Assessing disability severity on the Behavioral Risk Factor Surveillance System

The standard definition of disability used on the Behavioral Risk Factor Surveillance System (BRFSS) includes respondents who report an activity limitation or who use special equipment. Though this broad definition is useful for prevalence estimates and public health planning activities, it also may include individuals with short-term disability. In 2009, the Florida BRFSS included three additional questions about the type of assistance respondents with activity limitations needed and the duration of activity limitation. We created a scaled disability variable that included only respondents with an activity limitation lasting 6 months or longer who needed assistance with personal care (n=235), routine care (n=713), or neither type of assistance (n=1,619). Differences in demographic variables, health status, health care access, and health behaviors existed in Florida based on disability status. The disparities became more evident when people with long-term disability who needed personal or routine assistance were identified. For example, respondents with disability were significantly more likely than respondents without disability (n=8,335) to report that transportation was often or always a problem in getting health care (8.3% versus 2.5%). However, transportation was an increasingly common barrier with increasing severity (16.0% personal care, 16.3% routine care, 3.7% no assistance). Collecting information about needs for assistance and disability duration provides a more precise measure of disability on the BRFSS and highlights the variation in health behaviors, health care access, and needs among a population with heterogeneous disability.