Comparing Measures Of Functional Difficulty With Self-Identified Disability: Implications For Health Policy

Abstract

The Affordable Care Act mandated data collection standards to identify people with disabilities in federal surveys to better understand and address health disparities within this population. Most federal surveys use six questions from the American Community Survey (ACS-6) to identify people with disabilities, whereas many international surveys use the six-item Washington Group Short Set (WG-SS). The National Survey on Health and Disability (NSHD), which focuses on working-age adults ages 18–64, uses both question sets and contains other disability questions. We compared ACS-6 and WG-SS responses with self-reported disability types. The ACS-6 and WG-SS failed to identify 20 percent and 43 percent, respectively, of respondents who reported disabilities in response to other NSHD questions (a broader WG-SS version missed 4.4 percent of respondents). The ACS-6 and the WG-SS performed especially poorly in capturing respondents with psychiatric disabilities or chronic health conditions. Researchers and policy makers must augment or strengthen federal disability questions to improve the accuracy of disability prevalence counts, understanding of health disparities, and planning of appropriate services for a diverse and growing population.

Impairment and Disability Identity and Perceptions of Trust, Respect, and Fairness

“…These findings add to the existing body of literature about the inadequacies of current disability measures . For example, 1 study found that the ACS-6 failed to identify 20% of impairments and disabilities as captured in the National Survey on Health and Disability (NSHD) .…”

“…15 The growing attention to disability disparities has coincided with an increasing recognition of a need to capture high-quality data. 3,[19][20][21][22] Section 4302 of the Affordable Care Act calls for a minimum standardized measure of disability in all federally funded surveys. 21,22 The chosen method was a series of 6 yes-no questions from the American Community Survey (ACS-6) that ask about serious difficulty with the following basic functions: seeing; hearing; remembering, making decisions, or concentrating; ambulating; caring for self; and/or doing errands.…”

“…The growing attention to disability disparities has coincided with an increasing recognition of a need to capture high-quality data . Section 4302 of the Affordable Care Act calls for a minimum standardized measure of disability in all federally funded surveys .…”

Disability Documentation in the National Health Interview Survey and Its Consequence: Comparing the American Community Survey to the Washington Group Disability Measures

“…It is important to note that there is evidence that neither the ACS or WG-SS disability questions are fully sufficient in documenting disability status. Hall et al 35 recently reported that in the National Survey of Health and Disability (NSHD), a national sample of US adults with disabilities age 18 years and older that uses multiple measures to document disability status, including open-ended self-identification questions, both the ACS and WG-SS questions failed to capture 20% and 43% of people with disabilities, respectively. Specifically, both the ACS and WG-SS do not account for disabled people with intellectual and developmental disability, mental health disability, and chronic illness.…”

“…Specifically, both the ACS and WG-SS do not account for disabled people with intellectual and developmental disability, mental health disability, and chronic illness. 35 The work by Hall et al builds off of prior research documenting the limitations of the ACS and WG-SS disability questions, 23,28,36–38 which highlight a long-term goal to expand and improve the questions used to assess disability.…”