Disability Questions Research Articles

P84 Length of hospital stay for elderly patients after cancer surgery is depending on ASA state and length of surgery but not on age

The use of comprehensive geriatric assessment (CGA) in cancer patients older than 70 is recommended. Three pre-screening instruments have been proposed: the abbreviated comprehensive geriatric assessment (aCGA), the Vulnerable Elders Survey (VES-13), and the Groningen frailty index (GFI). The objective of the study was to identify the most efficient pre-screening tool that accurately determines individuals who may benefit from the entire CGA. A total of 113 elderly cancer patients were assessed by means of the aCGA, VES-13, GFI and the full CGA. The sensitivity, specificity of the three instruments was calculated, using the results from the entire CGA as the gold standard for the GFI and the VES-13. The aCGA was assessed whether each sub-component reliably predicts impairment on each sub-component of the full CGA.The majority of the participants were defined as being at risk of vulnerability: 68.14% had two or more impairments of the CGA or were cognitively impaired. The physical and disability questions are useful, but all other screening instruments miss too many cases.

Long-term results after Boston brace treatment in adolescent idiopathic scoliosis

BackgroundFew studies have evaluated long-term outcome after bracing using validated health related quality of life outcome measures. The aim of the present study was to evaluate the long-term outcome in adolescent idiopathic scoliosis (AIS) 12 years or more after treatment with the Boston brace.Methods109 (80%) of 135 patients (7 men) with AIS treated with the Boston brace at a mean of 19.2 (range 12–28) years previously responded to long-term follow-up examination.All patients (n = 109) answered a standardised questionnaire including demographics, work status, treatment, Global Back Disability Question, Oswestry Disability Index (ODI) (100-worst possible), General Function Score (GFS) (100 – worst possible), EuroQol (EQ-5D) (1 – best possible), EQ-VAS (100 – best possible)) and Scoliosis Research Society -22 (SRS – 22) (5 – best possible). Clinical and radiological examination was obtained in 86 patients.ResultsThe magnitude of the primary prebrace major curve was in average 33.4° (range 20 – 52). At weaning and at the last follow-up the corresponding values were 28.3° (9–56) and 34.2° (8 – 87), respectively. The mean age at follow-up was 35 (27 – 46) years. Work status was: full time (80%), on sick-leave (3%), on rehabilitation (4%), disability pension (4%), homemaker (7%), students (2%), 7% had changed their job because of back pain. 88% had had delivered a baby, 55% of them had pain in pregnancy. Global back status was excellent or good in 81%. The mean (standard deviation) ODI was 6.4 (9.8), GFS 5.4 (10.5), EQ-5D 0.84 (0.2), SRS-22: pain 4.2 (0.8), mental health 4.2 (0.7), self-image 3.9 (0.7), function 4.1 (0.6), satisfaction with treatment 3.7 (1.0). 28% had taken physiotherapy for back pain the last year and 12% had visited a doctor.ConclusionLong-term results were satisfactory in most patients with AIS treated with the Boston brace.

Complex Survey Questions and the Impact of Enumeration Procedures: Census/American Community Survey Disability Questions

This paper explores challenges relating to the identification of the population with disabilities, focusing on Census Bureau efforts using the 2000 Decennial Census Long-Form (Census 2000) and 2000-2005 American Community Survey (ACS). In particular, the analyses explore the impact of survey methods on responses to the work limitation (i.e., employment disability) question in these two Census products. Building on the research of Stern (2003) and Stern and Brault (2005), we look for further evidence of misreporting of an employment disability by specific sub-populations using the participation in the Supplemental Security Income program as an exogenous employment disability status indicator along with a subset of ACS disability questions. We expand upon these earlier studies by examining both false-positive and false-negative reports of employment disability by implementing logit estimations to examine the role of respondent/enumerator error on the accuracy of the employment disability response. In this manner, we enhance our understanding of Census 2000 and ACS responses to employment disability questions through an exploration of the role of enumeration procedures in two types of misclassifications, as well as by evaluating existing data and estimates to uncover characteristics that might make an individual more likely to misreport an employment disability.

Measuring disability in censuses: The case of South Africa

This paper reports on findings from the South African census content research to develop a disability set of questions for Census 2011. The findings of this research are used to determine, firstly, whether the Washington Group on Disability Statistics (WG) Short Set (revised for the South African context) is an appropriate set of questions to measure disability in Censuses, and, secondly, whether it is sufficient to ask about basic domains in order to identify the population at risk of experiencing disability related disadvantage and discrimination. The methodology is a national survey using a population based representative sample. The focus of the research were two sets of questions: the first being the Short Set for Census proposed by the WG, and the second being the disability questions used in the 2001 South African Census. The survey comprised three questionnaires: a Household Questionnaire with one member of the household responding for the whole household; a Living Standard Measure (LSM) questionnaire administered to the same person about the whole household; and an adult questionnaire administered to all household members 15 years and older who could respond for themselves. The findings support the use of the revised WG Short Set as an appropriate Census measures. It captures a broader and more inclusive population as having difficulties compared to that captured on the Census 2001 disability question, without excluding the Census 2001 population captured as disabled. The results are inconclusive with regard to the sufficiency of basic domains as a measure of the population at risk. Further testing is required to understand how people understand and respond to questions such as ‘do you have difficulties in taking care of your household responsibilities or in your day to day work/schoolwork?’.

Transportation use patterns of U.S. children and teenagers with disabilities

Background Little is known about the differences in disabled and nondisabled children's travel patterns, means of transportation, and problems in getting needed transportation. Methods Data from the 2002 Transportation Availability and Use Survey for Persons with Disabilities (NTAUSPD) were used to make comparisons between children (≤17 years) with disabilities and children without disabilities. Disability was defined as meeting the criteria of at least one of three disability measures: responding yes to any of the national disability questions from the 2000 U.S. Census, meeting provisions in the Americans with Disabilities Act (ADA), or receiving special education. Using χ 2 analysis, comparisons were made across the following variables: sex, age, race, number of days leaving home, residency, household income, and availability of transportation. Children with and without disabilities were also compared in terms of their modes of transportation and destinations. Both children with and without disabilities were included in logistic regression models that considered sociodemographics, disability severity, and types of disability and their associations with the problem of getting needed transportation. Disability severity and types of disability were considered as explanatory variables in separate models because of collinearity. Results Overall, 6.6% (95% confidence interval [CI], 3.9-10.6) of children with disabilities and 4.2% (95% CI, 2.6-6.7) of children without disabilities reported having trouble getting needed transportation. While they did not differ in their mode of transportation for medical visits, local travel, and long-distance travel, children with disabilities used a bus for school travel more frequently than did children without disabilities ( P < .05). The availability of various modes of transportation (personal vehicle, bus, paratransit, train, and taxi) was similar when comparisons were made between the two groups of children. Disability severity was associated with the problem of getting needed transportation in the univariable model. However, when disability severity was considered in a multivariable model, only age (odds ratio [OR], 8.59; 95% CI, 2.35-31.31) and income (OR, 6.08; 95% CI, 1.71-21.61) were statistically significant. In a separate model, the presence of mobility difficulties (OR, 6.78; 95% CI, 1.44-31.93) was statistically significant, as were age and income, while controlling for sex, race, residency, and other types of disability. Conclusion Bus transportation was used by over a third of children without disabilities and close to half of children with disabilities for school travel. Multivariable logistic models showed significant associations with the problem of getting needed transportation and the age of the child, household income, and mobility difficulties.

Health-related quality of life and health behaviors by social and emotional support

Social and emotional support is an important construct, which has been associated with a reduced risk of mental illness, physical illness, and mortality. Despite its apparent relevance to health, there have been no recent state or national population-based U.S. studies regarding social and emotional support. In order to better address this issue, we examined health-related quality of life (HRQOL) and health behaviors by level of social and emotional support in community-dwelling adults in the United States and its territories. Data were obtained from the Behavioral Risk Factor Surveillance System, an ongoing, state-based, random digit telephone survey of the noninstitutionalized U.S. population aged > or =18 years. In 2005, one social and emotional support question, four HRQOL questions, two disability questions, one life satisfaction question, and four health behavior questions were administered in the 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. An additional five HRQOL questions were administered in two states. An estimated 8.6% of adults reported that they rarely/never received social and emotional support; ranging in value from 4.2% in Minnesota to 12.4% in the U.S. Virgin Islands. As the level of social and emotional support decreased, the prevalence of fair/poor general health, dissatisfaction with life, and disability increased, as did the mean number of days of physical distress, mental distress, activity limitation, depressive symptoms, anxiety symptoms, insufficient sleep, and pain. Moreover, the prevalence of smoking, obesity, physical inactivity, and heavy drinking increased with decreasing level of social and emotional support. Additionally, the mean number of days of vitality slightly decreased with decreasing level of social and emotional support; particularly between those who always/usually received social and emotional support and those who sometimes received support. These findings indicate that the assessment of social and emotional support is highly congruent with the practice of psychiatry. Assessment of social and emotional support, both in psychiatric and medical settings, may identify risk factors germane to adverse health behaviors, and foster interventions designed to improve the mental and physical health of at risk segments of the population.

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Association of Mood, Anxiety, and Substance Use Disorders With Occupational Status and Disability in a Community Sample

Relationship between low back pain, disability, MR imaging findings and health care provider

To determine the association between the self-report of pain and disability and findings on lumbar MR images, and to compare two different health care providers in Spanish patients with low back pain (LBP). Cross-sectional A total of 278 patients, 137 men and 141 women aged 44+/-14 years submitted with low back pain (LBP) were studied. One hundred and nine patients were from the National Health System (NHS) and 169 from private practice. Patients with previous discitis, surgery, neoplasm or traumatic episodes were excluded. Every patient completed a disability questionnaire with six core items, providing a score of disability from 2 to 28. All patients had sagittal spin-echo T1 and turbo spin-echo T2, axial proton-density and MR myelography weighted images. MR images of the two most affected disc levels were read, offering an MR imaging score from 0 to 30. Patients with a combination of LBP and sciatica showed the highest levels of disability (p=0.002). MR imaging scores only correlated with pain interference with normal work (p=0.04), but not with other disability questions. Patients from the NHS showed greater disability scores than private ones (p=0.001) and higher MR imaging scores (p=0.01). In patients with LBP, MR imaging only correlates with pain interference with work but not with other disability questions. Differences are found between private and NHS patients, the latter being more physically affected.

Hurricane Response Often Ignored Mentally Ill People

Hurricane Response Often Ignored Mentally Ill People

Klinische Resultate 2 Jahre nach Hüfttotalendoprothese (WOMAC/SF-36) und Vergleich mit der Normbevölkerung (SF-36)

The aim of this study was to determine the outcome after total hip replacement (THR) with the WOMAC and the SF-36 as well as to identify the most responsive items and to elucidate the reasons for increased pain postoperatively. 73 patients filled out the questionnaires preoperatively and 3, 6, 12, 24 months postoperatively. All mean subscales and the responsiveness for each question were calculated. The patients with increased pain postoperatively were reassessed. All WOMAC subscales and six of the eight SF-36 subscales showed significant improvements after THR (p < 0.05). The most responsive items were the pain and disability questions (SRM, ES > 1.5). Two patients with a higher pain score postoperatively had associated symptomatic degenerative lumbar spinal disease. The WOMAC and the SF-36 are valid measures of the outcomes of THR in their German translations and document the good results after THR. Two years after THR the patients reach the same health state compared to an age matched control group in the population. The WOMAC contains more questions of higher responsiveness than the SF-36. A higher pain score postoperatively may be caused by degenerative disease of the lumbar spine.

Introducing the ASQE: The English Version of the Amblyopia and Strabismus Questionnaire

Introduction: Existing visual function questionnaires (such as NEI’s VFQ-25) have insufficient discriminatory validity to assess the impact of amblyopia and strabismus on quality-of-life. For this reason the Amblyopia and Strabismus Questionnaire was developed in the Netherlands, a Dutch-language instrument containing five subscales for fear of losing the better eye, distance estimation, visual disorientation, double vision, and social contact and appearance (Strabismus 2004;12:181-93). Here we establish and validate the English version, the ASQE. Methods: Structured translation (twice forward, consensus, backward) resulted in the 26-item ASQE, which was administered to 138 consecutive strabismic adults as part of a quality-of-life survey that also included disability and time tradeoff utility questions. Subjects were clinically characterized by level of amblyopia, asthenopia, binocularity, and diplopia. Results: The ASQE “total score” correlated with disability (Spearman r= 0.71, P< 0.0001), utility (r= 0.45, P< 0.0001), and with all clinical parameters (r= 0.19 to 0.45, all P values< 0.025). Particularly, the ASQE subscale “fear of losing the better eye” correlated with level of amblyopia (r= 0.29, P= 0.0006); “distance estimation” scores correlated with binocularity (r= 0.23, P= 0.0085); “double vision” scores correlated with the clinical impression of diplopia (r= 0.54, P< 0.0001). Conclusions: Excellent correlations between ASQE results and the other quality-of-life indicators establish good construct validity, similar to the original instrument. The correlations between ASQE subscales and clinical parameters indicate good discriminatory validity. Therefore, the ASQE appears meaningful for quality-of-life assessment. We expect it to become a valuable tool for the evaluation of treatment of adult strabismus because it appears sensitive to variations in sensory status.

Variation in Thresholds for Reporting Mobility Disability Between National Population Subgroups and Studies

Disability questions require older people to report difficulties with everyday activities, using broad categorical responses. Relatively little is known about population group differences in the thresholds for reporting difficulty or inability with medium-distance mobility against tested mobility-related performance. We aimed to estimate the thresholds on tested performance at which self-reports change from one category to another, across a range of sociodemographic subgroups. We also aimed to compare reported and tested performance across two national population studies. The samples were from the third U.S. National Health and Nutrition Examination Study (NHANES III) and the Longitudinal Aging Study Amsterdam (LASA). Measures of gait speed, chair stands, and peak expiratory flow rate in both studies yielded the validated index of mobility-related physical limitations (MOBLI). Latent probit models were used to estimate cutpoints (thresholds) on the index for reporting difficulty or inability to walk a medium distance. Thresholds for reporting difficulty or inability were studied by age, sex, race, educational level, and income in NHANES III. In models adjusting for the other factors, performance thresholds for reporting disability categories varied by age and income. The younger elderly persons in NHANES III on average reported difficulties or inabilities only when they reached a more severe level of tested limitation compared with older old persons. A similar pattern exists for those on higher incomes. For race, differences in threshold were present only for reporting inability, but not difficulty. Significant differences in thresholds were not present between groups defined by sex or for years of education. Comparisons between the NHANES and LASA studies show that lower reported mobility difficulty or inability prevalence in the Dutch sample is attributable both to reporting at higher levels of limitation and to better functioning. There is evidence of differences in thresholds for reporting mobility disability, especially across age and income groups in older Americans. Further work is needed to understand the perceptual, attitudinal, or environmental factors that cause these reporting differences.

Ethnicity, health and health services utilization in a British study

Despite the exponential growth in the number of studies addressing ethnicity and health, there is considerable debate about definitions of ethnicity, the appropriate use of ethnicity in health research and whether research focusing on ethnicity in the health field will ultimately result in reduced disadvantage or will simply contribute to the reification of ethnic origin as a cause of health problems. The authors present and discuss health outcomes among White (n = 227), African-Caribbean (n = 213) and Indian and Pakistani (n = 233) adults aged between 18 and 59 years living in Leeds as measured in a stratified population survey, with particular emphasis on the interaction between reports of health conditions and health status in relation to ethnicity and gender. The survey included both general and specific measures of health and impairment and was undertaken following extensive qualitative fieldwork. Overall the results of the study suggest that adults in both broad minority ethnic groups studied have a somewhat less favourable profile of physical and mental health and risk factors such as obesity and low birthweight. Despite an absence of ethnic differences in reporting of long-term conditions, minority groups had lower health status because those with long-term conditions were generally in worse health than their White counterparts. The study findings agree with previous research in suggesting that variation in health status was better explained by specific measures of actual limitations in daily activities than by general measures of limiting long-term illness. These data suggest that limiting long-term illness or disability questions may underestimate functional limitation relative to more specific measures and consequently their use in resource allocation may be problematic.

Reliability and validity of the Japanese Migraine Disability Assessment (MIDAS) Questionnaire.

This study was designed to assess the test-retest reliability, internal consistency, and validity of a Japanese translation of the Migraine Disability Assessment (MIDAS) Questionnaire in a sample of Japanese patients with headache. Previous studies have demonstrated that the English-language version of the MIDAS Questionnaire is a reliable and valid instrument for the assessment of migraine-related disability. Any translations of the MIDAS Questionnaire must also be assessed for reliability and validity. Study participants were recruited from the patient population attending either the Neurology Department of Kitasato University or an affiliated clinic. Participants were eligible for study entry if they had 6 or more primary headaches per year. For reliability testing, participants completed the MIDAS Questionnaire on 2 occasions, exactly 2 weeks apart. To assess validity, patients were also invited to participate in a 90-day daily diary study. Composite measures from the 90-day diaries were compared to equivalent MIDAS measures (ie, 5 questions on headache-related disability and 1 question each on average pain intensity and headache frequency in the last 3 months) and to the total MIDAS score obtained from a third MIDAS Questionnaire completed at the end of this 90-day period. One hundred one patients between the ages of 21 and 77 years were recruited (81 women and 20 men). Ninety-nine patients (80 women and 19 men) participated in the diary study. At baseline, 46.5% of patients were MIDAS grade I or II (minimal, mild, or infrequent disability), 22.2% were MIDAS grade III (moderate disability), and 31.3% were MIDAS grade IV (severe disability). Test-retest Spearman correlations for the 5 disability questions and the questions on average pain intensity and headache frequency ranged from 0.59 to 0.80 (P<.0001). The test-retest Spearman correlation coefficient for the total MIDAS score was 0.83 (P<.0001). The degree to which individual MIDAS questions correlated with the diary-based measures ranged from 0.36 to 0.88. The correlation between the total MIDAS score and the equivalent diary-based measure was 0.66. In general, the mean and median values for the MIDAS items and total MIDAS score were similar to the means and medians for the diary-based measures. However, the mean MIDAS scores for the number of days on which headache was experienced and the number of missed workdays were significantly different compared to the diary-based estimates for these items (P<.05). In addition, the mean MIDAS score for the number of days of missed housework was significantly higher than the corresponding diary-based estimate (P<.01). The results from this study show that the Japanese translation of the MIDAS Questionnaire is comparable with the English-language version in terms of reliability and validity.

Patients' reasons for undergoing total hip arthroplasty can change over time

The purpose of this study was to determine if a patient's reasons for undergoing a primary total hip arthroplasty (THA) changed at 1 year follow-up and, if the reasons did change, how does this change influence patient satisfaction with the procedure. Patients undergoing THA (101 patients) were evaluated with the McMaster Toronto Arthritis Patient Preference Disability (MACTAR) questionnaire and questions related to their expectations regarding the procedure. With the exception of pain and walking, most patients did not select the same preoperative and postoperative reasons for undergoing the procedure. In fact, 60% chose 2 new postoperative items. Patients whose expectations were not met were less likely to choose the same reasons for undergoing THA. Surgeons need to clarify patients' reasons for wanting a THA and attempt to identify new factors at follow-up that may influence patient satisfaction with the procedure. Copyright 2003, Elsevier Science (USA). All rights reserved.

A cross-sectional study correlating degeneration of the cervical spine with disability and pain in United kingdom patients.

A prospective cross-sectional study was conducted. To determine the relation between degeneration of all the joints in the cervical spine, and to identify the effects of litigation on pain and disability levels in trauma and nontrauma patients. The link between spinal degeneration and patient symptoms remains controversial. Two recent similar studies present conflicting results concerning the association between spinal degeneration and symptomatology. These two studies, performed in different countries, did not consider the impact of impending litigation on self-reported pain and disability levels. The role of the uncovertebral and facet articulations has hitherto not been investigated. Radiographic and questionnaire data from 180 consecutive patients with neck pain were collected. Neck pain severity was measured using two time-dependent scales. All patients completed the Neck Disability Index (NDI) and questions about chronicity, etiology, and associated litigation. The radiographs were evaluated for the number of levels of degeneration and the severity of degeneration in the discs as well as the uncovertebral and facet articulations. In this study, 71 patients (40.57%) reported neck pain as a result of injury. However, only 5.1% had associated litigation. There was no statistically significant difference in pain severity or disability levels between the patients with and those without cervical degeneration. According to the findings, the number of levels of cervical degeneration and the severity of degeneration in the discs, facets, and uncovertebral joints are not related to the levels of pain and disability. Patients reporting neck pain caused by injury had a tendency (P = 0.055) to more pain during the preceding week and significantly more disability (P < 0.001). Significant differences included pain intensity (P < 0.025), reading (P < 0.001), headaches (P < 0.025), ability to drive (P < 0.01), and concentration (P < 0.01). Women reported significantly more pain (P < 0.01) and disability (P < 0.001) than men, but did not have more degeneration in any of the joints. In patients with neck pain, there is no difference in reported pain and disability levels between those with and those without evidence of cervical spine degeneration. Patients whose neck pain is the result of trauma report significantly more pain and disability than nontrauma patients. This is not because of more spinal degeneration or overriding litigation issues.

Validity and responsiveness of Short Form 12-item survey in patients with back pain

Purpose of study: There is a growing recognition in the area of back pain research that evaluation of health-related quality of life (HRQL) is important for assessing the treatment effectiveness and for making clinical decisions. Numerous measures have been developed to assess HRQL. Among them, Short Form 12-item survey (SF-12) has become many back pain researchers' top choice, because this instrument is much shorter than many other HRQL measures and can significantly reduce the burden of respondents and the cost for data collection. Despite its widespread use, the validity and responsiveness of SF-12 in patients with back pain have not been well established. The purpose of this study is to evaluate the validity and responsiveness of SF-12 in patients with back pain.Methods used: Starting from January 1998, patients who consulted the Duke University Spine Center were asked to complete a comprehensive computerized survey questionnaire. The questionnaire included SF-12, Oswestry Back Disability Index and questions concerning patients' demographic characteristics, psychosocioeconomic status, medical history, present spine symptoms and the severity of back pain. A total of 2,520 patients who indicated in their first surveys that they had back pain were included in the validity study. Of these patients, 506 completed another survey in 3 to 6 months of follow-up and were used for assessing the responsiveness of SF-12. Only construct validity was evaluated, because content validity has been established, and the current lack of the “gold standard” for HRQL measure makes it difficult to determine the criteria validity. Construct validity was evaluated by assessing the correlation between the two summary scales of SF-12 and six other measures theoretically related or unrelated to these scales.of findings: Physical component summary of SF-12 (PSC-12) was significantly correlated with age, back pain, measures of overall well being and Oswestry Back Disability Index. Mental component summary of SF-12 (MCS-12) was significantly correlated with stress, depression, back pain, measures of overall well being and Oswestry Back Disability Index. Both PCS and MCS performed as expected without exception, demonstrating the construct validity of SF-12. The responsiveness of SF-12 was supported by several pieces of evidence. First, the changes in PCS-12 and MCS-12 were significantly correlated with the changes in back pain intensity. Second, for patients whose back pain improved, there was a significant increase in the follow-up PCS-12 and MCS-12 as compared with the baseline. Third, in the group whose back pain became improved or became worse, small to large effect size was obtained for PCS-12 or MCS-12.Relationship between findings and existing knowledge: To our knowledge, the current study is the first to evaluate the validity and responsiveness of SF-12 in patients with back pain.Overall Significance of findings: The current study demonstrated that SF-12 was a valid and responsive instrument for measuring health status or HRQL in patients with back pain. Given its brevity and the current findings, SF-12 may be considered as a useful outcome tool in the future back pain research.Disclosures: No disclosures.Conflict of interest: No conflicts.

Disability status differentials across fifteen Asian and pacific Islander groups and the effect of nativity and duration of residence in the U.S.*

This study examines disparities in disability status across 15 Asian and Pacific Islander American (API) subpopulations and how nativity and duration in the U.S. influence these differences. Employing three disability questions (work limitations, mobility limitations, and self-care limitations) from the 1990 PUMS, the authors find substantial heterogeneity in disability status across API subgroups: while Japanese American adults have the most favorable outcomes, Other Southeast Asian adults (Laotians, Hmong, and Cambodians), followed by Vietnamese and Pacific Islander adults, suffer from a high risk of disabilities. Many of the disparities in disability status across API subpopulation adults are attributable to differentials in demographic characteristics and SES. The inclusion of an interaction term of age and nativity/duration of residence in the U.S. in multivariate regression analyses demonstrates that the effect of nativity/duration plays a different role across age, net of demographic, and SES risk factors. The overall findings are also consistent with previous studies on the relationship between immigrant health and nativity/duration. That is, immigrants with short duration in the U.S. have superior health status, measured by risk of disability, than longer-term immigrants and their U.S.-born counterparts.

The Prevalence of Functional Limitations and Disability in Older Persons in the US: Data from the National Health and Nutrition Examination Survey III

To provide estimates by sex and age and by sex and race/ethnicity of the proportion of older Americans who have difficulty with functional limitations and daily activities. The Third National Health and Nutrition Examination Survey (NHANES III) 1988-1994. A cross-sectional nationally representative survey. All persons aged 60 and older who completed a household interview (N = 6,866) during NHANES III (conducted 1988-1994). The self-reported physical and functional disability questions from NHANES III included: lower-extremity function, instrumental activities of daily living, basic activities of daily living, needing help with personal and routine daily activities, and use of assistive devices for walking. Non-Hispanic black and Mexican-American men and women generally reported significantly (P < .01) more disability than did non-Hispanic white men and women. Disability was greater for minority women than for men. For both men and women, the prevalence in disability increased significantly (P < .01) with age for each measure. These sex-age and sex-race/ethnicity national estimates of disability indicate that minority women may represent a vulnerable subpopulation.

Reliability and validity of disability questions for US Census 2000.

We investigated the validity and proxy reliability of 7 new disability questions from the 2000 US census ("Census 2000"). A total of 131 people with disabilities and their proxies from St Louis, Mo, and Massachusetts were interviewed, and responses were compared for concordance. Responses also were compared with responses to questions from the Behavioral Risk Factor Surveillance System (BRFSS) and the Activities of Daily Living (ADL) instrument. Overall, proxies reported more impairment than did people with disabilities, and agreement was low (kappa = 0.24-0.55). Concordance was moderate between the census questions and their BRFSS and ADL counterparts. The Census 2000 questions may not provide an accurate profile of disability in America.