional limitation, over one-third (36.7 percent) had no
work disability at all. These figures do not include persons with a work
disability who are unemployed or discouraged workers who have left the labor
force altogether. When considering all labor force statuses, including
persons who are unemployed or out of the labor force, the distinction between
functional limitation status and work disability decreased, but remained
significant. Of the 15.7 million persons 16 to 64 years of age with a
non-severe functional limitation, less than half (43.5 percent) had a work
disability. For the 6.0 million in this age group with a severe functional
limitation, there were still 16.1 percent with no work disability.
** Chronic Conditions Causing Work Disability
The 1984 Survey of Income and Program Participation also provides prevalence
statistics the individual chronic conditions mainly responsible for work
disability. As Table U shows, for the population 16 to 72 years of age, the
conditions most often responsible for work disability are back or spine
problems (19.0 percent), heart trouble (15.2 percent), arthritis or
rheumatism (11.6 percent), respiratory problems (7.2 percent), stiffness or
deformity of limbs or extremities (4.5 percent), and high blood pressure (4.2
percent). In the survey, each respondent indicated which one condition was
mainly responsible for the work disability; so the numbers and percentages
can be added without duplication.
The 1984 SIPP used a somewhat different chronic condition nomenclature than
the NHIS; however, these work disability figures follow a pattern similar to
Table M on all types of activity limitation.
Table U: Conditions Mainly Responsible for Work Disability, 1984
(Persons 16 to 72 years with a work disability)
Population Base=23,514,000
Condition Percent Distribution
Total 100.0
Arthritis or rheumatism 11.6
Back or spine problems 19.0
Blindness or poor vision 2.9
Cancer 2.0
Deafness or poor hearing 1.5
Diabetes 3.4
Heart trouble 15.2
Hernia 1.1
High blood pressure 4.2
Kidney problem 1.0
Respiratory problems 7.2
Mental illness 1.8
Mental retardation 2.6
Missing limbs or extremities 0.8
Nervous or emotional problems 2.7
Paralysis 1.3
Senility or Alzheimer's disease 0.3
Stiffness or deformity of limbs or extremities 4.5
Stomach trouble 1.6
Stroke 2.4
Thyroid trouble 0.2
Tumor or growth 0.5
Other or not reported 12.2
Source: U.S. Bureau of the Census, 1984 Survey of Income and Program
Participation, Current Population Reports, Series P-70, No. 19,
Table 9.
** Occupational Injuries and Illnesses
Job-related injuries and illnesses, both acute and chronic, are another
component of work disability, as measured by the U.S. Department of Labor in
an annual survey of employers. The survey shows nearly 6.3 million cases of
occupational injuries and 284,000 cases of occupational illnesses occurring
in 1989, for a total rate of 8.6 injury and illness cases per 100 full-time
workers (see Table V). One tool for monitoring the severity of these cases
is the incidence rate for lost workdays, computed as the number of workdays
lost per 100 full-time workers. This includes the number of days employees
were either away from work or restricted in their work activity due to
injuries and illnesses. Across all industry divisions, the lost workday rate
was 78.7 in 1989. Table V shows the 1973 - 1989 trend in total cases of job-
related illness and injury relative to the lost workdays involved. While the
number of cases per 100 full-time workers decreased from 11.0 to 8.6 during
this period, the corresponding workday loss increased from 53.3 to 78.7 due
to a significant increase in the lost days per case. Another measure of
severity is the number of lost workday cases relative to the total.
Approximately 46 percent of the all cases of injury and illness resulted in
lost workdays in 1989, an increase from the 31 percent in 1973. The
association between an illness (as opposed to an injury) and the work place
may be difficult to make, especially regarding long-term latent ones, and for
this reason the Department of Labor believes the illness figures (which are
incorporated into the overall table rates) are understated.
Table V: Occupational Injury and Illness
Incidence Rates per 100 Full-Time Workers, 1973-1989
Year Total Cases Lost Workday Cases Lost Workdays
1973 11.0 3.4 53.3
1974 10.4 3.5 54.6
1975 9.1 3.3 56.1
1976 9.2 3.5 60.5
1977 9.3 3.8 61.6
1978 9.4 4.1 63.5
1979 9.5 4.3 67.7
1980 8.7 4.0 65.2
1981 8.3 3.8 61.7
1982 7.7 3.5 58.7
1983 7.6 3.4 58.5
1984 8.0 3.7 63.4
1985 7.9 3.6 64.9
1986 7.9 3.6 65.8
1987 8.3 3.8 69.9
1988 8.6 4.0 76.1
1989 8.6 4.0 78.7
Source: U.S. Bureau of Labor Statistics, News, USDL-90-582, BLS Reports
on Survey of Occupational Injuries and Illnesses in 1989, U.S.
Department of Labor, Washington, D.C. 1990. Table 6.
** Disability in Long-Term Care Facilities
The National Health Interview Survey and other household studies do not cover
residents of institutions, which results in the exclusion of data on persons
with the most severe disabilities. For this reason, the Digest also includes
data from several studies of the institutional population, including nursing
homes, mental health inpatient facilities, and institutions for the mentally
retarded.
** Nursing Home Residents
The 1985 National Nursing Home Survey, another NCHS effort, included all
types of nursing and related care homes with three or more beds set up and
staffed for use by residents and routinely providing nursing and personal
care services. Among the 19,100 nursing homes in the United States in 1985,
there were 1,491,400 residents, as Table W shows. Of these persons,
virtually all (88 percent) were 65 years of age or over, representing
approximately 5 percent of the total elderly population. This rate of
institutionalization at any point in time increases with age, rising to 22
percent for those 85 years of age and over. Compared to studies in 1973-74
and 1977, this percentage has remained virtually unchanged; although the
numbers of persons 85 and over have decreased from 257 per 1,000 residents
(25.7 percent) to 220 per 1,000 (22.0 percent) since 1973-74. The reasons
for a decline in use among those with the highest nursing home utilization
rates are unknown; however, they may be a function of competition due to
lower vacancy rates than in the past. The median length of stay was 1.7
years and the mean was 2.9 years, the latter not varying by either sex or
race; however, persons under 65 had longer mean stays (3.6 years) than their
elderly counterpart (2.8 years).
The National Nursing Home Survey used "dependency in activities of daily
living" to measure disability, as presented in Table W. Over three-fourths
of the residents required assistance in bathing and dressing, and over half
needed help with the remaining activities, with the exception of eating where
nearly 40 percent required assistance.
Table W: Number and Percent of Nursing Home Residents by
Dependency in Activities of Daily Living (ADL): United States, 1985
ADL Number Percent
Requires assistance in bathing 1,323,200 88.7
Requires assistance in dressing 1,124,600 75.4
Requires assistance in using toilet room 907,600 60.9
Requires assistance in transferring* 893,400 59.9
Has difficulty with bowel and/or bladder 774,400 51.9
control
Requires assistance in eating 586,300 39.3
Total 1,491,400 100.0
* Transferring - Getting into or out of a chair or bed.
Source: National Center for Health Statistics, 1985 National Nursing
Home Survey, Vital and Health Statistics, Series 13, No. 102,
Table 6.
Table X identifies the chronic conditions with the highest prevalence among
nursing home residents. Heart disease, senile dementia or organic brain
syndrome, cerebrovascular disease, arthritis or rheumatism, and essential
hypertension were the most frequently occurring conditions. While not high
prevalence conditions, Alzheimer's disease and other specified and
unspecified degeneration of the brain had the highest average number of ADL
dependencies at 4.9, followed by Parkinson's disease with 4.6, and senility
without psychoses at 4.5. High prevalence conditions which also had a high
number of ADL dependencies were senile dementia or organic brain syndrome and
cerebrovascular disease, each with 4.5 average ADL dependencies.
Table X: Number of Chronic Conditions with the Highest
Prevalence among Nursing Home Residents: United States, 1985
Number of Average
Condition Rank Conditions per Number of ADL
1,000 Persons Dependencies
Ischemic Heart Disease 1 241.5 3.7
Senile Dementia or Organic Brain Syndrome 2 233.7 4.5
Cerebrovascular Disease 3 182.1 4.5
Arthritis or Rheumatism 4 179.1 3.4
Essential Hypertension 5 156.4 3.3
Other Heart Disease 6 152.3 3.6
Diabetes Mellitus 7 124.2 3.7
Psychoses other than Senile Dementia 8 110.6 2.1
Congestive Heart Failure 9 106.8 3.5
Atherosclerosis 10 74.7 3.6
Chronic Obstructive Pulmonary Disease and 11 68.4 3.0
Allied Conditions
Alzheimer's Disease and Other Specified and 12 49.2 4.9
Unspecified Degeneration of the Brain
Malignant Neoplasms 13 48.1 3.9
Other Mental Disorders 14 47.9 2.0
Parkinson's Disease 15 47.4 4.6
Anemia 16 47.0 *
Urinary Tract Infection 17 38.9 *
Senility without Psychoses 18 38.5 *
Mental Retardation 19 33.9 2.6
Osteoporosis 20 32.9 *
* Information not available
Source: National Center for Health Statistics, 1985 National Nursing Home
Survey, Vital and Health Statistics, Series 13, No. 102, Tables 8
and 11.
Note: Rank and number of conditions per 1,000 persons pertain to all
listed diagnoses; ADL dependency figures pertain to primary diagnosis.
In terms of severity of ADL limitation, Table Y shows the percentage
distribution of nursing home residents who have from zero to six
dependencies. Nearly 30 percent, or 431,700 residents, are dependent in all
six categories, while nearly 10 percent, or 146,200 show no ADL dependency at
all.
Table Y: Percent of Nursing Home Residents by
Number of Dependencies: United States, 1985
Number of Dependencies Percent Distribution
None 9.8%
1 11.2%
2 10.2%
3 7.7%
4 13.1%
5 19.1%
6 28.9%
Average Number of Dependencies 3.8 ADL Dependencies
Source: National Center for Health Statistics, 1985 National Nursing
Home Survey, Vital and Health Statistics, Series 13, No. 102,
Table 6.
** Mental Health Facilities and Organizations
Using the results of a sample survey, the National Institute of Mental Health
publishes data on the numbers and characteristics of persons served by
organizations designed primarily to provide mental health services. These
organizations include both residential treatment facilities and a range of
outpatient and partial hospitalizations programs, consisting of the
following:
o state and county mental hospitals;
o private psychiatric hospitals;
o Veterans Administration medical centers;
o non-federal general hospitals with separate psychiatric service(s);
o residential treatment centers for emotionally disturbed children (RTC);
o freestanding outpatient mental health clinics;
o freestanding mental health partial care organizations; and
o multi-service mental health organizations (including community mental
health centers not operated as part of the above organizations).
Excluded from the NIMH data collection are private office-based practices of
psychiatrists, psychologists, and other providers; psychiatric services of
all types of hospitals or outpatient clinics operated by federal agencies
other than the Department of Veterans Affairs (e.g., Public Health Service,
Indian Health Service, Department of Defense, Bureau of Prisons); general
hospitals which have no separate psychiatric services but admit psychiatric
patients to non-psychiatric units; and psychiatric services of schools,
colleges, halfway houses, community residential organizations, local and
county jails, state prisons, and other human service providers.
For presentation purposes, NIMH categorizes mental health organizations as
inpatient care (24 hour care in a mental hospital setting), outpatient care
(ambulatory services for less than three hours at a single visit), and
partial care (planned program of treatment generally in visits of three or
more hours). The following data focuses primarily on the inpatient component
of mental health services.
As Table 30 shows, in 1986 the average daily inpatient census for all
surveyed mental health organizations was 228,530 persons in 3,039
organizations providing residential treatment. NIMH divides the mental
health inpatient population into two groups for analysis. The first is
patients under care, which represents the long-term institutional caseload.
NIMH estimates there were 160,862 persons in this category as of April 1,
1986 (see Table 31). The second group consists of annual admissions, and
there were 1.6 million persons admitted during 1986. The large difference
results from a short median length of stay, only 15 days, confirming the
distinct nature of the under care population relative to the vast majority of
inpatients, who are not part of the long-term caseload.
Among the five inpatient NIMH facility and organization categories, state and
county mental hospitals accounted for 59 percent of the patients under care,
followed by general hospitals at 20 percent. A reversal of this relationship
exists for admissions, with general hospitals accounting for 50 percent of
admissions during 1986 and state and county mental hospitals accounting for
20 percent. This shows that a major portion of long-term mental health care
is provided by state and county facilities, while general hospital mental
health services address primarily short-term, acute care mental health needs.
NIMH reported that of the 160,862 inpatients under care, 59 percent were
male, 41 percent were female, 71 percent were white and 29 percent were from
other racial groups. The corresponding figures for the sex and race of
inpatient admissions presented a pattern similar to those under care. Of the
1.6 million admissions in 1986, 57 percent were male and 43 percent female,
while 76 percent were white and 24 percent of other races.
Nearly half (48 percent) of those under care were between the ages of 25 and
44 and almost one-fifth (19 percent) were between 45 and 64. The other age
cohorts each comprised between 10 and 12 percent of the total inpatient
population under care: under 18 years of age (10 percent), 18 to 24 (12
percent), and 65 and over (12 percent). While the total figures and those of
state and county mental hospitals present similar patterns concerning age,
race and sex, differences occur among the other types of facilities and
organizations regarding inpatient care. For example, private psychiatric
hospitals show only a four percentage point difference based on gender, with
females out numbering males 52 to 48 percent, and persons under 18
constituting the largest age group, at 41 percent.
For admissions in 1986, the 25 to 44 age cohort was the largest at 52 percent
followed by the 45 to 64 age group at 19 percent, reflecting a pattern
similar to patients under care. However, the under 18, and 65 and over age
cohorts were at 7 and 8 percent, respectively, which are lower than for the
under care group. Those 18 to 24 years of age represented 14 percent of
admissions.
NIMH also collected data and reported on the principal psychiatric diagnosis
for both patients under care and inpatient admissions, as Table 31 shows..
For those under care, schizophrenia at 44 percent and affective disorders at
22 percent were the most frequently occurring. The same two were also most
prevalent among admissions, but in the opposite order, with affective
disorders at 31 percent and schizophrenia at 23 percent. For admissions,
alcohol-related disorders constituted 15 percent, as compared to only 6
percent for those under care. The remaining conditions made up 15 and 20
percent of the patients under care and inpatient admissions, respectively.
NIMH also uses another measure of inpatient care - the rate per 100,000
civilian population - which provides a common denominator for comparison
purposes. For patients under care, males had a relatively higher rate than
females (82 versus 53), and whites had a lower rate than other races (56
versus 127). Within the "other races" category, the male-female difference
was much greater than for the total mental health inpatient population under
care (185 versus 75). Regarding age cohorts, the 25-44 group had the highest
rate at 103, followed by those 18-24 years at a rate of 70, 45-64 years at a
rate of 68, and under 18 at a rate of 26 per 100,000 civilian population.
The median age was 34, which varied from 42 in VA medical centers to 22 in
private psychiatric hospitals.
For inpatient admissions per 100,000 civilian population, males at 790 had a
higher rate than females at 551. For whites, the rate was 593 versus 1,074
for all other racial groups. The 25-44 age group constituted the highest
rate per 100,000 for inpatient admissions at 1,119, followed by those 18-24
years of age at 802, and the 45-64 age group at 663. The elderly 65 and over
had a rate of 447, and those under 18 had the lowest rate at 177 per 100,000
persons. Outpatient mental health organizations had 1.4 million persons under
care and 2.1 million admissions during 1986. Partial care organizations had
133,194 persons under care and 156,912 admissions during that year.
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