Disability Documentation in the National Health Interview Survey and Its Consequence: Comparing the American Community Survey to the Washington Group Disability Measures

Abstract

AbstractBackground and Objective.The objective of the National Health Interview Survey (NHIS) is to provide data that can be used to monitor the health of the US population. In this study, we evaluate whether the disability questions currently used in the NHIS – the Washington Group questions – threaten the ability of this survey to fulfil its stated objective for disabled people.Methods.Data were from the 2011-2012 NHIS with linkage to mortality status through 2019. We examined the percentage and characteristics of people reporting a disability in the American Community Survey (ACS) disability questions who were documented as such in the Washington Group (WG) disability questions. We then examined the consequence of use of the WG, as opposed to the ACS questions, on estimates of disability prevalence and comparative mortality risk.Results.We find that when compared to their predecessor, the American Community Survey disability questions, the Washington Group questions account for less than half of disabled people, primarily documenting disabled people with a more than one disability status, but excluding many disabled people with only one disability status. As a result of these exclusions, disability prevalence rates based on the Washington Group questions underestimate the size of the disabled population in the US, and overestimate the comparatively higher mortality risk associated with disability status.Conclusions.These results underscore the need to re-evaluate the disability questions used in the NHIS, and invest in the development of improved and expanded disability questionnaires for use in national surveys.