The prevalence of disability from chronic conditions due to injury among adults ages 18-69 years: United States, 1994

Use of Statistics From National Data Sources to Inform Rehabilitation Program Planning, Evaluation, and Advocacy

Data on people with disabilities can be used to confirm service needs and to evaluate the resulting impact of services. Disability statistics from surveys and administrative records can play a meaningful role in such efforts. In this article, the authors describe the array of available data and statistics and their potential uses in rehabilitation service planning and evaluation. They discuss the 2000 Decennial Census Long Form, the American Community Survey, the National Health Information Survey, the National Health Information Survey on Disability, the Current Population Survey Annual Demographics Survey, the Survey of Income and Program Participation, and the Health and Retirement Survey, administrative records such as the Rehabilitation Services Administration (RSA) 911 and the Social Security Administration (SSA) Title 2 and Title 16 records, and matched data such as linked RSA and SSA records. They also provide examples of applications of these data sets to rehabilitation service planning and evaluation, along with recommendations for rehabilitation education, practice, and research.

Incomplete elongation of the chondroitin sulfate linkage region on aggrecan and response to interleukin-1β

Aggrecan is the prominent proteoglycan in cartilage and is modified with approximately 100 chondroitin sulfate (CS) chains through a tetrasaccharide linkage structure. In osteoarthritis (OA), the viscoelastic properties of cartilage are compromised on both the quantity and integrity of aggrecan core protein expressed as well as reduced overall CS chain length. Herein, we postulated that chronic low-level inflammation may also contribute to OA progression by promoting regulatory mechanisms in early CS biosynthesis that yield incomplete linkage structures on aggrecan. To test this idea, chondrocytes extracted from human tali were cultured in alginate beads and challenged with 5 ng/mL IL-1β as a model for chronic inflammation leading to OA progression. Novel mass spectrometry-based methods were devised to detect and quantify partially elongated linkage structures relative to control cultures. The total mole fraction of unelongated xylose residues per aggrecan was significantly less (p = 0.03) after IL-1β treatment compared to control cultures, with unelongated xylose residues constituting between 6% and 12% of the fraction of total CS measured. A portion (<1%) of the partially elongated linkage structures was found to be either phosphorylated or sulfated. These results establish quantitative mass spectrometry as a very sensitive and effective platform for evaluating truncated proteoglycan linkage structures. Our observations using this method suggest a possible role for aberrant linkage structure elongation in OA progression.

Disability among adults injured in motor-vehicle crashes in the United States

INTRODUCTION

Little population-based information exists about the long-term effects of motor-vehicle crash-related injuries.

METHOD

We analyzed data from the 1995 National Health Interview Survey Disability (NHIS-D) Supplement to estimate the prevalence of crash-related disability among noninstitutionalized U.S. adults aged 18 years and older.

RESULTS

More than 1.2 million adults were living in their homes with the disabling effects of motor-vehicle crash-related injuries in 1995. The prevalence of crash-related disability was highest for persons in their mid-life years, ages 35-64. Half of the respondents had sustained the injuries more than 5 years before the interview. Forty-one percent of working-aged individuals reported being unable to work because of their disability.

CONCLUSIONS

Because crash-related disability is most prevalent during the mid-life years, quality of life and productivity may be affected for decades. These findings highlight the personal and societal burden associated with motor-vehicle crash-related disability in the United States.

Dissatisfaction with medical services among Medicare beneficiaries with disabilities

OBJECTIVE

To test the hypothesis that Medicare beneficiaries who have difficulties performing activities of daily living (ADLs) are more likely to report dissatisfaction with their health care than those without ADL difficulties.

DESIGN

Cross-sectional study.

SETTING

Sample from the 1998 Medicare Current Beneficiaries Survey.

PARTICIPANTS

A population-based sample (N=19,650) of noninstitutionalized Medicare beneficiaries.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Satisfaction with overall quality and 9 specific aspects of medical services received in the last year.

RESULTS

After adjusting for sociodemographic, behavioral, and system characteristics and compared with those without ADL difficulties, Medicare enrollees were more likely to report dissatisfaction with the overall quality of their health care as their number of activity restrictions increased (1-2 ADLs: odds ratio [OR]=1.5; 95% confidence interval [CI], 1.2-2.0; 3-4 ADLs: OR=1.7; 95% CI, 1.2-2.4; 5-6 ADLs: OR=1.9; 95% CI, 1.4-2.8). Analysis of satisfaction with the 9 specific aspects of care yielded similar results.

CONCLUSION

Disability is a significant independent risk factor for dissatisfaction with health care in the Medicare population. Efforts should be made to identify individuals with ADL difficulties and to improve their ease and convenience of getting to a doctor, the availability of care off hours, the access to specialists, and the follow-up care received.