State-level estimates: A tool for eliminating disparities
in access to assistive technology (AT)

Text-only Version

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State-level estimates: A tool for eliminating disparities in access to assistive technology (AT)

Prepared by: Lita Jans, Ph.D.

For : 128th APHA Annual Meeting

November 14, 2000

InfoUse
2560 Ninth Street, Suite 320
Berkeley, CA 94710
(510) 549-6520

InfoUse
AT Data Collection Project, H224B9900001
National Institute on Disability and Rehabilitation Research

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Slide 2

AT Data Collection Project: State Estimates

Part of 4 year NIDRR-funded project to create Web-based reporting system on State Projects that are funded by the Assistive Technology Act of 1998 (AT Act)
Compile, estimate, and summarize data on AT at the state level to create state profiles
In each state, identify groups with disparities in access to AT, so that projects can target those with greatest need

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Slide 3

Assistive Technology: Definition and need

AT broadly defined in the AT Act:

AT devices include any item, piece of equipment, or product system that is used to increase, maintain, or improve functional capacities of individuals with disabilities

Need for AT varies across the life cycle and for people with different kinds of disabilities
Not "one size fits all:" People need AT appropriate to their specific capabilities, tasks, and environments

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Slide 4

One in five Americans has a disability.

Americans with disability

Disability Status	Population	Percentage
Disability	53,907,000	21%
No disability	207,842,000	79%

Source: McNeil (1997)
Survey: SIPP, 1994-95

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Slide 5

In 1990, only 5% of the population (about 1/4 of people with disabilities) used any AT.

Prevalence of assistive devices

AT Use	Population	Percentage
Use AT	13,100,000	5.3%
Report unmet need for AT	2,500,000	1%
No reported AT use	247,600,000	93.7%

Source: LaPlante, Hendershot, & Moss (1997)
Survey: NHIS-AT supplement, 1990

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Slide 6

Estimates based on national surveys tell part of the AT story.

7.4 million people use mobility devices
4.8 million people use canes
1.8 million people use walkers
1.6 million people use wheelchairs
4.6 million people use anatomical devices such as back, neck, leg and arm braces and artificial limbs
4.2 million people use hearing devices
Over half a million people use vision devices (white canes, telescopic lenses, Braille or computer aids)

Source: NCHS website
Survey: NHIS, 1994

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Slide 7

But national statistics do not capture complexity of AT use and need at the state level.

Current surveys ask people about most common AT devices and do not capture broad range of AT from low tech to high tech
Relative infrequency of AT use makes it difficult to get state-level estimates (small cell size)
States vary greatly on demographics that affect AT use and need

Poverty
Age groups (Children, working age adults, seniors)
Ethnic minorities
Disability rates

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Slide 8

AT Data Collection Project: Gathering the pieces to put together the puzzle

Image: Map of United States as puzzle pieces

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Slide 9

Start with data from 10 sample states

Image: Map of United States with the following states highlighted: California, Oregon, New Mexico, Iowa, Arkansas, Alabama, North Carolina, District of Columbia, New York, Massachusetts

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Slide 10

Goal: Draw from many sources to capture demographic differences in AT use and need

General to specific estimates all provide some data:

Level I: State population demographics
Level II: Overall disability prevalence
Level III: Specific disability populations
Level IV: AT use (low tech to high tech)

Image: Four circles containing the following phrases: pre-school children, school-age children, working-age adults, seniors

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Slide 11

What do state population demographics tell us about AT use and access?

Focus on Level I: State population demographics
Level II: Overall disability prevalence
Level III: Specific disability populations
Level IV: AT use (low tech to high tech)

Image: Four circles containing the following phrases: pre-school children, school-age children, working-age adults, seniors

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Slide 12

Poor people have more disability and less access to AT.

U.S. Census state population estimates, 1998

Percentage of population below poverty level

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
12.7%	14.5%	14.8%	15.4%	22.3%	N/A	N/A	20.4%	16.7%	14.0%	15.0%

N/A = below national average (US)

Source: US Census Website

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Slide 13

It is important to target seniors' AT needs, especially in states with more elders.

Percentage of people 65 and over

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
12.7%	13.1%	14.3%	N/A	13.9%	15.1%	14.0%	N/A	13.3%	N/A	13.2%

N/A = below national average (US)

U.S. Census state population estimates, 1998

Source: US Census Website

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Slide 14

The percentage of African-Americans varies greatly from state to state.

Percentage of African-American people

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
12.7%	26.0%	16.1%	N/A	62.3%	N/A	N/A	N/A	17.7%	22.1%	N/A

N/A = below national average (US)

U.S. Census state population estimates, 1998

Source: US Census Website

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Slide 15

States with more Latinos must address language and cultural barriers to AT access.

Latino percentage of population

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
11.2%	N/A	N/A	31.0%	N/A	N/A	N/A	40.3%	14.4%	N/A	N/A

N/A = below national average (US)

U.S. Census state population estimates, 1998

Source: US Census Website

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Slide 16

What does overall disability prevalence in the state tell us about AT use and need?

Level I: State population demographics
Focus on Level II: Overall disability prevalence
Level III: Specific disability populations
Level IV: AT use (low tech to high tech)

Image showing that next section focuses on Level II: Overall disability prevalence, for working-age adults.

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Slide 17

Recent CPS estimates of work disability show differences among the states.

Percentage with work disability (CPS, 1999)

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
7.9%	9.9%	11.3%	N/A	8.5%	N/A	N/A	8.1%	9.1%	8.7%	N/A

N/A = below national average (US)

Source: Houtenville (2000) EDRR #1 Estimates of the prevalence of disability in the US by state, 1981-1999
Survey: CPS, 1999

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Slide 18

The percentage of people who receive SSDI Disabled Worker benefits varies among states.

Percentage on SSDI (Disabled Workers), 1999

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
1.79%	2.64%	2.85%	N/A	N/A	N/A	1.97%	N/A	N/A	2.43%	N/A

N/A = below national average (US)

Sources: Social Security Administration Web site; U.S. Bureau of the Census Web site

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Slide 19

The picture of state variation is slightly different for disability-related SSI benefits.

Percentage receiving SSI (as disabled or blind)

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
1.92%	3.01%	2.83%	2.22%	3.35%	N/A	1.96%	2.12%	2.59%	2.03%	N/A

N/A = below national average (US)

Sources: Social Security Administration Web site; U.S. Bureau of the Census Web site

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Slide 20

The Behavioral Risk Factor Surveillance System found large variation among states.

Percentage with activity limitation (BRFSS, 1996)

US	AL	AR	CA	IA	MA	NM	NY	NC	OR
5.1%	6.9%	10.6%	N/A	N/A	N/A	7.4%	N/A	10.7%	N/A

N/A = below national average (US)

1999 State Health Profiles, Centers for Disease Control and Prevention

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Slide 21

Estimates of specific disability populations: what do they tell us about AT use and need?

Level I: State population demographics
Level II: Overall disability prevalence
Focus on Level III: Specific disability populations
Level IV: AT use (low tech to high tech)

Visual showing that next section focuses on Level III: Specific disability populations, for working-age adults and for seniors.

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Slide 22

The southern states in this group have higher rates of visual impairment.

Percentage with visual impairment (difficulty reading)

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
5.2%	7.2%	7.5%	N/A	6.7%	N/A	N/A	N/A	N/A	6.4%	N/A

N/A = below national average (US)

Source: U.S. Bureau of the Census, Disability, 1990 Census, Table 3 (Model-based estimates)

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Slide 23

States also vary in percent with hearing impairment.

Percentage with hearing impairment

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
5.8%	6.6%	7.4%	N/A	N/A	6.4%	N/A	N/A	N/A	6.3%	6.2%

N/A = below national average (US)

Source: U.S. Bureau of the Census, Disability, 1990 Census, Table 3 (Model-based estimates)

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Slide 24

Estimates of the number of people who have difficulty walking also vary from state to state.

Mobility impairment (difficulty walking)

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
9.2%	11.8%	12.8%	N/A	10.2%	9.2%	N/A	N/A	N/A	10.5%	N/A

N/A = below national average (US)

Source: U.S. Bureau of the Census, Disability, 1990 Census, Table 3 (Model-based estimates)

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Slide 25

Data on use of Assistive Technology: Very young children

Level I: State population demographics
Level II: Overall disability prevalence
Level III: Specific disability populations
Focus on Level IV: AT use (low tech to high tech)

Visual showing that next section focuses on Level IV: AT use (low tech to high tech), for pre-school children.

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Slide 26

The percentage of very young children who receive any early intervention under IDEA varies from state to state.

Percentage of children 0-2 years receiving early intervention services under IDEA, 1996

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
1.6%	N/A	2.0%	N/A	N/A	N/A	3.7%	2.6%	1.9%	N/A	N/A

N/A = below national average (US)

Sources: RESNA Technical Assistance Project (2000, July). Update on the use of AT among infants and toddlers. U.S. Census Bureau Web site: Detailed Files - Population Electronic Product #45 (population projections, 1996)

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Slide 27

There is even greater variation in percentage of very young children who receive AT.

Percentage of children 0-2 years receiving AT devices & services under IDEA, 1996

US	AL	AR	CA	DC	IA	NM	NY	NC	OR
0.12%	N/A	N/A	0.15%	N/A	N/A	0.94%	N/A	1.08%	N/A

N/A = below national average (US)

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Slide 28

Data on use of Assistive Technology: Adults

Level I: State population demographics
Level II: Overall disability prevalence
Level III: Specific disability populations
Focus on Level IV: AT use (low tech to high tech)

Visual showing that next section focuses on Level IV: AT use (low tech to high tech), for working-age adults and for seniors.

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Slide 29

Data on AT: Variations in Medicare DME expenditures

Medicare Durable Medication Equipment Expenditures divided by population (1998)

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
$21.35	$29.88	$27.18	N/A	N/A	N/A	$24.25	N/A	N/A	$21.60	N/A

N/A = below national average (US)

Sources: HCFA Web site: 1998 State Estimates - Medicare - DME and U.S. Bureau of the Census Web site for population projections, 1998

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States also vary on how rapidly their expenditures for DME have grown since 1980.

Average annual percent growth in DME

US	AL	AR	CA	DC	IA	MA	NM	NY	NC	OR
15.5%	17.1%	N/A	N/A	N/A	15.6%	N/A	16.6%	N/A	19.2%	15.9%

N/A = below national average (US)

Source: HCFA Web site: 1998 State Estimates - Medicare - Vision Products and other Medical Durables

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Slide 31

Where do we go from here?

Looked at patterns across 10 states to get the "lay of the land" and see what data currently exist
Continuing to identify sources, some of which are available only on a state-by-state basis
Next step is developing profiles for individual states

For each state, make a chartbook comparing with national picture
Fill in other data specific to each state
Highlight specific groups with disparities in access to AT

State-level estimates: A tool for eliminating disparitiesin access to assistive technology (AT)

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State-level estimates: A tool for eliminating disparities
in access to assistive technology (AT)