142nd APHA Annual Meeting and Exposition

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315236
Geographic variation in severe vision or hearing impairment: The American Community Survey (ACS), 2008-2012

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 5:00 PM - 5:15 PM

Howard J. Hoffman, MA , Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD
Chuan-Ming Li, MD, PhD , Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD
May S. Chiu, BS , Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health (NIH), Bethesda, MD
Matthew W. Brault, MPP , PhD Program in Health Policy, Harvard University (formerly with the U.S. Census Bureau), Cambridge, MA
Mary Frances Cotch, PhD , Division of Epidemiology and Clinical Applications, National Eye Institute (NEI), National Institutes of Health (NIH), Bethesda, MD
Background:   Serious vision and hearing impairments limit the ability of many individuals to function independently, particularly older adults with acute and chronic health conditions.  The 2013 National Center for Health Statistics (NCHS) Urban–Rural Classification Scheme of Counties was developed to examine health disparities by geography, based on population density.  Furthermore, the Census Bureau’s American Community Survey (ACS) is uniquely capable of generating small area estimates of reported disabilities to document disparities at local administrative levels. 

Methods:  The ACS collects data in a rolling sample of 250,000 households each month on over 40 topics, including disability, in the civilian non-institutionalized U.S. population.  Since 2008 the six disability questions have asked about difficulty with hearing (deaf or having serious difficulty), vision (blind or having serious difficulty, even when wearing glasses), cognition, ambulation, self-care, and independent living.  By aggregating five years of data collection, the ACS is capable of generating reliable estimates for all 3,143 U.S. counties.  We have estimated  county-level disability rates from the 2008-2012 ACS.  The counties were further partitioned according to the 2013 NCHS Urban–Rural Classification Scheme. 

Results:  Lowest disability rates were in 368 large 'fringe' metropolitan counties; highest rates in 1,335 rural noncore counties.  In fringe metropolitan counties, children <18 years, had prevalences of hearing, vision, and overall disability of 0.55% (+0.02%; 95% confidence interval), 0.56% (+0.02%), and 3.59% (+0.05%); adults aged 18–64 had prevalences of 1.76% (+0.02%), 1.33% (+0.02%), and 8.36 (+0.05%); older adults 65+ had prevalences of 13.82% (+0.09%), 5.89% (+0.07%), and 33.92% (+0.12%), respectively.  Among older adults in low population density rural counties, these prevalences were 18.69% (+0.15%), 8.42% (+0.10%), and 41.30% (+0.21%).  Of 14.5 million (M) older adults with disability, serious hearing and vision impairment comprised 41.2% (6.0M) and 18.8% (2.7M), respectively.  

Conclusions:  As population density decreases, the prevalence of serious vision and hearing impairment (and all disability) increases.  A recent NCHS report showed similar geographic patterns for "all-cause mortality" and "no health insurance coverage".  Our analysis revealed geographic areas with poor healthcare access; area-level models will be used to examine underlying factors that contribute to poorer vision and hearing health outcomes.

Learning Areas:

Assessment of individual and community needs for health education
Biostatistics, economics
Chronic disease management and prevention
Clinical medicine applied in public health
Epidemiology
Provision of health care to the public

Learning Objectives:
Describe how 5-years of the American Community Survey (ACS), 2008-2012, data can be analyzed for specific sensory (serious vision or hearing impairment) disability rates by local area administrative units (counties). Explain how the National Center for Health Statistics has used the OMB designated standard metropolitan areas (MSAs) and micropolitan or rural areas based on the 2010 U.S. census to update the classification of all 3,143 counties in the U.S. Compare the rates of serious hearing and vision impairment across age, race/ethnicity, SES measures, e.g., poverty level, Social Security payments, etc., and levels of healthcare access, by the 2013 National Center for Health Statistics (NCHS) Urban-Rural Classification Scheme for Counties based on population density.

Keyword(s): Disabilities, Health Disparities/Inequities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have directed the Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), NIH since 1992 and have published more than 220 peer-reviewed papers. This research program focuses on the prevalence, incidence, risk factors, and preventive interventions for disorders in all 7 mission areas of the Institute: hearing, balance, smell, taste, voice, speech, and language. I am also the Institute’s coordinator for measuring and tracking healthcare objectives in Healthy People 2010/HP2020.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.