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 person's with specific health conditions; or, disability may exist where a child has difficulty learning because the school cannot accommodate the childs deafness.
Furthermore, disability is a dynamic concept that changes over time as ones 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 disabled population 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.
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.
Hearing difficulty 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."
Cognitive difficulty 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."
Ambulatory difficulty 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.
Self-care difficulty 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."
Independent living difficulty
Independent living difficulty 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 doctors 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."
In the 2009 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.
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" (http://www.census.gov/hhes/www/disability/GQdisability.pdf
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 2009 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 in 2008 and 2009 are 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" (http://www.census.gov/hhes/www/disability/2008ACS_disability.pdf
The 2009 disability estimates should also not be compared with disability estimates from Census 2000 for reasons similar to the ones made above. ACS disability estimates should also 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 2009 ACS disability estimates are comparable with the ACS disability estimates from 2008.