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August 25, 1995 / 44(33);609-613

During 1991-1992, an estimated 48.9 million persons (19.4% of the total U.S. population of 251.8 million) had a disability; of these, 3.8 million (7.9%) were aged less than or equal to 17 years (1). For children aged less than 3 years, the overall estimated prevalence of disabilities was 2.2%; for those aged 3-5 years, 5.2%; for those aged 6-14 years, 6.3%; and for those aged 15-17 years, 9.3% Table_1. In all age groups, the prevalence of disabilities was higher among boys than girls; this sex-specific difference was greatest in the 6-14-year age group.

The condition most frequently reported as a cause of functional limitation among children aged less than or equal to 17 years was learning disability (29.5%), followed by speech problems (13.1%), mental retardation (6.8%), asthma (6.4%), and mental or emotional problems or disorders (6.3%) Table_2. Reported by: JM McNeil, Bur of the Census, Economics and Statistics Administration, US Dept of Commerce. Disabilities Prevention Program; Developmental Disabilities Br, Div of Birth Defects and Developmental Disabilities, National Center for Environmental Health; Behavioral Risk Factor Surveillance Br, Office of Surveillance and Analysis, National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: In the United States, the impact of disabilities is disproportionately higher among children because disabilities with onset during childhood account for approximately one third of the years of disability *** in the U.S. population (4). Improved characterization of the magnitude and distribution of disabilities among children is important to identify needed services and to target appropriate interventions. The findings in this report further document age and sex variations in the prevalence of disabilities among children. The increase in the prevalence of disabilities with advancing age probably reflects the ability to identify more readily academic or behavioral limitations among older children and variations in the way educational systems identify children limited in the ability to do regular school work (5). Reasons for sex-specific differences are unclear and require further study.

The approach used in this report to estimate the prevalence of disabilities was based on limitations in function resulting from chronic conditions rather than on the diagnosis of such conditions. Previous studies may have underestimated the prevalence of disabilities among children because the definitions were restricted to certain conditions (6). To improve the precision of estimates of disability, the SIPP definitions were broadened to include the functional consequences of chronic conditions. The inclusion of these functional limitations enables more accurate estimates of the prevalence of disabilities. However, the SIPP data are subject to at least two limitations. First, because children living in institutions or group homes were excluded from the study, the prevalence of disabilities among children probably is underestimated. Second, age-group-specific variations in the definitions of disability limit the basis for comparison across age groups.

In SIPP, health conditions associated with disabilities comprise a combination of diseases (e.g., asthma or diabetes), impairments (e.g., missing extremities or paralysis), and primary conditions considered to be disabilities (e.g., mental retardation or cerebral palsy). Efforts to improve the precision of national estimates of disabilities among children should distinguish between those impairments, disabilities, and handicaps that are consequences of the disabling process. One such effort is the 1999 revision of the ICIDH, which will emphasize measures of disability and handicap among children (7) and assist in standardizing collection of information about disabilities among children.

Improved estimates of the prevalence of disabilities and their associated health consequences among children are needed to develop and evaluate prevention strategies. Estimates based on analysis of data from SIPP can assist public health planners in identifying primary services for children with disabilities and in projecting long-range needs of these children. In addition, the linking of data about primary disabling conditions among children with the functional consequences of these conditions enables more precise estimation of costs required to meet the continuing needs of these children.

References

1. McNeil JM. Americans with disabilities, 1991-1992. Washington, DC: US Department of Commerce, Economics and Statistics Administration, Bureau of the Census, 1993. (Current population reports; series p70, no. 33).
2. CDC. Prevalence of disabilities and associated health conditions. MMWR 1994;43:730-1,737-9.
3. World Health Organization. International classification of impairments, disabilities, and handicaps. Geneva: World Health Organization, 1980.
4. Houk VN, Thacker SB. Program to prevent primary and secondary disabilities in the United States. Public Health Rep 1989;104:226-31.
5. US Department of Education. 11th Annual report to Congress on the implementation of the Individuals with Disability Education Act. Washington, DC: US Department of Education, Office of Special Education and Rehabilitative Services, Office of Special Education Programs, 1989.
6. Verbrugge LM. The disability supplement to the 1994-95 National Health Interview Survey (NHIS-Disability). Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1993.
7. Badley EM. An introduction to the concepts and classifications of the International Classification of Impairments, Disabilities, and Handicaps. Disabil Rehabil 1993;15:161-78.
   • Based on the ICIDH, an impairment is an abnormality of an organ system, a disability is a person's limitation in function resulting from an impairment, and a handicap is the social consequence(s) or disadvantage(s) resulting from impairment and disability that a person experiences while interacting in the physical and social environment. ** Ability to 1) "get around inside the home"; 2) "get in and out of bed or a chair"; 3) "take a bath or shower, dress, and eat;" and 4) "get to and use the toilet." *** Years of disability are calculated by multiplying the number of persons with new cases of disabilities by the expected lifespan of each person with a disability per year. Because years of disability reflect both prevalence and duration of disability, it is useful in assessing the impact of preventive interventions.

     
     
     Table_1
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     TABLE 1. Number * and percentage of children aged <=17 years with disabilities, by sex, age group, and criteria of the definition Survey of Income and Program Participation, United States, 1991-1992 +="==========================================================================================" Male Female Total (n="33,879)" (n="32,256)" (n="66,135)" Age group/ Criteria of definition & No. (%) No. (%) No. (%) <3 yrs (n="6,000)" (n="5791)" (n="11,791)" Limited in usual kind of activities 72 ( 1.2) 76 (1.3) 149 (1.3) Received services for developmental needs 106 ( 1.8) 77 (1.3) 183 (1.6) With autism/cerebral palsy/ mental retardation 32 ( 0.5) 8 (0.1) 41 (0.4) Total with a disability 133 ( 2.2) 121 (2.1) 254 (2.2) 3-5 yrs (n="5,946)" (n="5,565)" (n="11,511)" Limited in usual kind of activities 184 ( 3.1) 110 (2.0) 294 (2.6) Received services for developmental needs 323 ( 5.4) 176 (3.2) 498 (4.3) Limited in ability to walk, run, or use stairs 76 ( 1.3) 71 (1.3) 147 (1.3) With autism/cerebral palsy/ mental retardation 54 ( 0.9) 21 (0.4) 75 (0.7) Total with a disability 370 ( 6.2) 228 (4.1) 597 (5.2) 6-14 yrs (n="16,761)" (n="16,005)" (n="32,766)" Limited in ability to do regular school work 1,197 ( 7.1) 567 (3.5) 1,764 (5.4) Limited in ability to walk, run, or use stairs 301 ( 1.8) 223 (1.4) 524 (1.6) With autism/cerebral palsy/ mental retardation 250 ( 1.5) 163 (1.0) 412 (1.3) Total with a disability 1,373 ( 8.2) 689 (4.3) 2,062 (6.3) 15-17 yrs (n="5,172)" (n="4,895)" (n="10,067)" Limited in ability to do regular school work 321 ( 6.2) 116 (2.4) 438 (4.4) With autism/cerebral palsy/ mental retardation @ 159 ( 3.1) 150 (3.1) 309 (3.1) Total with a disability 558 (10.8) 374 (7.7) 933 (9.3) * In thousands. + Unweighted sample size="66,135." & Categories are not mutually exclusive. @ For these older children, this category includes additional measures of limitations in functional activity.="==========================================================================================" 

     
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     Table_2
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     TABLE 2. Conditions reported as the cause of disability among                                                                                                                                                                                                
     children aged <=17 years Survey of Income and Program Participation, United States, 1991-1992="==============================================================" Condition No. * (%) Learning disability 1435 ( 29.5) Speech problems 634 ( 13.1) Mental retardation 331 ( 6.8) Asthma 311 ( 6.4) Mental or emotional problem or disorder 305 ( 6.3) Blindness or vision problems 144 ( 3.0) Cerebral palsy 129 ( 2.7) Epilepsy or seizure disorder 128 ( 2.6) Impairment deformity of back, side, foot, or leg 121 ( 2.5) Deafness or serious trouble hearing 116 ( 2.4) Tonsilitis or repeated ear infections 80 ( 1.6) Hay fever or other respiratory allergies 76 ( 1.6) Paralysis of any kind 73 ( 1.5) Missing legs, feet, toes, arms, hands, or fingers 70 ( 1.4) Autism 48 ( 1.0) Drug or alcohol problem or disorder 48 ( 1.0) Head or spinal cord injury 45 ( 0.9) Heart trouble 44 ( 0.9) Impairment deformity of finger, hand, or arm 27 ( 0.6) Cancer 26 ( 0.5) Diabetes 14 ( 0.3) Other 653 ( 13.4) Total 4858 (100.0) * In thousands.="==============================================================" 

     
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