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Disability

The disability report in the Health Survey for England 2001 series provides the latest estimates of the prevalence of disability among those living in private households in England. To improve the precision of estimates, the 2000 and 2001 general population samples have been combined. For the most part, therefore, the disability prevalence estimates reported relate to the combined years 2000-2001.

Disability was first measured in the Health Survey for England in 1995, and this forms the baseline for measuring change between 1995 and 2000-2001.

Using an adaptation of the World Health Organisation (WHO) classification system for impairments, disabilities and handicaps (ICIDH), the disability questions in the Health Survey for England series included five domains of physical and sensory disability. These domains were:

• Locomotor (walking and using stairs)
• Seeing
• Hearing
• Communication
• Personal care (activities of daily living including getting in and out of bed or a chair, dressing, washing, feeding and toileting).

For each domain, the level of severity was scored as none (0), moderate (1) and serious (2). A summary disability score was then calculated by taking the highest of the constituent domain scores, resulting in possible overall score values: has no disability (0), has a moderate disability (1) or has a serious disability (2).

Questions on incontinence were also asked in the survey but were not included in the disability scoring. This was mainly because the broad definition of 'bladder problems' used in the survey did not easily lend itself to distinguishing between those with an incontinence disability and those without.

Results are presented here for adults and children aged 10-15.

Disability prevalence among adults

In 2000-2001, 18% of men and women aged 16 and over reported having one or more of five types of disability (locomotor, personal care, sight, hearing and communication). 5% of adults were found to have a serious disability. Overall, just over half (55%) of men and women with any disability had one disability, a third had two disabilities and about a tenth had three or more disabilities.

Under age 55, the proportions reporting at least one disability were similar for men and women. Between the ages of 55 and 74, disability prevalence was slightly higher for men, though the difference was not statistically significant. From age 75 onwards, rates for women aged 75-84 were significantly higher than for men (51% versus 43%). In the oldest age group, 85 and over, 7 in 10 of men and women were disabled, the proportions with serious disability being higher for women (42%) than men (33%). It is likely that the higher prevalence of disability among women than men in older age groups reflects their longer survival with disability, with the concomitant progression to more severe forms of disability.

The most commonly reported type of disability was locomotor disability. 12% of men and 14% of women reported having locomotor disability. A quarter of men with a locomotor disability reported it as being serious, the corresponding proportion for women being a third. Personal care disability, with the second largest prevalence, had rates half those of locomotor disability (6% among men and 7% among women). These two types of disabilities were strongly age-related, and were also the most commonly occurring combinations of disabilities for both men and women.

For the main types of disabilities, prevalence was generally higher among women than men, except for hearing disability with a higher prevalence among men (6%) than women (4%), and this gender difference was observed for all age groups except the oldest (aged 85 and over).

Few people reported sight disability (2% of men, 3% of women) or communication disability (2% of men, 1% of women), and these disabilities also showed least variation between age groups.

Disability prevalence by socio-economic position

There was a stepped increase in the (age-standardised) prevalence of disability from 8% for men and women in Social Class I to 22% for men and 24% for women in Social Class IV, with similar rates for Social Class V. Among those with a disability, the proportion categorised as seriously disabled was also lower in Social Classes I and II (about one in four) than in Social Classes IIIM, IV and V (one in three).

The pattern of disability prevalence by the new classification of social position, NS-SEC (National Statistics Socio-Economic Classification), was similar to that by social class, although the increase between the first and last categories was less marked and the progression less uniform. After controlling for age and social position, disabled people were significantly more likely than those without a disability to have no formal educational qualifications, to live in rented social housing, not to be in paid employment and to have lower earnings.

Trends in adult disability prevalence

The prevalence of disability among men was lower in 2000-2001 (16%) than in 1995 (17%). The difference was small (1.2 percentage points (pp), representing a relative fall of 7%) but statistically significant. However, in spite of the overall fall, the proportion of men with a serious disability increased from 3% to 4%, the proportion with a moderate disability decreasing from 13% to 11%.

There was no significant change in the overall proportions with a disability, or by severity, for women.

For men, there were small, but significant, increases in the (age-standardised) prevalence of locomotor disability (absolute increase of 1.6 pp) and personal care disability (1.3 pp), at both levels of severity, between 1995 and 2000-2001. At the same time, there was a significant fall in hearing disability (-2.2 pp), particularly in moderate hearing disability. Improvements in the technical quality and affordability of hearing aids may partly account for the decline in hearing disability.

Disability rates for women in 2000-2001 showed a significant increase over 1995 for serious locomotor disability (0.8 pp) and moderate personal care disability (0.8 pp), and a fall in sight disability (-0.9 pp).

An increase in the prevalence of locomotor and personal care disabilities, both related to the ageing process and found most often to occur in combination, suggests that the observed rise in serious disability in the population resident in private households could be related to the shift in the balance between institutional and home care over the period 1995 to 2000-2001. The decline in the number of residential and nursing home places over this period suggests that older disabled people, who might previously have been admitted to institutional care facilities, are increasingly being looked after in their own homes. This may partly explain the observed increase in serious disability prevalence in private households in 2000-2001 relative to 1995.

Overall, for both sexes combined, there was a significant fall in disability prevalence for Social Classes I, II and V, and an increase for Social Class IV households. The absolute decline (-4 pp) in disability prevalence was similar for Social Classes I and V, but relative decline was twice as great for Social Class I (33%) as for Social Class V (15%). The inequality gap in disability prevalence rates therefore increased from 2.25 times higher in Social Class V relative to Social Class I in 1995, to 2.88 times higher in 2000-2001.

Disability among children

In 2000-2001, 4% of boys and 3% of girls aged 10-15 had a disability, and 1% had a serious disability. Prevalence estimates in 1995 were slightly higher (5% for both boys and girls), but the difference was not statistically significant. As in 1995, there were no significant differences in the prevalence of disability by age. Moderate levels of hearing and locomotor disability were the most common forms of disability among children.

Geographical variation in disability prevalence among adults

The survey informants were classified in three ways on the basis of the area they lived in: by region, by area type and by area deprivation level. The area type classification is one developed by the Office for National Statistics and uses six area types: Inner London, Mining and Industrial, Urban, Mature, Prosperous and Rural. The deprivation index is a composite index derived from six socio-economic indicators of deprivation. The score calculated for each area is assigned to all households within it.

Geographical differences in the prevalence of disability showed the familiar 'north-south' divide, with prevalence highest in the North East and the North West (about 21%), remaining significantly high in East Midlands (about 20%), and lowest in the south of England (about14%). This regional pattern was more marked for men than women. Classified by area type, disability prevalence was highest in Mining and Industrial areas (about 22%), lower in Urban (about19%), Rural and Mature areas (about 17%) and lowest in Prosperous areas (about 13%). Among men, prevalence in Inner London was similar to that in Urban areas (18%), but for women was somewhat higher in Inner London (22%) than in Urban areas (20%).

Bladder problems among adults

The proportion of people reporting a bladder problem (7% of men and 13% of women) was similar to the proportion reporting one in 1995. A high proportion of those with a bladder problem had a problem at least once a week (men 5% out of 7%, and women 8% out of 13%).

Although the prevalence and severity of incontinence did not change significantly over the period, there was a large and significant increase in 2000-2001 in the percentage of men and women with a bladder problem who had consulted a health professional as well as, or instead of, their GP. This change in consultation patterns was accompanied by an increase in the use of incontinence aids among those with a bladder problem. Both findings point to the greater involvement of specialist services (hospital doctors and continence advisors) and community nursing (health visitors and district nurses) in the management of continence problems.

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