NCHS Data Brief ■ No. 73 ■ September 2011

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Prevalence of Complex Activity Limitations Among

Racial/Ethnic Groups and Hispanic Subgroups of Adults: 

United States, 2003–2009

Brian W. Ward, Ph.D.; and Jeannine S. Schiller, M.P.H.

Key findings

Data from the National 

Health Interview Survey, 

2003–2009

• Non-Hispanic black adults 

(17.5%) were the most likely 

to have one or more complex 

activity limitations, followed 

by non-Hispanic white (15.5%) 

and Hispanic (10.0%) adults.

• Puerto Rican (17.9%) and 

other Hispanic (15.8%) adults 

were more likely to have a 

complex activity limitation 

than Cuban (12.8%), Mexican 

(8.9%), and Central or South 

American (6.2%) adults.

• Among Hispanic, nonHispanic white, and nonHispanic black persons, men 

were less likely than women 

to have one or more complex 

activity limitations.

• There was at least a 14 

percentage point difference 

in the prevalence of having 

a complex activity limitation 

among adults aged 65–74 

compared with those aged 75 

and over, for all race/ethnicity 

categories.

Despite declines in disability in some racial/ethnic groups during the past 

several decades, disparities among some groups remain (1,2). Given these 

disparities and the rapid growth of the U.S. Hispanic population (3,4), studying 

disability within the Hispanic population is important. This brief focuses 

on one measure of disability—differences in complex activity limitations—

among Hispanic, non-Hispanic white, and non-Hispanic black adults and in 

five Hispanic subgroups. Complex activity limitations, introduced in Disability 

and Health in the United States, 2001–2005 (5), are limitations in “the tasks 

and organized activities that, when executed, make up numerous social roles,” 

such as working and attending school. The three types of complex activity 

limitations analyzed in this brief are self-care, social, and work limitations.

Keywords: disability • National Health Interview Survey

Does the prevalence of complex activity limitations differ by 

race/ethnicity among adults?

• Non-Hispanic black adults (17.5%) were the most likely to have one or 

more complex activity limitations, followed by non-Hispanic white (15.5%) 

and Hispanic (10.0%) adults (Figure 1).

Figure 1. Prevalence of complex activity limitations among adults aged 18 and over, by 

race/ethnicity: United States, 2003–2009

NOTE: Persons of Hispanic or Latino origin may be of any race or combination of races. Similarly, non-Hispanic or Latino refers 

to all persons who are not of Hispanic origin, regardless of race. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2003–2009, Sample Adult component. Percent

10.0

3.0

5.3

7.6

15.5

12.5

17.5

7.8 8.4

14.7

4.5

5.7

519.0

One or more limitations Self-care limitation Social limitation Work limitation

Hispanic Non-Hispanic white Non-Hispanic black

0

5

10

15

20
NCHS Data Brief ■ No. 73 ■ September 2011

■  2  ■

• Hispanic adults were less likely than non-Hispanic white and non-Hispanic black adults—and 

non-Hispanic white adults were less likely than non-Hispanic black adults—to have each type of 

complex activity limitation. 

• For each race/ethnicity, work limitations were the most prevalent type of complex activity 

limitation, followed by social limitations and self-care limitations.

Does the prevalence of complex activity limitations differ by Hispanic 

subgroup among adults?

• Puerto Rican (17.9%) and other Hispanic (15.8%) adults were more likely to have one or 

more complex activity limitations than Cuban (12.8%), Mexican (8.9%), and Central or South 

American (6.2%) adults (Figure 2).

• Puerto Rican adults were more likely to have a social limitation and more likely to have a 

work limitation than Mexican, Cuban, and Central or South American adults. Other Hispanic 

adults were more likely to have a social limitation and more likely to have a work limitation than 

Mexican and Central or South American adults and more likely to have a work limitation than 

Cuban adults.

• Puerto Rican (5.5%), Cuban (4.8%), and other Hispanic (4.5%) adults were more likely to have 

a self-care limitation than Mexican (2.6%) and Central or South American (1.8%) adults.

• Among all five Hispanic subgroups, work limitations were more prevalent than self-care and 

social limitations.

Figure 2. Prevalence of complex activity limitations among adults aged 18 and over, by Hispanic subgroup: United States, 

2003–2009

NOTE: Persons of Hispanic or Latino origin may be of any race or combination of races. Other Hispanic includes Dominican, other Latin American, and other 

Hispanic/Latino/Spanish. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2003–2009, Sample Adult component. Percent

8.9

2.6

4.7

6.8

17.9

12.8

6.4 6.2

9.7

4.4 4.5

8.1

12.3

15.8

4.8 5.5

10.0

13.4

3.2

1.8

One or more limitations Self-care limitation Social limitation Work limitation

0

5

10

15

20

Central or Other Hispanic

South American

Mexican Puerto Rican Cuban
NCHS Data Brief ■ No. 73 ■ September 2011

■  3  ■

Does the prevalence of one or more complex activity limitations differ by 

race/ethnicity and sex among adults?

• Among Hispanic, non-Hispanic white, and non-Hispanic black adults, men were less likely 

than women to have one or more complex activity limitations (Figure 3).

• Among men, non-Hispanic black adults (15.5%) were the most likely to have a complex 

activity limitation, followed by non-Hispanic white (14.1%) and Hispanic (8.4%) adults.

• Among women, non-Hispanic black adults (19.1%) were more likely to have a complex 

activity limitation than non-Hispanic white (16.8%) and Hispanic (11.7%) adults.

Does the prevalence of one or more complex activity limitations differ by 

Hispanic subgroup and sex among adults?

• Among Mexican (7.3%) and Central or South American (5.0%) adults, men were less likely 

to have one or more complex activity limitations than women. Differences by sex for the other 

Hispanic subgroups were not statistically significant (Figure 4).

• Among both men and women, Central or South American adults were least likely to have a 

complex activity limitation; Puerto Rican adults were more likely to have a complex activity 

limitation than Mexican, Cuban, and Central or South American adults; and Cuban and other 

Hispanic adults were more likely to have a complex activity limitation than Mexican and Central 

or South American adults.

Figure 3. Prevalence of one or more complex activity limitations among adults aged 18 and over, by race/ethnicity and sex: 

United States, 2003–2009

NOTE: Persons of Hispanic or Latino origin may be of any race or combination of races. Similarly, non-Hispanic or Latino refers to all persons who are not of 

Hispanic origin, regardless of race. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2003–2009, Sample Adult component. Percent

Male Female

0

5

10

15

20

Hispanic Non-Hispanic white Non-Hispanic black

8.4

11.7

14.1

16.8

19.1

15.5
NCHS Data Brief ■ No. 73 ■ September 2011

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Figure 4. Prevalence of one or more complex activity limitations among adults aged 18 and over, by Hispanic subgroup 

and sex: United States, 2003–2009

NOTE: Persons of Hispanic or Latino origin may be of any race or combination of races. Other Hispanic includes Dominican, other Latin American, and other 

Hispanic/Latino/Spanish. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2003–2009, Sample Adult component. Percent

Male Female

7.3

10.6

16.6

18.9

11.6

14.0

5.0

7.6

14.1

17.4

0

5

10

15

20

Central or Other Hispanic

South American

Mexican Puerto Rican Cuban

Does the prevalence of one or more complex activity limitations differ by 

race/ethnicity and age group among adults?

• As age increases, so do the percentages of Hispanic, non-Hispanic white, and non-Hispanic 

black adults who have one or more complex activity limitations (Figure 5).

• For all age groups, non-Hispanic black adults were more likely than Hispanic and nonHispanic white adults to have a complex activity limitation.

• Hispanic adults aged 18–44 (5.1%) were less likely to have a complex activity limitation than 

non-Hispanic white (7.4%) and non-Hispanic black adults (8.3%) in that age group; however, 

Hispanic adults aged 75 and over (44.6%) were more likely to have a complex activity limitation 

than non-Hispanic white adults (39.9%) in the same age group.

Figure 5. Prevalence of one or more complex activity limitations among adults aged 18 and over, by race/ethnicity and 

age group: United States, 2003–2009

NOTE: Persons of Hispanic or Latino origin may be of any race or combination of races. Similarly, non-Hispanic or Latino refers to all persons who are not of 

Hispanic origin, regardless of race. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2003–2009, Sample Adult component. Percent

5.1

16.2

25.4

44.6

7.4

17.0

25.1

39.9

8.3

24.9

34.4

52.2

0

10

20

30

40

50

60

Hispanic Non-Hispanic white Non-Hispanic black

18–44 years 45–64 years 65–74 years 75 years and over
NCHS Data Brief ■ No. 73 ■ September 2011

■  5  ■

• There was at least a 14 percentage point difference in the prevalence of having a complex 

activity limitation among adults aged 65–74 compared with those aged 75 years and over, for all 

race/ethnicity categories.

Does the prevalence of one or more complex activity limitations differ by 

Hispanic subgroup and age group among adults?

• For each of the five Hispanic subgroups, as age increased so did the percentage of adults who 

had one or more complex activity limitations (Figure 6).

• There was at least a 15 percentage point difference in the prevalence of having a complex 

activity limitation among adults aged 65–74 compared with those aged 75 years and over, for all 

Hispanic subgroups.

• Among adults aged 45–64, Puerto Rican adults were the most likely (25.3%) and Central or 

South American adults the least likely (9.7%) to have a complex activity limitation.

• Among adults aged 65–74, Mexican (29.1%) and Puerto Rican (28.8%) adults were the most 

likely and Central or South American adults (14.3%) the least likely to have a complex activity 

limitation. 

• Among adults aged 75 and over, other Hispanic adults were the most likely (54.3%) and Cuban 

adults the least likely (34.3%) to have a complex activity limitation.

Figure 6. Prevalence of one or more complex activity limitations among adults aged 18 and over, by Hispanic subgroup 

and age group: United States, 2003–2009

NOTE: Persons of Hispanic or Latino origin may be of any race or combination of races. Other Hispanic includes Dominican, other Latin American, and other 

Hispanic/Latino/Spanish. 

SOURCE: CDC/NCHS, National Health Interview Survey, 2003–2009, Sample Adult component. Percent

4.3

16.0

29.1

11.4

25.3

28.8

44.3 46.1

3.1

9.7

14.3

42.8

9.7

20.223.4

54.3

4.7

14.9

19.1

34.3

0

10

20

30

40

50

60

Central or Other Hispanic

South American

Mexican Puerto Rican Cuban

18–44 years 45–64 years 65–74 years 75 years and over
NCHS Data Brief ■ No. 73 ■ September 2011

■  6  ■

Summary

This brief has shown that racial and ethnic differences exist in the prevalence of complex activity 

limitations among adults. Further, within the U.S. Hispanic adult population, a number of 

significant differences were found in complex activity limitations among Mexican, Puerto Rican, 

Cuban, Central or South American, and other Hispanic adults—differences that would likely 

go unnoticed if the Hispanic population were treated as a single group. These disparities in the 

prevalence of complex activity limitations are further influenced by sex and age.

Definitions

Complex activity limitation: A limitation in an activity that “consists of the tasks and organized 

activities that, when executed, make up numerous social roles,” such as working and attending 

school (5). The three types of complex activity limitations examined in this brief are self-care 

activity limitations, social activity limitations, and work activity limitations. 

• Self-care activity limitation: An activity limitation based on whether a person has difficulty 

with any activities of daily living (ADLs) or instrumental activities of daily living (IADLs) 

(5). For ADLs, respondents to the National Health Interview Survey (NHIS) are asked 

whether they or family members aged 3 years and over need the help of another person with 

personal care because of a physical, mental, or emotional problem. For IADLs, respondents 

are asked whether they or family members aged 18 and over need the help of another person 

for handling routine IADL needs because of a physical, mental, or emotional problem. 

People are considered to have an ADL or IADL limitation if they respond affirmatively to 

any of the ADL or IADL questions (5).

• Social activity limitation: Identified on the basis of three NHIS questions:

“By yourself, and without using any special equipment, how difficult is it for you to

– Go out to things like shopping, movies, or sporting events?

– Participate in social activities such as visiting friends, attending clubs and meetings, 

going to parties?

– Do things to relax at home or for leisure (reading, watching TV, sewing, listening to 

music)?”

Social activity limitation is defined as a response of “somewhat difficult,” “very difficult,” 

or “cannot do at all” for any of the three questions. Respondents who did not do the activity, 

refused to answer, or didn’t know were treated as missing data in the analyses (5).

• Work activity limitation: Indicated as either a respondent-defined limitation in the kind or 

amount of work the person in question can do, or as a complete inability to work. Identified 

on the basis of two NHIS questions:

“Does a physical, mental, or emotional problem NOW keep {you/anyone in the family (age 

18+)} from working at a job or business?”

If not “yes”: 
NCHS Data Brief ■ No. 73 ■ September 2011

■  7  ■

“{Are/any of these family members} limited in the kind OR amount of work {you/they} can 

do because of a physical, mental or emotional problem?”

A positive answer to either question identifies the person as having a work activity limitation 

(5).

Data source and methods

Data from the 2003–2009 NHIS were used in this analysis. NHIS data are collected continuously 

throughout the year for the Centers for Disease Control and Prevention’s (CDC) National Center 

for Health Statistics (NCHS). NHIS collects information about the health and health care of the 

civilian noninstitutionalized U.S. population. Interviews are conducted in respondents’ homes, 

but follow-ups to complete interviews may be conducted over the telephone. The Family Core 

component collects information on all family members; the Sample Adult Core component 

collects additional data on a randomly selected adult (the “Sample Adult”); and the Sample Child 

Core component collects additional data about a randomly selected child (the “Sample Child”). 

Questions used to create the self-care and work limitation measures, and questions asking about 

family members’ sex, age, and race/ethnicity, are asked of a family respondent in the Family Core 

component of the survey. Other questions used to create the social limitation measure are from 

the Sample Adult component. In 2003–2009, information was collected on a total of 629,039 

persons in the Family Core component and 190,786 persons in the Sample Adult component of 

the survey. There were 33,762 Hispanic, 118,005 non-Hispanic white, and 27,904 non-Hispanic 

black adults in the Sample Adult files. Among the Hispanic adults in the Sample Adult files, 

there were 20,899 Mexican, 3,393 Puerto Rican, 1,741 Cuban, 5,072 Central or South American, 

and 2,657 other Hispanic adults. For further information about NHIS, and to view the survey 

questionnaire, visit the NHIS website at http://www.cdc.gov/nchs/nhis.htm.

NHIS is designed to yield a sample that is representative of the civilian noninstitutionalized 

population of the United States, and the analysis in this brief uses weights to produce national 

estimates. Data weighting procedures are described in more detail elsewhere (6). Point estimates, 

and estimates of their variances, were calculated using SUDAAN software (7) to account for 

the complex sampling design of NHIS. The Taylor series linearization method was chosen for 

variance estimation. All estimates shown meet the NCHS standard of reliability (relative standard 

error less than or equal to 30%). Differences between percentages were evaluated using twosided significance tests at the 0.05 level. Terms such as “higher than” and “less than” indicate 

statistically significant differences. Terms such as “similar” and “no difference” indicate that 

the statistics being compared were not significantly different. Lack of comment regarding the 

difference between any two statistics does not necessarily suggest that the difference was tested 

and found not to be significant.

About the authors

Brian Ward and Jeannine Schiller are with the Centers for Disease Control and Prevention’s 

National Center for Health Statistics, Division of Health Interview Statistics.
NCHS Data Brief ■ No. 73 ■ September 2011

References

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mmwr/preview/mmwrhtml/mm5206a2.htm.

4. Dunlop DD, Song J, Manheim LM, Davigius ML, Chang RW. Racial/

ethnic differences in the development of disability among older adults. Am J 

Public Health 97(12):2209–15. 2007.

5. Altman B, Bernstein A. Disability and health in the United States, 2001–

2005. Hyattsville, MD: National Center for Health Statistics. 2008. Available 

from: http://www.cdc.gov/nchs/data/misc/disability2001-2005.pdf.

6. Botman SL, Moore TF, Moriarity CL, Parsons VL. Design and estimation 

for the National Health Interview Survey, 1995–2004. National Center for 

Health Statistics. Vital Health Stat 2(130). 2000. Available from: http://www.

cdc.gov/nchs/data/series/sr_02/sr02_130.pdf.

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Suggested citation

Ward BW, Schiller JS. Prevalence of 

complex activity limitations among racial/

ethnic groups and Hispanic subgroups of 

adults: United States, 2003–2009. NCHS 

data brief, no 73. Hyattsville, MD: National 

Center for Health Statistics. 2011.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Edward J. Sondik, Ph.D., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Health Interview Statistics

Jane F. Gentleman, Ph.D., Director

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