November 20, 2019

RTC:Rural researchers publish paper on health status and transitory disability

Screenshot of the first page of the journal article "Health status changes with transitory disability over time."RTC:Rural researchers Andrew Myers, Dr. Bryce Ward, Dr. Jennifer Wong, and Dr. Craig Ravesloot recently published a paper in the journal Social Science & Medicine titled “Health status changes with transitory disability over time.”  Myers is a RTC:Rural Project Director, Dr. Bryce Ward is the RTC:Rural Statistician, and Dr. Ravesloot is RTC:Rural Research Director. Dr. Wong is a former RTC:Rural Research Associate and University of Washington research fellow.

This paper builds on previous RTC:Rural research published in the Journal of Rural Health, titled “Transitory and enduring disability among urban and rural people,” and “Disability items from the Current Population Survey (2008-2015) and permanent versus temporary disability status,” published in the American Journal of Public Health. This study was a secondary analysis from a previous RTC:Rural study, which was published in 2016 in the Disability and Health Journal: “Why stay home? Temporal association of pain, fatigue and depression with being at home.”

The relationship between disability and health status

In the current paper, the researchers build upon previous work by examining how changes in self-reported disability status are related to changes in self-reported health status. Currently, the US Census Bureau, and other federal agencies, use a set of six questions to estimate how many people with disabilities there are in the US. These questions do not directly measure disability. Instead, they ask about functional difficulty and activity limitation, and if a respondent says ‘yes’ to any of these questions, they are identified as having a disability. The long-standing assumption is that these questions identify people with long-term, or enduring disabilities.

The six-question disability measure:

  1. Walking: Do you have serious difficulty walking or climbing stairs?
  2. Dressing: Do you have difficulty bathing or dressing?
  3. Errands: Because of a physical, mental, or emotional problem, do you have difficulty doing errands alone such as visiting a doctor’s office or shopping?
  4. Remembering: Because of a physical, mental, or emotional problem, do you have difficulty remembering, concentrating, or making decisions?
  5. Seeing: Are you blind or do you have serious difficulty seeing, even when wearing glasses?
  6. Hearing: Are you deaf or do you have serious difficulty hearing?

However, RTC:Rural’s previous research, as well as work from other researchers, shows that some people change their answers to the disability measure questions over time. These changing answers mean that, instead of only identifying people with long-term, or enduring, disabilities, the questions are also identifying another group of people—those who move in and out of disability, or people experiencing transitory disability.

In order to begin better understanding the similarities and differences of people experiencing enduring and transitory disability, RTC:Rural researchers conducted a survey to try to better understand how changes in disability status are related to changes in health status and mobility equipment use.

To do this, researchers sent out a survey that asked people to answer the six disability measure questions, as well four questions about their health status and a yes/no question about their use of mobility equipment. All of the survey questions are self-reported.

Respondents filled out the same survey four times, four months apart, and researchers analyzed their responses to see how they changed over time and how certain responses may be related or linked to other responses.

Transitory disability and health status

The researchers found that the people who say that they are moving in and out of disability, or who are experiencing transitory disability, also change how they report their health and their use of mobility equipment at the same time. So, if someone’s answer to a disability question changes, then their answer to a health question or about their use of mobility equipment will also change.

“These findings are important because they suggest that when people change their responses to the six-question set, it reflects a real change in their health and impairment,” said Myers.

a woman has her blood pressure taken by a nurse

The four core health indicators from the Health Related Quality of Life-14 measure:

  1. Would you say that in general your health is excellent, very good, good, fair, or poor?
  2. Now thinking about your physical health, which includes physical illness and injury, for how many days during the past 30 days was your physical health not good?
  3. Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good?
  4. During the past 30 days, for about how many days did poor physical or mental health keep you from doing your usual activities, such as self-care, work, or recreation? 

Implications for disability research

These findings, which build upon findings from previous RTC:Rural papers, have implications for how the data gathered using the ACS disability questions should be used—“the questions may not accurately describe the characteristics of the population of people with enduring disabilities,” said Myers. “For example, analysts using these questions should be aware that they may: 1) overestimate the population of people with enduring disabilities; 2) underestimate the population of people with transitory disabilities; and 3) underestimate the disparities between people with enduring disabilities and those with no disabilities.”

What’s next

A man with a prosthetic leg spots a man in a wheelchair lifting weightsMore work is needed to develop questions that can better separate people who experience enduring disability from those who experience transitory disability. Knowing more about the differences between these two groups would also be very valuable in helping to better understand how disability occurs over time, and would help better understand the differences in health between people experiencing enduring disability and those without disability.

While the needs of these two groups of people experiencing disability do certainly overlap, current programs and policies based on data from the six-question disability set may not adequately address the needs of those experiencing transitory disability, or slow the onset of enduring disability. The onset of enduring disability could be slowed with both medical interventions that address impairment (such as providing adaptive equipment or physical therapy) and social interventions that provide earlier accommodations and promote universal design. Policies and programs targeted toward people experiencing enduring disabilities may focus on transitions back into community living settings from a hospital or nursing home and promote community participation, while those targeted towards people experiencing transitory disability may focus on retaining employment and maintaining an active and healthy lifestyle.



Read the journal article here: Health status changes with transitory disability over time (Social Science & Medicine, January 2020).


This paper builds on previous RTC:Rural research: