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| 3 Long-term Disability and Activity Restriction |
| Description | Specific Indicators | Corresponding Mandatory Objectives | Corresponding National Indicators | Data Sources | Alternative Data Sources | ICD Codes | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Cross-References to Other Sections | References
Description | | The proportion of the community-dwelling population that either reports the presence of a health-related long-term disability or handicap (lasting six months or more) or finds it necessary to restrict their activities at work, home, school or leisure due to a long-term health problem. | | Specific Indicators | - Prevalence of activity restriction (2 methods of calculation)
- Prevalence of long-term disability
Corresponding Mandatory Objectives | | |
Corresponding National Indicators | |
Data Sources (see Resources: Data Sources)
Numerator & Denominator: 1990 Ontario Health Survey (OHS)
Original source: Ontario MOHLTC
Distributed by:
Health Planning Branch, Ontario MOHLTC
Suggested citation (see Data Citation Notes):
Ontario Health Survey 1990, Health Planning Branch, Ontario MOHLTC
Numerator & Denominator: 1996/97 Ontario Health Survey (OHS)
Original source: Statistics Canada
Distributed by:
1. Health Planning Branch, Ontario MOHLTC
2. Statistics Canada
Suggested citation (see Data Citation Notes):
1. Ontario Health Survey 1996/97, Statistics Canada, Share File, Health Planning Branch, Ontario MOHLTC
2. Ontario Health Survey 1996/97, Statistics Canada, Public Use Microdata File, Statistics Canada
Numerator & Denominator: Canadian Community Health Survey (CCHS)
Original source: Statistics Canada
Distributed by:
1. Health Planning Branch, Ontario MOHLTC
2. Statistics Canada
Suggested citation (see Data Citation Notes):
1. Canadian Community Health Survey [year], Statistics Canada, Share File, Health Planning Branch, Ontario MOHLTC
2. Canadian Community Health Survey [year], Statistics Canada, Public Use Microdata File, Statistics Canada
Survey Questions |
NPHS 1994/95 – 2000/01 and Ontario Health Survey 1996/97 Questions:
Question RESTR-Q1: "Because of a long-term physical or mental condition or a health problem, are you limited in the kind or amount of activity you can do… | …at home?
Variable Name: 1994/95 NPHS (original): res_q1a; 1994/95 NPHS (revised): rac4_1a;
1996/97 OHS/NPHS: rac6_1a; 1998/99 NPHS: rac8_1a; 2000/01 NPHS: rac0_1a.
…at school?
Variable Name: 1994/95 NPHS (original): res_q1b; 1994/95 NPHS (revised): rac4_1b;
1996/97 OHS/NPHS: rac6_1b; 1998/99 NPHS: rac8_1b; 2000/01 NPHS: rac0_1b.
…at work?
Variable Name: 1994/95 NPHS (original): res_q1c; 1994/95 NPHS (revised): rac4_1c; 1996/97 OHS/NPHS: rac6_1c; 1998/99 NPHS: rac8_1c; 2000/01 NPHS: rac0_1c.
…in other activities such as transportation to or from work or leisure time activities?
Variable Name: 1994/95 NPHS (original): res_q1d; 1994/95 NPHS (revised): rac4_1d; 1996/97 OHS/NPHS: rac6_1d; 1998/99 NPHS: rac8_1d; 2000/01 NPHS: rac0_1d. Question RESTR-Q2: "Do you have any long-term disabilities or handicaps?"
Variable Name: 1994/95 NPHS (original): res_q2; 1994/95 NPHS (revised): rac4_2; 1996/97 OHS/NPHS: rac6_2; 1998/99 NPHS: rac8_2; 2000/01 NPHS: rac0_2. Response format for all the above questions: Yes/No Answers to these questions are combined into the derived variable "Restriction of Activity Flag", which is set to yes if the respondent answers ‘yes’ to any of the above questions.
Variable Name: 1994/95 NPHS (original): res_flg; 1994/95 NPHS (revised): rac4f1; 1996/97 OHS/NPHS: rac6f1; 1998/99 NPHS: rac8f1; 2000/01 NPHS: rac0f1. |
Alternative Data Sources |
Ontario Health Survey 1990 Questions:
Questions 70-73
70a. "Compared to other people of the age in good health, are you limited in the kind or amount of activity you can do because of a long-term physical or mental condition or health problem?"
Variable Name: q70a Response Format: Yes/No
[70b. "From what age have you been limited in the your activities?"]
71a. "Does your health limit your activities at home?"
Variable Name: q71a Response Format: Yes/No
[71b. "Are you unable to do most everyday household chores?"]
72a. "Are your activities at school or work limited because your health?"
Variable Name: q72a Response Format: Yes/No
[72b. "Are you unable to work or go to school?"]
73. "Are you limited in other activities such as leisure time pursuits or transportation to and from work and school because of your health?"
Variable Name: q73 Response Format: Yes/NoRestriction of Activity in the 2000/01 Canadian Community Health Survey:
The 2000/01 CCHS also contains questions on activity restriction: Question RA-Q1: "Do you have any difficulty hearing, seeing, communicating, walking, climbing stairs, bending, learning or doing any similar activities?"
Variable Name: raca_1 Response Format: Sometimes/Often/Never Question RA_Q2A: "Because of a long-term physical or mental condition or a health problem, are you limited in the kind or amount of activity you can do …at home?
Variable Name: raca_2a Response Format: Sometimes/Often/Never Question RA_Q2B: …at work or school?
Variable Name: raca_2b Response Format: Sometimes/Often/Never Question RA_Q2C …in other activities, for example, transportation or leisure?"
Variable Name: raca_2d Response Format: Sometimes/Often/Never In the CCHS, responses from the latter three questions are combined into the derived variable racadimp that is described as "a crude measure of the impact of long-term physical conditions, mental conditions and health problems on 3 principal domains of life: home work or school and other activities". Statistics Canada emphasizes that this variable is not comparable with the derived variable from the NPHS due to the differences in the questions. They also state that this derived variable should not be used to estimate the prevalence of activity restriction, and that a common approach to measuring disability and activity restriction is currently under development.
Analysis Check List
| - Before releasing and/or publishing these data, users should first determine the number of sampled respondents who contributed to the calculation of the estimate. If this unweighted number is less than 30, the weighted estimate should not be released regardless of the estimate’s coefficient of variation (C.V.). For unweighted estimates of 30 or more, users should determine the C.V. of the rounded weighted estimate and follow the guidelines below:
- Acceptable (C.V. of 0.0 - 16.5) Weighted estimates can be considered for general unrestricted release. Requires no special notation.
- Marginal (C.V. of 16.6 - 33.3) Weighted estimates can be considered for general unrestricted release but should be accompanied by a warning cautioning of high sampling variability.
- Unacceptable (C.V. greater than 33.3) Statistics Canada recommends not releasing estimates of unacceptable quality. However, if the user chooses to do so then estimates should be flagged and the following warning should accompany the estimates: "The user is advised that . . .(specify the data) . . . do not meet Statistics Canada’s quality standards for this statistical program. Conclusions based on these data will be unreliable and most likely invalid". These data and any consequent findings should not be published. If the user chooses to publish these data or findings, then this disclaimer must be published with the data.
- The release guidelines for the 1990 OHS are slightly different: No qualification (C.V. less than 16.6), Qualified estimate (C.V. of 16.6 – 25.0), Suppress estimate (C.V. greater than 25.0).
Method of Calculation Activity Restriction (Method 1)
(NPHS (all cycles) and 1996/97OHS only, variable examples are from 1996/97OHS) | Total weighted population aged 12+ who report the need to restrict activities at home OR at school OR at work OR at leisure OR who report a long-term disability or handicap (rac6_1a=1 OR rac6_1b=1 OR rac6_1c=1 OR rac6_1d=1 OR rac6_2=1); alternate is total population 12+ with activity restriction flag set to ‘yes’ (rac6f1=1) | x 100 |
| Total weighted population aged 12 + |
Activity Restriction (Method 2)
(NPHS (all cycles) and 1996/97OHS only, variable examples are from 1996/97OHS) | Total weighted population aged 12+ who report the need to restrict activities at home OR at school OR at work OR at leisure (rac6_1a=1 OR rac6_1b=1 OR rac6_1c=1 OR rac6_1d=1) | x 100 |
| Total weighted population aged 12 + |
Proportion Reporting Long-term Disability
(NPHS (all cycles) and 1996/97OHS only, variable examples are from 1996/97OHS) | Total weighted population aged 12+ reporting a long-term disability or handicap (rac6_2=1) | x 100 |
| Total weighted population aged 12 + |
Basic Categories | | - Geographic areas for: CCHS - all 37 Public Health Units and 16 District Health Councils in Ontario; 1996/97 OHS - 23 health areas; 1990 OHS - all 42 Public Health Units and 32 District Health Councils that existed at the time.
Indicator Comments
| - To date, no ‘gold standard’ for the measurement of disability and activity restriction exists. Internationally, while many countries report indicators such as prevalence of disability and disability-free life expectancy, there is no uniformity in the measurement of disability used in their calculation. In some countries, estimates are based on the response to the single question "Do you have any long-term disabilities or handicaps?" In others, multi-question surveys are used to determine the presence of disability. The need to restrict one’s regular activities in the common domains of home, school/work or leisure is often used as a proxy for disability. In Canada, the NPHS used the activity restriction proxy and the direct question about long-term disabilities or handicaps to estimate the prevalence of disability.
- With the development of the CCHS and the release of the new WHO International Classification of Functioning, Disability and Health (http://www3.who.int/icf/icftemplate.cfm), in particular the sections on "activities and participation" (see (1) for an overview), it was decided that the proxy approach was inadequate. For this reason, while the CCHS still contains the activity restriction questions, they are no longer interpreted as indicating disability, but are now being interpreted as an indicator of the impact of long-term health conditions
- A uniform measure of disability for use in future surveys in currently under development at Statistics Canada.
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Cross-References to Other Sections | |
References | - Manuel D, Schultz S. Adding Life to Years and Years to Life: Life and Health Expectancy in Ontario. An ICES Atlas Update: Health Status Series. Toronto: ICES; 2001 January 2001. URL: http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=31&morg_id=0&gsec_id=0&item_id=1280
Date of Last Revision: June 05, 2006 .
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