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Social Security Disability Benefits Reform Act of 1984: legislative history and summary of provisions.

This article describes the legislative history of the Social Security Disability Benefits Reform Act of 1984 (Public Law 98-460), and contains a summary of the provisions in the new law. Major provisions include: standards for continuing disability reviews (CDR's) of disability insurance (DI) beneficiaries and supplemental security income (SSI) recipients who get payments based on disability or blindness; the right of a DI beneficiary or an SSI recipient to have payments continued during appeal of a CDR decision to an administrative law judge that disability or blindness has ceased; and suspension of CDR's of mentally impaired persons until the evaluation criteria for mental impairments are revised. The new law was enacted in response to problems that arose as a result of the implementation by the Social Security Administration (SSA) of a provision in the 1980 disability amendments that required periodic CDR's. In enacting the new law, Congress intended to assure more accurate, consistent, and uniform disability decisions at all levels and equitable and humane treatment not only to beneficiaries who must undergo CDR's but also to new applicants for DI benefits or SSI payments based on disability or blindness.

Blindness↗

[The mentally ill and disabled-stepchildren of rehabilitation].

The institutions traditionally catering for the mentally ill and disabled are more and more turning into Psychiatric Hospitals (Clinification). Efforts are being concentrated on treatment and therapy, while a majority of the chronically ill and disabled are placed in nursing homes for their long-term care (and are pensioned prematurely). Though an extensive network of rehabilitation facilities has been developed in the Federal Republic of Germany, and although social legislation has provided for equal status of the mentally ill and disabled with other ill or disabled persons, only a negligibly small number of patients from psychiatric facilities are given the opportunity for participating in rehabilitative measures. This arises from the fact that the present range of facilities has in the fist line been developed according to the rehabilitational needs of people with physical disability, and from a reluctance on the part of the agencies financially responsible for rehabilitation services and benefits (with the exception of social welfare) to honour this social legislative title of their mentally ill or disabled insured (except for patients with dependence problems and neuroses). As the official disability statistics, too, usually negate the specificity of mental illness and disability the problematic issue does not emerge openly.

Persons with Disabilities↗

Prevalence and health impact of developmental disabilities in US children.

OBJECTIVE: Data from the 1988 National Health Interview Survey--Child Health Supplement were used to examine the prevalence of selected developmental disabilities and their impact among children ages 0 through 17 years. DESIGN: The following conditions, identified through a structured in-person interview with a parent or other adult household member, were examined: deafness or trouble hearing, blindness, epilepsy or seizures, stammering and stuttering, other speech defects, cerebral palsy, delay in growth or development, learning disabilities, and emotional or behavioral problems. The impact was defined by measures of perceived health status, school performance and attendance, and health care utilization. RESULTS: Seventeen percent of children in the United States were reported to have ever had a developmental disability. The prevalence of the individual disabilities ranged from 0.2% for cerebral palsy to 6.5% for learning disabilities. These conditions taken together had a substantial impact on the health and educational functioning of affected children: 1.5 times more doctor visits, 3.5 times more hospital-days, twice the number of school-days lost, and a 2.5-fold increase in the likelihood of repeating a grade in school compared with children without these conditions. The extent of this impact was much greater among children with multiple disabilities or with either cerebral palsy, epilepsy or seizures, delays in growth and development, or emotional or behavioral problems. The impact on school performance was most pronounced for children reported to have learning disabilities. CONCLUSIONS: Future research efforts should be focused on ways to reduce the impact of these developmental disabilities on quality of life.

Absenteeism↗

Prevalence of mobility and self-care disability--United States, 1990.

An estimated 43 million persons in the United States have a disability; the estimated annual economic impact of disabilities--representing loss of wages, medical-care expenditures, and additional household expenditures--is approximately $176.7 billion. The Institute of Medicine recently recommended surveillance and systematic collection of information at the national and state levels to assist in program planning and evaluation for state-based programs for the prevention of disabilities and secondary conditions (i.e., health conditions resulting from a disability). To characterize state-specific disability patterns and better plan for funding of disability services, the National Institute of Disability and Rehabilitation Research (NIDRR) and CDC assessed data from the 1990 census on two forms of disability: difficulty with mobility and self-care activities. This report summarizes the results of the assessment for persons aged > or = 16 years.

Activities of Daily Living↗

Postnatal causes of developmental disabilities in children aged 3-10 years--Atlanta, Georgia, 1991.

Primary prevention of developmental disabilities requires knowledge of the specific causes of these conditions. Postnatal causes account for 3%-15% of all developmental disabilities and often are preventable. To assess the prevalence and determine the specific etiology of postnatally acquired developmental disabilities, CDC analyzed data from its ongoing Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP) for 1991 (the most recent year for which complete data were available). This report summarizes the findings of the analysis, which indicate that bacterial meningitis and child battering were the leading postnatal causes of developmental disabilities and that children with postnatally acquired developmental disabilities had a higher average number of disabilities than all other children with developmental disabilities.

Cerebral Palsy↗

[Leprosy as a cause of physical disability in rural and urban areas of Mali].

We performed a cross-sectional study of populations from two areas of Mali, in May and June 1996. The aim of the study was to assess the extent to which leprosy causes physical disability in Mali. One area was rural (Circle of Bougouni), the other urban (Bamako District). We used a cluster sampling method, with 500 households selected for study in each of the two areas. All members of the households randomly selected were included in the study. For all survey sites, the number of households was proportional to the number of inhabitants. The total study population was 8,175, including 172 cases of physical handicap, 76 in Bamako and 96 in Bougouni. The prevalence of physical handicap was 21 per 1,000 inhabitants (25.3 per 1,000 in rural areas and 17.3 per 1,000 in the city). The difference in the prevalence of physical handicap between the two areas was statistically significant (p = 0.01). Ten per cent of the disabilities were caused by leprosy. The most common causes of disability other than leprosy were trauma and poliomyelitis. Leprosy mostly caused disabilities in rural areas. In both areas, leprosy caused more disabilities in men and boys (64% of cases) than in women and girls. The frequency of disabilities caused by leprosy increased with age, whereas the frequency of handicaps with other causes decreased with age. This study shows that leprosy is still a major cause of disability in countries in which it is endemic, such as Mali. Disability prevention measures and physical rehabilitation programs should be incorporated into the national program for the elimination of epilepsy.

Adult↗

Functional disability and school activity limitations in 41,300 school-age children: relationship to medical impairments.

OBJECTIVE: Our purpose was to examine the contribution of medical impairments to functional disability and school activity limitations in 41,300 school-age children participating in the 1994-1995 National Health Interview Survey. METHODS: The 1994 and 1995 National Health Interview Survey and Disability Interview Supplement samples provide International Classification of Diseases, Ninth Revision medical impairment codes for children with functional limitations or school activity limitations in a nationally representative US sample. Functional limitations were distributed as follows: mobility 12.4/1000 (95% confidence interval [CI]: 11.1-13.6), self-care 8.8/1000 (95% CI: 7.7-9.8), communication 52.9/1000 (95% CI: 50.2-55.5), and learning 104.6/1000 (95% CI: 100.7-108.4). Functional disability status was classified as 4.1% mild, 5.9% major, and 1.9% multiple. School activity limitations included 4.1% needing or receiving special education, 0.7% unable to attend, and 0.9% limited attendance. We categorized International Classification of Diseases, Ninth Revision impairment codes reported in conjunction with medical usage as physical disorders (n = 1251; eg, leukemia, diabetes), asthma (n = 916), neurodevelopmental disorders (n = 802; eg, cerebral palsy, epilepsy, mental retardation, autism, blindness, deafness), and learning-behavior disorders (n = 806; eg, attention-deficit/hyperactivity disorder, learning disability, anxiety) for children with functional or school activity limitations. Of children with multiple functional disabilities, 29.9% had neurodevelopmental disorders, 27.1% had learning-behavior disorders, 18.1% had physical disorders, 4.2% had asthma, and 20.8% did not have an identified medical impairment because they had not received medical services in the past year. Among children requiring special education, physical disorders accounted for 9.4%, neurodevelopmental disorders for 16.7%, learning and behavior disorders for 17%, asthma for 3.4%, and 53.4% did not have an identified medical impairment because they had not received medical services in the past year. CONCLUSIONS: Chronic health impairments, neurodevelopmental disorders, learning-behavior disorders, and functional limitations in essential activities are required to understand the complexity of disability in school-age children. A large number of children with functional disability or school activity limitations have not received ongoing medical services.

Activities of Daily Living↗

Neuropsychologic impairment in early HIV infection. A risk factor for work disability.

OBJECTIVE: To explore the functional significance of incident neuropsychologic impairment among initially asymptomatic subjects infected with human immunodeficiency virus. DESIGN: Prospective, observational cohort study of homosexual and bisexual men to examine the incidence of work disability related to the onset of neuropsychologic impairment. SETTING: A university clinical and behavioral research site in New York City. PARTICIPANTS: Sample of 207 homosexual and bisexual men; 123 were seropositive and 84 were seronegative. PRINCIPAL OUTCOME MEASURES: Incident work disability in the course of 4.5 years of follow-up, with disability defined as a persistent (> or = 24 months) change in work hours (from 20 or more to less than 20 h/wk). RESULTS: Compared with seronegative control subjects (n = 72), the relative risk of work disability among initially asymptomatic seropositive men (n = 44) was 2.76 (95% confidence interval, 1.2 to 6.5), nearly a threefold increase. Proportional hazards models show that this increased risk is attributable to the development of major neuropsychologic impairment in a subset (eight of 44) of the initially asymptomatic men, which is significantly associated with incident work disability (6/8 [75%]). Adjusting for symptom status and CD4+ cell count at the time of disability did not eliminate the increased risk associated with neuropsychologic impairment. CONCLUSIONS: In this cohort, the increased risk of work disability among initially asymptomatic human immunodeficiency virus-positive men was related to incident neuropsychologic impairment; such impairment predicted work disability independently of symptom status and CD4+ cell count over the follow-up period. Neuropsychologic impairment in the course of human immunodeficiency virus infection may indicate increased risk for poor outcomes over and above that associated with systemic disease.

Cohort Studies↗

Evidence of axonal damage in the early stages of multiple sclerosis and its relevance to disability.

OBJECTIVE: To assess axonal damage and its contribution to disability at different stages of multiple sclerosis (MS). BACKGROUND: Recent in vivo imaging and in situ pathologic studies have demonstrated that substantial axonal damage accompanies the inflammatory lesions of MS. However, the relation of axonal damage to the duration of MS and its contribution to disability at different stages of the disease remain poorly defined. DESIGN: We performed proton magnetic resonance spectroscopic imaging in 88 patients with a wide range of clinical disability and disease duration to measure N-acetylaspartate (NAA, an index of axonal integrity) relative to creatine (Cr) in a large central brain volume that included mostly normal-appearing white matter on magnetic resonance imaging. RESULTS: We observed that the NAA/Cr values were abnormally low in the early stages of MS, even before significant disability (measured using the Expanded Disability Status Scale [EDSS]) was evident clinically, and declined more rapidly with respect to EDSS at lower than at higher EDSS scores (P<.001). The correlation of NAA/Cr values with EDSS score was significantly (P<.03) stronger in patients with mild disability (EDSS score <5, Spearman rank order correlation = -0.54, P<.001) than in patients with more severe disability (EDSS score >/=5, Spearman rank order correlation = -0.1, P<.9). When similar analyses were performed in patients with MS grouped for duration of disease, the subgroup with early disease duration (<5 years) also showed central brain NAA/Cr resonance intensity ratios significantly lower than healthy controls (P<.001). CONCLUSION: Cerebral axonal damage begins and contributes to disability from the earliest stages of the disease.

Adult↗

Disparities in the prevalence of disability between black and white children.

OBJECTIVES: To examine disparities in the prevalence of the limitation of activity caused by chronic conditions or disability for black and white non-Hispanic children and to examine trends over time in the prevalence of disability. DESIGN: We analyzed data on 419,843 children (22,758 with a disability) younger than 18 years included in 14 annual editions of the National Health Interview Survey spanning the period 1979-2000. SETTING: Noninstitutionalized population in the United States. INTERVENTIONS: None. MAIN OUTCOME MEASURE: Prevalence of disability. RESULTS: The prevalence of disability increased markedly for both black and white children between 1979 and 2000. Bivariate analysis demonstrated racial differences that fluctuated through time, but persisted through 2000, with black children experiencing a higher prevalence of disability than white children. Multivariate analyses conducted on the 1999-2000 data indicated that the black-white difference in disability prevalence could be explained entirely by differences in poverty status. CONCLUSION: Black children have higher rates of disability primarily owing to their increased exposure to poverty.

Adolescent↗

Access to health care for young adults with disabling chronic conditions.

OBJECTIVE: To assess health insurance status and health care access of young adults with disabilities attributable to a chronic condition. DESIGN AND SETTING: We analyzed data from the National Health Interview Survey from 1999 to 2002. We present bivariate analysis and multiple logistic regression of reported health care access barriers in the United States stratified by health insurance status. PARTICIPANTS: The study population included 1109 survey respondents with and 22 481 without disabling chronic conditions, aged 19 to 29 years. MAIN OUTCOME MEASURES: Delayed or unmet health needs owing to cost, no contact with a health professional in the prior year, and no usual source of care. RESULTS: Thirty-five percent of respondents with and 15% without disabling chronic conditions reported an unmet health care need owing to cost (P< .001). Uninsurance rates for young adults with and without disabling chronic conditions were similar (26% vs 28%, respectively), and uninsurance was significantly associated with unmet health care needs. More than two thirds of uninsured respondents with a disabling chronic condition reported an unmet health need and 45% reported no usual source of care. After adjusting for sociodemographic factors, uninsured young adults with disabling chronic conditions had 8 times greater odds of reporting unmet health care needs and 6 times greater odds of having no usual source of care relative to insured respondents with disabling chronic conditions. CONCLUSIONS: Despite increasing attention to issues of health care transition for young adults with disabling chronic conditions, this study suggests that uninsurance is as common among these young adults as nondisabled peers and is significantly associated with health care access barriers in this population.

Adult↗

Psychopathology in young people with intellectual disability.

CONTEXT: Comorbid severe mental health problems complicating intellectual disability are a common and costly public health problem. Although these problems are known to begin in early childhood, little is known of how they evolve over time or whether they continue into adulthood. OBJECTIVE: To study the course of psychopathology in a representative population of children and adolescents with intellectual disability. DESIGN, SETTING, AND PARTICIPANTS: The participants of the Australian Child to Adult Development Study, an epidemiological cohort of 578 children and adolescents recruited in 1991 from health, education, and family agencies that provided services to children with intellectual disability aged 5 to 19.5 years in 6 rural and urban census regions in Australia, were followed up for 14 years with 4 time waves of data collection. Data were obtained from 507 participants, with 84% of wave 1 (1991-1992) participants being followed up at wave 4 (2002-2003). MAIN OUTCOME MEASURES: The Developmental Behaviour Checklist (DBC), a validated measure of psychopathology in young people with intellectual disability, completed by parents or other caregivers. Changes over time in the Total Behaviour Problem Score and 5 subscale scores of the DBC scores were modeled using growth curve analysis. RESULTS: High initial levels of behavioral and emotional disturbance decreased only slowly over time, remaining high into young adulthood, declining by 1.05 per year on the DBC Total Behaviour Problem Score. Overall severity of psychopathology was similar across mild to severe ranges of intellectual disability (with mean Total Behaviour Problem Scores of approximately 44). Psychopathology decreased more in boys than girls over time (boys starting with scores 2.61 points higher at baseline and ending with scores 2.57 points lower at wave 4), and more so in participants with mild intellectual disability compared with those with severe or profound intellectual disability who diverged from having scores 0.53 points lower at study commencement increasing to a difference of 6.98 points below severely affected children by wave 4. This trend was observed in each of the subscales, except the social-relating disturbance subscale, which increased over time. Prevalence of participants meeting criteria for major psychopathology or definite psychiatric disorder decreased from 41% at wave 1 to 31% at wave 4. Few of the participants (10%) with psychopathology received mental health interventions during the study period. CONCLUSION: These results provide evidence that the problem of psychopathology comorbid with intellectual disability is both substantial and persistent and suggest the need for effective mental health interventions.

Adolescent↗

Self-reported carpal tunnel syndrome: predictors of work disability from the National Health Interview Survey Occupational Health Supplement.

The objective of this study was to identify risk factors for work disability among persons with carpal tunnel syndrome (CTS). The study was designed to analyze data from the Occupational Health Supplement of the National Health Interview Survey, a nationwide, population-based survey. Subjects included 544 survey respondents with self-report of CTS and 32,688 survey respondents without CTS, all aged 18-64 years, and with a history of labor force participation. Measurements were as follows: Dependent variables were work disability, defined either as cessation of employment without attribution of cause or, alternatively, as cessation of employment or job change specifically attributed to CTS by the survey respondent. Independent variables were ergonomic risk of work disability, defined by minutes of workplace repetitive hand and wrist bending for the most recent job held. This measure was derived from responses categorized by an occupation and industry matrix independent of CTS status. Socio-demographic and health status risk factors for work disability were based on the respondent report. The main results were as follows: Among 544 persons with CTS, 58 (11%, CI 8-13%) reported work disability specifically attributed to CTS, representing an estimated national prevalence of 240,578 persons with this limitation. Workplace ergonomic risk, measured as repetitive hand or wrist bending in the occupation and industry of last employment, was a significant factor predictive of CTS-attributed work disability (per 120 min of daily exposure, OR 1.7, CI 1.1-2.6), even after taking into account socio-demographic factors and health status. The conclusions were that work disability among persons with CTS is common. For those with CTS, working conditions characterized by repetitive bending of the hand or wrist may increase the risk of work disability associated with this condition.

Adolescent↗

Alternative approaches for measuring duration of work disability after low back injury based on administrative workers' compensation data.

BACKGROUND: Studies of low back pain (LBP) disability remain largely incomparable because of different outcome definitions. To date, systematic comparisons of alternative outcome measures have not been made. METHODS: Duration of work disability was studied in a 3-year cohort of 850 workers' compensation LBP claimants. Eleven administrative outcome measures were compared using Kaplan-Meier estimates of the proportion of claimants still on disability benefits during 3.5 years of follow-up. RESULTS: The estimated mean duration of work disability was 75 days for the first temporary disability (TD) episode, 108 days for cumulative time on TD, and 337 for total compensated days, which includes all types of wage replacement benefits during vocational rehabilitation, temporary and permanent disability. CONCLUSIONS: Commonly used administrative measures of lost workdays--time to first return to work and time on temporary disability--substantially underestimate the duration of work disability compared to measures based on all wage replacement benefits.

Adult↗

Employment of individuals with mental disabilities: business response to the ADA's challenge.

This research examines the response of the business community to the Americans with Disabilities Act (ADA) with specific focus on the employment of those with mental disabilities. The ADA is viewed as an important "rational myth" in that it represents both a legal and normative demand with which businesses are expected to comply. Yet employers' responses will be influenced by their attitudes toward persons with mental disabilities as well as their concern with legal sanction for discriminatory behaviors. A telephone survey was completed in a southern metropolitan area with a random sample of 117 businesses in order to access the knowledge employers have about the ADA (and its inclusion of those with mental disabilities), the compliance with the ADA, the employment practices, and the role played by stigma in the employment of individuals with mental disabilities. In terms of specific practices which indicated compliance with the ADA, a little over one-third of the companies which were surveyed by telephone had a Title 1 implementation plan, 15% had specific policies for hiring those with mental disabilities, and 37.6% had indeed hired such an individual. The role of coercive and normative rationales for compliance to the ADA was examined. It was found that receiving formal information about the ADA, threat of legal sanction, and previous employment of those with mental disabilities were all significant predictors of compliance with the ADA. Stigmatizing attitudes did not predict compliance, though employers did view those with mental disabilities with more discomfort than other types of employees.

Cooperative Behavior↗

The impact of physical performance and cognitive status on subsequent ADL disability in low-functioning older adults.

OBJECTIVES: The purpose of this study was to examine the independent contributions of physical performance and cognitive status to subsequent levels of ADL disability in low-functioning non-institutionalized older adults. METHODS: A prospective cohort study included 416 women and 141 men 57 years or older who were living in the community and who reported substantial physical limitation. Physical performance and cognitive status were assessed at baseline in 1993. ADL disability was assessed at baseline and in two follow-ups in 1994 and 1995. Data were analysed with correlation analyses and linear multiple regressions. RESULTS: Both physical performance and ADL disability at baseline were highly predictive of subsequent ADL disability. Although cognitive status was slightly related to (subsequent) ADL disability, we found no independent contributions of cognitive status to subsequent ADL disability. CONCLUSIONS: Measures of both physical performance and ADL disability may identify older low-functioning adults who may benefit from interventions to prevent them from further disablement.

Activities of Daily Living↗

Marital status and the progression of functional disability in patients with rheumatoid arthritis.

OBJECTIVE: To determine if marital status is associated with differences in rates of progression of functional disability in patients with rheumatoid arthritis (RA). METHODS: A community cohort of 282 persons with RA was followed prospectively for up to 9.5 years. The progression of functional disability over time was determined using the Health Assessment Questionnaire Disability Index, which was completed by study participants every 6 months. RESULTS: At study entry, the Disability Index was 1.1 +/- 0.8 (mean +/- 1 SD) (possible range 0-3) among the 188 married participants and 1.3 +/- 0.9 among the 94 unmarried participants. Over time, the rate of progression of functional disability was generally higher among unmarried participants. However, the extent of this difference varied somewhat over the disease course, with rates of progression higher among unmarried than among married participants during years 5-7 and years 17-29 of RA. Overall estimated rates of progression, adjusted for the effects of other sociodemographic factors, were 0.03 Disability Index units per year in unmarried participants and 0.01 Disability Index units per year in married participants (P < 0.0001). CONCLUSION: Marriage, possibly reflecting the influence of social support, is associated with a lower rate of progression of functional disability in persons with RA.

Adult↗

Impact of social support on valued activity disability and depressive symptoms in patients with rheumatoid arthritis.

OBJECTIVE: To examine the impact of instrumental and emotional support on valued life activity (VLA) disability and depressive symptoms. Instrumental support was expected to affect VLA disability; emotional support was expected to be associated with depressive symptoms and moderate the impact of VLA disability on depressive symptoms. METHODS: Data were collected over 3 years through interviews with the University of California, San Francisco, Rheumatoid Arthritis Panel. Analyses assessed whether instrumental support predicted later VLA disability and whether emotional support predicted both concurrent and later depressive symptoms. RESULTS: Receiving adequate instrumental support was associated with less subsequent VLA disability. Strong associations were noted between both VLA disability and emotional support with concurrent depressive symptoms. No relationship was found between emotional support and later depression. No evidence was found for the hypothesis that emotional support moderated the impact of VLA disability on depressive symptoms. CONCLUSION: Results highlight the need to assess different types of support and their unique impact on critical outcomes. Instrumental support is beneficial to the maintenance of valued activities, a critical factor in the psychological adjustment of individuals living with rheumatoid arthritis. Emotional support has a significant short-term impact on depression, although it may not buffer the impact of VLA disability on future depression.

Activities of Daily Living↗