Chartbook on Disability in New York State, 1998 - 2000

Health Status and Quality of Life

Quality of life (QoL) generally corresponds to total well-being, encompassing both physical and psychosocial determinants.4 Components of QoL include performance of social roles, physical status, emotional status, social interactions, intellectual functioning, economic status, and self-perceived or subjective health status.4,5,6 Quality of life for persons with disabilities is an outcome that reflects the influence and interaction of environmental factors, the life course of an individual or group, the disabling process, and opportunity.7 Health-related quality of life (HRQoL) refers to the "physical, psychological, and social domains of health, seen as distinct areas that are influenced by a person’s experiences, beliefs, expectations, and perceptions."8 HRQoL is multidimensional and is composed of, at a minimum, physical functioning, psychological well-being, social and role functioning, and health perceptions.9,10 HRQoL measures can be outcomes of other health events such as access to care,11 impact of chronic conditions,12 or the effects of aging.13 Therefore, the surveillance of HRQoL is important to monitoring changes in the health of people and populations. HRQoL is related to both self-reported chronic diseases and their risk factors.2

Health-related quality-of-life information on the BRFSS has consisted of both subjective ratings of health and perceptions of recent health. The HRQoL questions on perceived physical and mental health and function have become an important component of health surveillance and are generally considered valid indicators of service needs and intervention outcomes. Self-rated health, in particular, is considered to be a reliable indicator of a person’s perceived health and is a good global assessment of a person’s well-being. Moreover, it has proved a more powerful predictor of mortality and morbidity than many objective measures of health.14

The 14 HRQoL questions on the BRFSS have shown to have adequate validity and acceptability for use with people with disabilities in both surveillance and research.15,16 Four of the items were included on the 1998-2000 NYS BRFSS questionnaire as a core section; the other ten were part of the special Disability Module. The rating items requested that respondents give their perceptions of emotional support, satisfaction with life, and self-rated health. The HRQoL questions on recent health elicited information on impaired health days during the prior month by asking respondents to estimate the number of days in the past 30 that they had experienced a number of adverse health events. These questions included measures for physical health, mental health, activity limitation, pain, depression, anxiety, sleeplessness, and vitality. The rationale for these items is that HRQoL is a time-related phenomenon that is best measured with reference to a specified period of time.2 A recall period of 30 days is long enough to capture variability in health status, while still being within the limits of most persons’ memories.17 [For the purposes of this report, the number of days has been categorized as None, 1-14, and 15-30.]

Emotional Support

Question: How often do you get the social and emotional support you need?

Adults with disabilities requiring assistance were about twice as likely that those with no disabilities to respond as rarely or never getting the social or emotional support they needed (17.0% vs. 8.3%, respectively). [Appendix B: Table B-7]

Persons with disabilities were more likely than those with no disabilities to report not getting sufficient emotional support.

Sufficient Emotional Support among Adult New Yorkers, by Disability Status

Satisfaction with Life

Question: In general, how satisfied are you with your life?

Adults with disabilities were much more likely to respond that they were dissatisfied or very dissatisfied with their lives. Those needing assistance were over four times as likely to respond this way than were those with no disabilities (18.3% vs. 4.1%, respectively). [Appendix B: Table B-7]

Persons with disabilities were more likely than those with no disabilities to report being dissatisfied with life.

Satisification with Life among Adult New Yorkers, by Disability Status

Self-Rated General Health Status

Question: Would you say that in general your health is: excellent, very good, good, fair, or poor?

Adults with disabilities were far more likely to rate their perceived health status as "fair" or "poor" than were those without disabilities. More than half (57.9%) of those with disabilities requiring assistance rated their general health status either fair or poor, compared to only 7.6% of those without disabilities. [Appendix B: Table B-7]

Persons with disabilities were far more likely to report their health status as fair or poor than were those with no disabilities.

Self-Rated health Status of Adult New Yorkers, by Disability Status

Poor Physical Health

Question: Now thinking about your physical health, which includes illness and injury, for how many days during the past 30 days was your physical health not good?

Physical health varied by disability status. Nearly half (48.4%) of adults with disabilities requiring assistance reported having 15 or more days in the past 30 in which their physical health was not good, compared to 19.4% of those with disabilities needing no assistance, and only 3.3% of those without disabilities. [Appendix B: Table B-8]

Persons with disabilities were more likely to report days of poor physical health than were those without disabilities.

Number of Days in Past 30 of Poor Physical Health among New Yorkers, by Disability Status

Poor Mental Health

Question: Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?

Mental health differed by disability status. Of adults with disabilities requiring assistance, 24.3% reported having at least 15 days in the past 30 in which their mental health was not good. The comparable estimate among those with disabilities not needing assistance was 12.0%, and among those with no disabilities, 5.9%. [Appendix B: Table B-8]

Persons with disabilities were more likely to report days of poor mental health than were those without disabilities.

Number of Days in Past 30 of Poor Mental Health among New Yorkers, by Disability Status

Activity Limitation

Question: During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation?

Activity limitation due to poor physical or mental health varied by disability status. Among adults with disabilities requiring assistance, 40.7% responded as having 15 or more days during the past 30 in which poor physical or mental health limited their usual activities. Among those with disabilities needing no assistance, 9.3% reported having at least 15 days in which their activities were limited by poor physical or mental health. Only 1.4% of those with no disabilities gave this response. [Appendix B: Table B-8] [Technical note: The denominator of this estimate consisted of all survey respondents.]

Persons with disabilities were more likely to report days with activity limitation due to poor physical or mental health than were those without disabilities.

Number of Days in Past 30 of Poor Physical or Mental Health Limited Usual Activities among New Yorkers, by Disability Status

Pain

Question: During the past 30 days, for about how many days did pain make it hard for you to do your usual activities, such as self-care, work, or recreation?

Pain that interfered with usual activities was strongly associated with disability status. Nearly half (49.1%) of adults with disabilities requiring assistance reported 15 or more days in the past 30 of activity-limiting pain, compared to 16.3% of those with disabilities not needing assistance and only 2.4% of adults without disabilities. [Appendix B: Table B-8]

Persons with disabilities were far more likely to report days with activity-limiting pain than were those without disabilities.

Number of Days in Past 30 That pain Limited Usual Activities among New Yorkers, by Disability Status

Depressed Mood

Question: During the past 30 days, for about how many days have you felt sad, blue, or depressed?

Adults with disabilities were more likely to report 15 or more days in the past 30 of feeling sad, blue, or depressed than were those without disabilities. Among those with disabilities requiring assistance, 28.4% reported being sad or depressed on at least 15 days in the previous month, compared to 10.8% of those with disabilities not requiring assistance and 4.3% of those without disabilities. [Appendix B: Table B-8]

Persons with disabilities were more likely to report days with feelings of depressed mood than were those without disabilities.

Number of Days in Past 30 of Feeling Sad, Blue, or Depressed among New Yorkers, by Disability Status

Anxiety

Question: During the past 30 days, for about how many days have you felt worried, tense, or anxious?

Adults with disabilities were more likely to report more days of feeling worried, tense, or anxious than were those without disabilities. Nearly a third (32.9%) of those with disabilities requiring assistance reported feelings of anxiety on 15 or more days during the past 30, compared to 17.8% of those with disabilities needing no assistance and 9.3% of those without disabilities. [Appendix B: Table B-8]

Persons with disabilities were more likely to report days with feelings of anxiety than were those without disabilities.

Number of Days in Past 30 of Feeling Worried, Tense, or Anxious among New Yorkers, by Disability Status

Sleeplessness

Question: During the past 30 days, for about how many days have you felt that you did not get enough rest or sleep?

Adults with disabilities were slightly more likely to report more days of insufficient rest or sleep than were those with no disabilities. Among those with disabilities requiring assistance, 36.9% reported 15 or more days in the past 30 in which they did not get enough rest or sleep, compare to 28.8% of those with disabilities requiring no assistance and 22.1% of those with no disabilities. [Appendix B: Table B-8]

Persons with disabilities were more likely to report days with insufficient rest or sleep than were those without disabilities.

Number of Days in Past 30 of Not Enough rest or Sleep among New Yorkers, by Disability Status

Vitality

Question: During the past 30 days, for about how many days have you felt very healthy and full of energy?

Adults with disabilities were less likely to report 15 or more days in the past 30 of feeling full of energy than were those without disabilities. Less than one-third (31.3%) of those with disabilities requiring assistance reported at least 15 days of high vitality, compared to 54.6% of those with disabilities not requiring assistance and 75.3% of those without disabilities. [Appendix B: Table B-8]

Persons with disabilities were less likely to report days of high vitality than were those without disabilities.

Number of Days in Past 30 of High Vitality among New Yorkers, by Disability Status

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