142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014), Nov 18, 2014
ABSTRACT Background: Serious vision and hearing impairments limit the ability of many individuals... more ABSTRACT 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.
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