Linking job duties, functioning, and employment status using the Work-Disability Functional Assessment Battery (WD-FAB): An expert coding and quantitative analysis.

BACKGROUND: An understanding of the link between specific occupational demands and individual worker functioning is limited, although such information could permit an assessment of the fit between the two in a manner that would inform national and state disability programs such as vocational rehabilitation and Social Security disability programs. OBJECTIVE: Our goal was to examine the utility of assessing physical and mental functioning relative to self-reported job duties to identify the domains of worker functioning most likely to create barriers to fulfilling an occupation's specific requirements. METHODS: Through primary survey data collection, 1770 participants completed the Work-Disability Functional Assessment Battery (WD-FAB) instrument after reporting details on their occupations (or most recent occupation if not working). Expert coders evaluated the level of function expected to successfully carry out each self-reported job duty with respect to six scales of physical and mental function. Quantitative analysis is used to examine the relationship between functioning and job duties. RESULTS: Those not working due to disability were more likely to fall short of the threshold of the physical and mental functioning requirements of their last job's three main job duties compared to those currently employed. Mental function scales were most likely to be the area experiencing a shortfall. CONCLUSIONS: Functional difficulties impede the ability to continue working in particular jobs that require that ability. This points to a need for specific accommodations to be implemented to bridge the gap between job requirements and functional capacity so that workers may remain engaged in their current work.

Ambulatory Care Sensitive Conditions Among All-Payer Claimants With Intellectual and Developmental Disabilities.

Inpatient hospitalizations for ambulatory care sensitive conditions (ACSC) among beneficiaries with and without intellectual and developmental disabilities (IDD) were examined using Medicaid and commercial claims from 2010-2014 in New Hampshire. IDD was defined with International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes using algorithms from the Centers for Medicare and Medicaid Services, and inpatient encounters were identified using the Healthcare Effectiveness Data and Information Set. In adjusted analyses, beneficiaries with IDD had more hospitalizations for ACSC than those without IDD in both insurance groups. Differences in patterns of ACSC prevalence, comorbidities, and hospital admissions between the commercially and Medicaid-insured groups show the value of using all-payer claims data, when possible, to understand health needs and health care utilization of insurance beneficiaries with IDD.

Changes in the Employment Status of People With and Without Disabilities in the United States During the COVID-19 Pandemic.

OBJECTIVE: Using data from the monthly Current Population Survey, this paper provides monthly employment and unemployment statistics for people with and without disabilities in the United States before and during the coronavirus disease 2019 pandemic to date (January 2021). DESIGN: Cross-sectional analysis of the Current Population Survey. SETTING: The United States. PARTICIPANTS: People with and without disabilities ages 16-64 years. INTERVENTION: N/A MAIN OUTCOME MEASURES: Percentage employed, percentage unemployed, percentage not in labor force, percentage on temporary layoff, percentage looking for work. RESULTS: Estimates show that, like workers without disabilities, workers with disabilities experienced increases in unemployment at the beginning of the pandemic but continued to remain engaged in the labor force. Our analysis finds that employment rates dropped from 74.8% to 63.2% for those without disabilities and from 31.1% to 26.4% for those with disabilities between February 2020 and April 2020 but gradually improved in the succeeding months. CONCLUSIONS: As the pandemic continued, the percentage of unemployed people with and without disabilities on temporary layoff decreased and those looking for work increased.

The relationship between employment and health and health care among working-age adults with and without disabilities in the United States.

Purpose: To better understand the relationship between employment and health and health care for people with disabilities in the United States (US). Methods: We pooled US Medical Expenditure Panel Survey (2004-2010) data to examine health status, and access to health care among working-age adults, comparing people with physical disabilities or multiple disabilities to people without disabilities, based on their employment status. Logistic regression and least squares regression were conducted, controlling for sociodemographics, health insurance (when not the outcome), multiple chronic conditions, and need for assistance. Results: Employment was inversely related to access to care, insurance, and obesity. Yet, people with disabilities employed in the past year reported better general and mental health than their peers with the same disabilities who were not employed. Those who were employed were more likely to have delayed/forgone necessary care, across disability groups. Part-time employment, especially for people with multiple limitations, was associated with better health and health care outcomes than full-time employment. Conclusion: Findings highlight the importance of addressing employment-related causes of delayed or foregone receipt of necessary care (e.g., flex-time for attending appointments) that exist for all workers, especially those with physical or multiple disabilities. Implications for rehabilitation These findings demonstrate that rehabilitation professionals who are seeking to support employment for persons with physical limitations need to ensure that overall health concerns are adequately addressed, both for those seeking employment and for those who are currently employed. Assisting clients in prioritizing health equally with employment can ensure that both areas receive sufficient attention. Engaging with employers to develop innovative practices to improve health, health behaviors and access to care for employees with disabilities can decrease turnover, increase productivity, and ensure longer job tenure.

Estimates of prevalence, demographic characteristics and social factors among people with disabilities in the USA: a cross-survey comparison.

OBJECTIVE: A national priority for disability research in the USA is the standardised identification of people with disabilities in surveillance efforts. Mandated by federal statute, six dichotomous difficulty-focused questions were implemented in national surveys to identify people with disabilities. The aim of this study was to assess the prevalence, demographic characteristics and social factors among people with disabilities based on these six questions using multiple national surveys in the USA. SETTING: American Community Survey (ACS), Current Population Survey Annual Social and Economic Supplement (CPS-ASEC), National Health Interview Survey (NHIS) and the Survey of Income and Program Participation (SIPP). PARTICIPANTS: Civilian, non-institutionalised US residents aged 18 and over from the 2009 to 2014 ACS, 2009 to 2014 CPS-ASEC, 2009 to 2014 NHIS and 2008 SIPP waves 3, 7 and 10. PRIMARY AND SECONDARY OUTCOME MEASURES: Disability was assessed using six standardised questions asking people about hearing, vision, cognition, ambulatory, self-care and independent living disabilities. Social factors were assessed with questions asking people to report their education, employment status, family size, health and marital status, health insurance and income. RESULTS: Risk ratios and demographic distributions for people with disabilities were consistent across survey. People with disabilities were at decreased risk of having college education, employment, families with three or more people, excellent or very good self-reported health and a spouse. People with disabilities were also consistently at greater risk of having health insurance and living below the poverty line. Estimates of disability prevalence varied between surveys from 2009 to 2014 (range 11.76%-17.08%). CONCLUSION: Replicating the existing literature, we found the estimation of disparities and inequity people with disabilities experience to be consistent across survey. Although there was a range of prevalence estimates, demographic factors for people with disabilities were consistent across surveys. Variations in prevalence estimates can be explained by survey context effects.

Asthma and asthma-related health care utilization among people without disabilities and people with physical disabilities.

BACKGROUND: Previous research has shown that people with disabilities have higher rates of some chronic diseases and receive poorer disease-specific care than their counterparts without disabilities. Yet, little is known about the relationship between asthma and disability. OBJECTIVE: This study examines whether differences in the prevalence of asthma, asthma flare, and asthma-related measures of health care quality, utilization and cost exist among people with physical limitations (PL) and without any limitations. METHODS: Data from the 2004-2010 Medical Expenditure Panel Survey were pooled to compare outcomes for working-age adults (18-64) with PL to those with no limitations. RESULTS: People with PL had higher rates of asthma (13.8% vs. 5.9%, p < 0.001) and recent asthma flare (52.6% vs. 39.6%, p < 0.001) than people without limitations. There were no differences in health care quality, utilization or cost between people with PL and people without limitations in multivariate analyses. CONCLUSIONS: Although there are no differences in asthma-related quality or utilization of health care, people with PL have poorer asthma control than people without limitations. Research is needed to determine what factors (e.g., focus on other acute ailments, perceptions that asthma control cannot improve) are related to this outcome. Future research must also examine differences in asthma severity, and its impact on asthma control and health care-related outcomes, among people with and without disabilities.

People with disabilities in the United States.

A recent compilation of published disability statistics available for the United States showcases the pervasive and persistent disparities that exist between people with and without disabilities across multiple fronts, including employment, earnings, poverty, and participation in safety net programs. Understanding the relevance of these statistics within the current policy environment can help guide further innovations to improve the lives of persons with disabilities in the United States.

First in line: prioritizing receipt of Social Security disability benefits based on likelihood of death during adjudication.

BACKGROUND: Given the complexity of the adjudication process and volume of applications to Social Security Administration's (SSA) disability programs, many individuals with serious medical conditions die while awaiting an application decision. Limitations of traditional survival methods called for a new empirical approach to identify conditions resulting in rapid mortality. OBJECTIVE: To identify health conditions associated with significantly higher mortality than a key reference group among applicants for SSA disability programs. RESEARCH DESIGN: We identified mortality patterns and generated a survival surface for a reference group using conditions already designated for expedited processing. We identified conditions associated with significantly higher mortality than the reference group and prioritized them by the expected likelihood of death during the adjudication process. SUBJECTS: Administrative records of 29 million Social Security disability applicants, who applied for benefits from 1996 to 2007, were analyzed. MEASURES: We computed survival spells from time of onset of disability to death, and from date of application to death. Survival data were organized by entry cohort. RESULTS: In our sample, we observed that approximately 42,000 applicants died before a decision was made on their disability claims. We identified 24 conditions with survival profiles comparable with the reference group. Applicants with these conditions were not likely to survive adjudication. CONCLUSIONS: Our approach facilitates ongoing revision of the conditions SSA designates for expedited awards and has applicability to other programs where survival profiles are a consideration.

Age and disability employment discrimination: occupational rehabilitation implications.

INTRODUCTION: As concerns grow that a thinning labor force due to retirement will lead to worker shortages, it becomes critical to support positive employment outcomes of groups who have been underutilized, specifically older workers and workers with disabilities. Better understanding perceived age and disability discrimination and their intersection can help rehabilitation specialists and employers address challenges expected as a result of the evolving workforce. METHODS: Using U.S. Equal Employment Opportunity Commission Integrated Mission System data, we investigate the nature of employment discrimination charges that cite the Americans with Disabilities Act or Age Discrimination in Employment Act individually or jointly. We focus on trends in joint filings over time and across categories of age, types of disabilities, and alleged discriminatory behavior. RESULTS: We find that employment discrimination claims that originate from older or disabled workers are concentrated within a subset of issues that include reasonable accommodation, retaliation, and termination. Age-related disabilities are more frequently referenced in joint cases than in the overall pool of ADA filings, while the psychiatric disorders are less often referenced in joint cases. When examining charges made by those protected under both the ADA and ADEA, results from a logit model indicate that in comparison to charges filed under the ADA alone, jointly-filed ADA/ADEA charges are more likely to be filed by older individuals, by those who perceive discrimination in hiring and termination, and to originate from within the smallest firms. CONCLUSION: In light of these findings, rehabilitation and workplace practices to maximize the hiring and retention of older workers and those with disabilities are discussed.

Self-reported work-limitation data: what they can and cannot tell us.

Despite their widespread use in the literature, the Current Population Survey (CPS) and similar surveys have come under attack of late. We put the criticisms in perspective by systematically examining what the CPS data can and cannot be used for in disability research compared to the National Health Interview Survey. On the basis of our findings, we argue (1) that the CPS can be used to monitor trends in outcomes of those with disabilities and (2) that the dramatic decline in the employment of people with disabilities we describe in the CPS during the 1990s is not an artifact of the data.