| Data Dictionary: | ACS 2018 (5-Year Estimates) |
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Survey: ACS 2018 (5-Year Estimates)
| Data Source: | U.S. Census Bureau |
| Table: | B18135. Age By Disability Status By Health Insurance Coverage Status [34] |
Universe: Universe: Civilian Noninstitutionalized Population
Table Details
| B18135. | Age By Disability Status By Health Insurance Coverage Status | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Universe: Universe: Civilian Noninstitutionalized Population | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Relevant Documentation:
| Excerpt from: | Social Explorer; U.S. Census Bureau; 2018 ACS 1-year and 2014-2018 ACS 5-year Data Releases : Technical Documentation. |
| 2018 ACS 1-year and 2014-2018 ACS 5-year Data Releases: Technical Documentation -> Subject Definitions -> Population Variables -> Disability Status |
Under the conceptual framework of disability described by the Institute of Medicine (IOM) and the International Classification of Functioning, Disability, and Health (ICF), disability is defined as the product of interactions among individuals' bodies; their physical, emotional, and mental health; and the physical and social environment in which they live, work, or play. Disability exists where this interaction results in limitations of activities and restrictions to full participation at school, at work, at home, or in the community. For example, disability may exist where a person is limited in their ability to work due to job discrimination against persons with specific health conditions; or, disability may exist where a child has difficulty learning because the school cannot accommodate the child's deafness.
Furthermore, disability is a dynamic concept that changes over time as one's health improves or declines, as technology advances, and as social structures adapt. As such, disability is a continuum in which the degree of difficulty may also increase or decrease. Because disability exists along a continuum, various cut-offs are used to allow for a simpler understanding of the concept, the most common of which is the dichotomous "With a disability"/"no disability" differential.
Measuring this complex concept of disability with a short set of six questions is difficult. Because of the multitude of possible functional limitations that may present as disabilities, and in the absence of information on external factors that influence disability, surveys like the ACS are limited to capturing difficulty with only selected activities. As such, people identified by the ACS as having a disability are, in fact, those who exhibit difficulty with specific functions and may, in the absence of accommodation, have a disability. While this definition is different from the one described by the IOM and ICF conceptual frameworks, it relates to the programmatic definitions used in most Federal and state legislation.
In an attempt to capture a variety of characteristics that encompass the definition of disability, the ACS identifies serious difficulty with four basic areas of functioning - hearing, vision, cognition, and ambulation. These functional limitations are supplemented by questions about difficulties with selected activities from the Katz Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living (IADL) scales, namely difficulty bathing and dressing, and difficulty performing errands such as shopping. Overall, the ACS attempts to capture six aspects of disability, which can be used together to create an overall disability measure, or independently to identify populations with specific disability types.
Information on disability is used by a number of federal agencies to distribute funds and develop programs for people with disabilities. For example, data about the size, distribution, and needs of the population with a disability are essential for developing disability employment policy. For the Americans with Disabilities Act, data about functional limitations are important to ensure that comparable public transportation services are available for all segments of the population. Federal grants are awarded, under the Older Americans Act, based on the number of elderly people with physical and mental disabilities.
Question/Concept History
In the 2018 American Community Survey, disability concepts were asked in questions 17 through 19. Question 17 had two subparts and was asked of all persons regardless of age. Question 18 had three subparts and was asked of people age 5 years and older. Question 19 was asked of people age 15 years and older.
Furthermore, disability is a dynamic concept that changes over time as one's health improves or declines, as technology advances, and as social structures adapt. As such, disability is a continuum in which the degree of difficulty may also increase or decrease. Because disability exists along a continuum, various cut-offs are used to allow for a simpler understanding of the concept, the most common of which is the dichotomous "With a disability"/"no disability" differential.
Measuring this complex concept of disability with a short set of six questions is difficult. Because of the multitude of possible functional limitations that may present as disabilities, and in the absence of information on external factors that influence disability, surveys like the ACS are limited to capturing difficulty with only selected activities. As such, people identified by the ACS as having a disability are, in fact, those who exhibit difficulty with specific functions and may, in the absence of accommodation, have a disability. While this definition is different from the one described by the IOM and ICF conceptual frameworks, it relates to the programmatic definitions used in most Federal and state legislation.
In an attempt to capture a variety of characteristics that encompass the definition of disability, the ACS identifies serious difficulty with four basic areas of functioning - hearing, vision, cognition, and ambulation. These functional limitations are supplemented by questions about difficulties with selected activities from the Katz Activities of Daily Living (ADL) and Lawton Instrumental Activities of Daily Living (IADL) scales, namely difficulty bathing and dressing, and difficulty performing errands such as shopping. Overall, the ACS attempts to capture six aspects of disability, which can be used together to create an overall disability measure, or independently to identify populations with specific disability types.
Information on disability is used by a number of federal agencies to distribute funds and develop programs for people with disabilities. For example, data about the size, distribution, and needs of the population with a disability are essential for developing disability employment policy. For the Americans with Disabilities Act, data about functional limitations are important to ensure that comparable public transportation services are available for all segments of the population. Federal grants are awarded, under the Older Americans Act, based on the number of elderly people with physical and mental disabilities.
Question/Concept History
In the 2018 American Community Survey, disability concepts were asked in questions 17 through 19. Question 17 had two subparts and was asked of all persons regardless of age. Question 18 had three subparts and was asked of people age 5 years and older. Question 19 was asked of people age 15 years and older.
was derived from question 17a, which asked respondents if they were "deaf or ... [had] serious difficulty hearing." Vision difficulty was derived from question 17b, which asked respondents if they were "blind or ... [had] serious difficulty seeing even when wearing glasses." Prior to the 2008 ACS, hearing and vision difficulty were asked in a single question under the label "Sensory disability."
was derived from question 18a, which asked respondents if due to physical, mental, or emotional condition, they had "serious difficulty concentrating, remembering, or making decisions." Prior to the 2008 ACS, the question on cognitive functioning asked about difficulty "learning, remembering, or concentrating" under the label "Mental disability."
was derived from question 18b, which asked respondents if they had "serious difficulty walking or climbing stairs." Prior to 2008, the ACS asked if respondents had "a condition that substantially limits one or more basic physical activities such as walking, climbing stairs, reaching, lifting, or carrying." This measure was labeled "Physical difficulty" in ACS data products.
was derived from question 18c, which asked respondents if they had "difficulty dressing or bathing." Difficulty with these activities are two of six specific Activities of Daily Living (ADLs) often used by health care providers to assess patients' self- care needs. Prior to the 2008 ACS, the question on self-care limitations asked about difficulty "dressing, bathing, or getting around inside the home," under the label "Self-care disability."
was derived from question 19, which asked respondents if due to a physical, mental, or emotional condition, they had difficulty "doing errands alone such as visiting a doctor's office or shopping." Difficulty with this activity is one of several Instrumental Activities of Daily Living (IADL) used by health care providers in making care decisions. Prior to the 2008 ACS, a similar measure on difficulty "going outside the home alone to shop or visit a doctor's office" was asked under the label "Go-outside-home disability."
Disability status is determined from the answers from these six types of difficulty. For children under 5 years old, hearing and vision difficulty are used to determine disability status. For children between the ages of 5 and 14, disability status is determined from hearing, vision, cognitive, ambulatory, and self-care difficulties. For people aged 15 years and older, they are considered to have a disability if they have difficulty with any one of the six difficulty types.
Limitation of the Data
The universe for most disability data tabulations is the civilian noninstitutionalized population. Some types of GQ populations have disability distributions that are different from the household population. The inclusion of the noninstitutionalized GQ population could therefore have a noticeable impact on the disability distribution. This is particularly true for areas with a substantial noninstitutionalized GQ population. For a discussion of the effect of group quarters data has on estimates of disability status, see "Disability Status and the Characteristics of People in Group Quarters: A Brief Analysis of Disability Prevalence among the Civilian Noninstitutionalized and Total Populations in the American Community Survey" on the Census website. Go to http://www.census.gov and enter the paper title in the search box.
Comparability
Beginning in 2008, questions on disability represent a conceptual and empirical break from earlier years of the ACS. Hence, the Census Bureau does not recommend any comparisons of 2018 disability data to 2007 and earlier ACS disability data. Research suggests that combining the new separate measures of hearing and vision difficulty to generate a sensory difficulty measure does not create a comparable estimate to the old Sensory disability estimates in prior ACS products. Likewise, the cognitive difficulty, ambulatory difficulty, self-care difficulty, and independent living difficulty measures are based on different sets of activities and different question wordings from similar measures in ACS questionnaires prior to 2008 and thus should not be compared. Because the overall measure of disability status beginning in 2008 is based on different measures of difficulty,
these estimates should also not be compared to prior years. For additional information on the differences between the ACS disability questions beginning in 2008 and prior ACS disability questions, see "Review of Changes to the Measurement of Disability in the 2008 American Community Survey" on the Census website. Go to http://www.census.gov and enter the paper title in the search box.
The 2018 disability estimates also should not be compared with disability estimates from Census 2000 for reasons similar to the ones made above. ACS disability estimates also should not be compared with more detailed measures of disability from sources such as the National Health Interview Survey and the Survey of Income and Program Participation.
The 2018 ACS disability estimates are comparable with the ACS disability estimates from 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016.
Disability status is determined from the answers from these six types of difficulty. For children under 5 years old, hearing and vision difficulty are used to determine disability status. For children between the ages of 5 and 14, disability status is determined from hearing, vision, cognitive, ambulatory, and self-care difficulties. For people aged 15 years and older, they are considered to have a disability if they have difficulty with any one of the six difficulty types.
Limitation of the Data
The universe for most disability data tabulations is the civilian noninstitutionalized population. Some types of GQ populations have disability distributions that are different from the household population. The inclusion of the noninstitutionalized GQ population could therefore have a noticeable impact on the disability distribution. This is particularly true for areas with a substantial noninstitutionalized GQ population. For a discussion of the effect of group quarters data has on estimates of disability status, see "Disability Status and the Characteristics of People in Group Quarters: A Brief Analysis of Disability Prevalence among the Civilian Noninstitutionalized and Total Populations in the American Community Survey" on the Census website. Go to http://www.census.gov and enter the paper title in the search box.
Comparability
Beginning in 2008, questions on disability represent a conceptual and empirical break from earlier years of the ACS. Hence, the Census Bureau does not recommend any comparisons of 2018 disability data to 2007 and earlier ACS disability data. Research suggests that combining the new separate measures of hearing and vision difficulty to generate a sensory difficulty measure does not create a comparable estimate to the old Sensory disability estimates in prior ACS products. Likewise, the cognitive difficulty, ambulatory difficulty, self-care difficulty, and independent living difficulty measures are based on different sets of activities and different question wordings from similar measures in ACS questionnaires prior to 2008 and thus should not be compared. Because the overall measure of disability status beginning in 2008 is based on different measures of difficulty,
these estimates should also not be compared to prior years. For additional information on the differences between the ACS disability questions beginning in 2008 and prior ACS disability questions, see "Review of Changes to the Measurement of Disability in the 2008 American Community Survey" on the Census website. Go to http://www.census.gov and enter the paper title in the search box.
The 2018 disability estimates also should not be compared with disability estimates from Census 2000 for reasons similar to the ones made above. ACS disability estimates also should not be compared with more detailed measures of disability from sources such as the National Health Interview Survey and the Survey of Income and Program Participation.
The 2018 ACS disability estimates are comparable with the ACS disability estimates from 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, and 2016.
| Excerpt from: | Social Explorer; U.S. Census Bureau; 2018 ACS 1-year and 2014-2018 ACS 5-year Data Releases : Technical Documentation. |
| 2018 ACS 1-year and 2014-2018 ACS 5-year Data Releases: Technical Documentation -> Subject Definitions -> Population Variables -> Health Insurance Coverage |
In 2017, data on health insurance coverage were derived from answers to Question 16 in the American Community Survey, which was asked of all respondents. Respondents were instructed to report their current coverage and to mark "yes" or "no" for each of the eight types listed (labeled as parts 16a to 16h).
Health insurance coverage in the ACS and other Census Bureau surveys define coverage to include plans and programs that provide comprehensive health coverage. Plans that provide insurance for specific conditions or situations such as cancer and long-term care policies are not considered coverage. Likewise, other types of insurance like dental, vision, life, and disability insurance are not considered health insurance coverage.
In defining types of coverage, write-in responses were reclassified into one of the first seven types of coverage or determined not to be a coverage type. Write-in responses that referenced the coverage of a family member were edited to assign coverage based on responses from other family members. As a result, only the first seven types of health coverage are included in the microdata file.
An eligibility edit was applied to give Medicaid, Medicare, and TRICARE coverage to individuals based on program eligibility rules. TRICARE or other military health care was given to active-duty military personnel and their spouses and children. Medicaid or other means-tested public coverage was given to foster children, certain individuals receiving Supplementary Security Income or Public Assistance, and the spouses and children of certain Medicaid beneficiaries. Medicare coverage was given to people 65 and older who received Social Security or Medicaid benefits.
People were considered insured if they reported at least one "yes" to Questions 16a to 16f. People who had no reported health coverage, or those whose only health coverage was Indian Health Service, were considered uninsured. For reporting purposes, the Census Bureau broadly classifies health insurance coverage as private health insurance or public coverage. Private health insurance is a plan provided through an employer or union, a plan purchased by an individual from a private company, or TRICARE or other military health care. Respondents reporting a "yes" to the types listed in parts a, b, or e were considered to have private health insurance. Public health coverage includes the federal programs Medicare, Medicaid, and VA Health Care (provided through the Department of Veterans Affairs); the Children's Health Insurance Program (CHIP); and individual state health plans. Respondents reporting a "yes" to the types listed in c, d, or f were considered to have public coverage. The types of health insurance are not mutually exclusive; people may be covered by more than one at the same time.
The U.S. Department of Health and Human Services, as well as other federal agencies, use data on health insurance coverage to more accurately distribute resources and better understand state and local health insurance needs.
Question/Concept History
The ACS began asking questions about health insurance coverage in 2008. Because 2008 was the first year of collection, the Census Bureau limited the number and type of data products to simple age breakdowns of overall, private, and public coverage status. The evaluation of the 2008 data suggested that the data were of good quality, so the Census Bureau expanded the data products to include estimates of the specific types of coverage along with estimates about social, economic, and demographic details for people with and without health insurance.
For the 2008 data released September 2009, there was no eligibility edit applied. The eligibility edit that was developed for the 2009 was applied to the 2008 data during spring 2010. New estimates of health insurance coverage with this data are available (http://www.census.gov/hhes/www/hlthins/hlthins.html).
Limitation of the Data
The universe for most health insurance coverage estimates is the civilian noninstitutionalized population, which excludes active-duty military personnel and the population living in correctional facilities and nursing homes. Some noninstitutionalized GQ populations have health insurance coverage distributions that are different from the household population (e.g., the prevalence of private health insurance among residents of college dormitories is higher than the household population). The proportion of the universe that is in the noninstitutionalized GQ populations could therefore have a noticeable impact on estimates of the health insurance coverage. Institutionalized GQ populations may also have health insurance coverage distributions that are different from the civilian noninstitutionalized population, the distributions in the published tables may differ slightly from how they would look if the total population were represented.
Comparability
Health insurance coverage was added to the 2008 ACS and so no equivalent measure is available from previous ACS surveys or Census 2000. Because of the addition of the eligibility edit to 2009 ACS health insurance, data users should be careful as to which 2008 ACS estimates they use to make comparisons. National, state, county and place-level 2008 1-year data incorporating the eligibility edit are available
(https://www.census.gov/topics/health/health-insurance/guidance/acs-2008-1-year-re-run.html); they are comparable to the 2009 estimates in American Fact Finder (factfinder.census.gov). Please see
"Applying and Evaluating Logical Coverage Edits to Health Insurance Coverage in the American Community Survey" for more information on the logical coverage (eligibility) edits.
Because coverage in the ACS references an individual's current status, caution should be taken when making comparisons to other surveys which may define coverage as "at any time in the last year" or "throughout the past year." A discussion of how the ACS health insurance estimates relate to other survey health insurance estimates can be found in A Preliminary Evaluation of Health Insurance Coverage in the 2008 American Community Survey (https://www.census.gov/library/working-papers/2009/acs/2009_Turner_01.html).
- Insurance through a current or former employer or union (of this person or another family member)
- Insurance purchased directly from an insurance company (by this person or another family member)
- Medicare, for people 65 and older, or people with certain disabilities
- Medicaid, Medical Assistance, or any kind of government-assistance plan for those with low incomes or a disability
- TRICARE or other military health care
- VA (including those who have ever used or enrolled for VA health care)
- Indian Health Service
- Any other type of health insurance or health coverage plan
Health insurance coverage in the ACS and other Census Bureau surveys define coverage to include plans and programs that provide comprehensive health coverage. Plans that provide insurance for specific conditions or situations such as cancer and long-term care policies are not considered coverage. Likewise, other types of insurance like dental, vision, life, and disability insurance are not considered health insurance coverage.
In defining types of coverage, write-in responses were reclassified into one of the first seven types of coverage or determined not to be a coverage type. Write-in responses that referenced the coverage of a family member were edited to assign coverage based on responses from other family members. As a result, only the first seven types of health coverage are included in the microdata file.
An eligibility edit was applied to give Medicaid, Medicare, and TRICARE coverage to individuals based on program eligibility rules. TRICARE or other military health care was given to active-duty military personnel and their spouses and children. Medicaid or other means-tested public coverage was given to foster children, certain individuals receiving Supplementary Security Income or Public Assistance, and the spouses and children of certain Medicaid beneficiaries. Medicare coverage was given to people 65 and older who received Social Security or Medicaid benefits.
People were considered insured if they reported at least one "yes" to Questions 16a to 16f. People who had no reported health coverage, or those whose only health coverage was Indian Health Service, were considered uninsured. For reporting purposes, the Census Bureau broadly classifies health insurance coverage as private health insurance or public coverage. Private health insurance is a plan provided through an employer or union, a plan purchased by an individual from a private company, or TRICARE or other military health care. Respondents reporting a "yes" to the types listed in parts a, b, or e were considered to have private health insurance. Public health coverage includes the federal programs Medicare, Medicaid, and VA Health Care (provided through the Department of Veterans Affairs); the Children's Health Insurance Program (CHIP); and individual state health plans. Respondents reporting a "yes" to the types listed in c, d, or f were considered to have public coverage. The types of health insurance are not mutually exclusive; people may be covered by more than one at the same time.
The U.S. Department of Health and Human Services, as well as other federal agencies, use data on health insurance coverage to more accurately distribute resources and better understand state and local health insurance needs.
Question/Concept History
The ACS began asking questions about health insurance coverage in 2008. Because 2008 was the first year of collection, the Census Bureau limited the number and type of data products to simple age breakdowns of overall, private, and public coverage status. The evaluation of the 2008 data suggested that the data were of good quality, so the Census Bureau expanded the data products to include estimates of the specific types of coverage along with estimates about social, economic, and demographic details for people with and without health insurance.
For the 2008 data released September 2009, there was no eligibility edit applied. The eligibility edit that was developed for the 2009 was applied to the 2008 data during spring 2010. New estimates of health insurance coverage with this data are available (http://www.census.gov/hhes/www/hlthins/hlthins.html).
Limitation of the Data
The universe for most health insurance coverage estimates is the civilian noninstitutionalized population, which excludes active-duty military personnel and the population living in correctional facilities and nursing homes. Some noninstitutionalized GQ populations have health insurance coverage distributions that are different from the household population (e.g., the prevalence of private health insurance among residents of college dormitories is higher than the household population). The proportion of the universe that is in the noninstitutionalized GQ populations could therefore have a noticeable impact on estimates of the health insurance coverage. Institutionalized GQ populations may also have health insurance coverage distributions that are different from the civilian noninstitutionalized population, the distributions in the published tables may differ slightly from how they would look if the total population were represented.
Comparability
Health insurance coverage was added to the 2008 ACS and so no equivalent measure is available from previous ACS surveys or Census 2000. Because of the addition of the eligibility edit to 2009 ACS health insurance, data users should be careful as to which 2008 ACS estimates they use to make comparisons. National, state, county and place-level 2008 1-year data incorporating the eligibility edit are available
(https://www.census.gov/topics/health/health-insurance/guidance/acs-2008-1-year-re-run.html); they are comparable to the 2009 estimates in American Fact Finder (factfinder.census.gov). Please see
"Applying and Evaluating Logical Coverage Edits to Health Insurance Coverage in the American Community Survey" for more information on the logical coverage (eligibility) edits.
Because coverage in the ACS references an individual's current status, caution should be taken when making comparisons to other surveys which may define coverage as "at any time in the last year" or "throughout the past year." A discussion of how the ACS health insurance estimates relate to other survey health insurance estimates can be found in A Preliminary Evaluation of Health Insurance Coverage in the 2008 American Community Survey (https://www.census.gov/library/working-papers/2009/acs/2009_Turner_01.html).
