Objectives To estimate the prevalence and causes of functional paralysis in the United States. Methods We used the 2013 US Paralysis Prevalence & Health Disparities Survey to estimate the prevalence of paralysis, its causes, associated sociodemographic characteristics, and health effects among this population. Results Nearly 5.4 million persons live with paralysis. Most persons with paralysis were younger than 65 years (72.1%), female (51.7%), White (71.4%), high school graduates (64.8%), married or living with a partner (47.4%), and unable to work (41.8%). Stroke is the leading cause of paralysis, affecting 33.7% of the population with paralysis, followed by spinal cord injury (27.3%), multiple sclerosis (18.6%), and cerebral palsy (8.3%). Conclusions According to the functional definition, persons living with paralysis represent a large segment of the US population, and two thirds of them are between ages 18 and 64 years. Targeted health promotion that uses inclusion strategies to account for functional limitations related to paralysis can be undertaken in partnership with state and local health departments.

Objective-To examine the relationship between delivery volume and maternal complications.Study Design-We used administrative data to identify women admitted for childbirth in 2006. Hospitals were stratified into deciles based upon delivery volume. We compared composite complication rates across deciles.Results-We evaluated 1,683,754 childbirths in 1045 hospitals. Deciles 1 and 2 hospitals had significantly higher rates of composite complications than Decile 10 (11.8%, 10.1%, vs. 8.5%, P < .0001). Deciles 9 and 10 hospitals had modestly higher composite complications as compared to Decile 6 (8.8%, 8.5%, vs 7.6%, P < .0001). Sixty percent of Decile 1 and 2 hospitals were located within 25 miles of the nearest greater volume hospital.Conclusions-Women delivering at very low volume hospitals have higher complication rates, as well as those delivering at exceeding high volume hospitals. Most women delivering in extremely low volume hospitals have a higher volume hospital located within 25 miles.

Background Surveillance on paralysis prevalence has been conceptually and methodologically challenging. Numerous methods have been used to approximate population-level paralysis prevalence estimates leading to widely divergent prevalence estimates. Objective/hypotheses To describe three phases in use of the International Classification of Functioning, Disability and Health (ICF) as a framework and planning tool for defining paralysis and developing public health surveillance of this condition. Methods Description of the surveillance methodology covers four steps: an assessment of prior data collection efforts that included a review of existing surveys, registries and other data collection efforts designed to capture both case definitions in use and prevalence of paralysis; use of a consensus conference of experts to develop a case definition of paralysis based on the ICF rather than medical diagnostic criteria; explanation of use of the ICF framework for domains of interest to develop, cognitively test, validate and administer a brief self-report questionnaire for telephone administration on a population; and development and administration of a Paralysis Prevalence and Health Disparities Survey that used content mapping to back code items from existing national surveys to operationalize key domains. Results ICF coding led to a national population-based survey of paralysis that produced accurate estimates of prevalence and identification of factors related to the health of people in the U.S. living with paralysis. Conclusions The ICF can be a useful tool for developing valid and reliable surveillance strategies targeting subgroups of individuals with functional disabilities such as people with paralysis and others.

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