**Mobility	Device	Use	and	Hearing	Impairments	Among	Individuals and**  **Households ,	1990**  **- 2010**  Mitch ell P. LaPlante,	Ph.D.	and H.	Stephen Kaye,	Ph.D.

February	15,	2013
In response	to	a	request	by	the	US	Access	Board	for	population	based	data in conjunction with	proposed	scoping	requirements	for	guest	rooms	with	mobility features	and	guest	room s with	communication	features on	cruise	ships , this	report provides updated population	based statistics	on	trends in the	percentage	of individuals and	households with m embers who	use wheelchairs	or	other mobility devices and the percentage	of	individuals	and households with members who	have hearing impairments
. **Data	and	Methods** We	use all available data from	the	Survey	of	Income	and	Program	Participation (SIPP) over the	period 1990	to	2010
. The	SIPP	provides	stability	in	measuring disability	over	a	long	time	period with	a	large	sample	that	is	representative	of	US households	and	individuals. The SIPP	is	the	best	source	of	information	on	use	of wheelchairs	and	other mobility	devices	over	time	and	also	provides useful information	on	hearing impairments . The	statistics	are	for	the	civilian	household (non
- institutional)	population ages	6	and	older or	ages	18	and	older	as	noted
. H ousehold members often travel together	o n	recreational	trips,	especially	cruises. A guest room with	mobility	features	or	communication	features is needed	when	any travelling household member	requires these feature s . Therefore, in	considering proposed	scoping	requirements	for	guest room s with	mobility features or communication features, s tatistics	on	households	are more applicable than	statistics on	individuals
. However,	national	statistics	on	disability	are	rarely published for households ; this	report	presents the	authors’	analysis	of th e	SIPP	for	households as well	as	individuals
. The	data	and	methods	employed in	analyzing	the	SIPP for adults are	described	elsewhere (1)
. In the analysis of	households,	the	same	methods	were used,	with	the	additional	step	that	i nformation	from all household	members was aggregated to	the	household	level,	e.g.,	households	in	which	any	member used a wheelchair
. For	estimation of	household	statistics,	the	survey	weight	for	the	head	of the	household	was	used
. For mobility	device trends,	h ousehold	statistics include only members ages 18 and	above because	the	SIPP	did	not	ask	about	mobility	device use	among	children	ages	6
- 17	in 1990
- 1995.	H earing	questions were	changed	in the SIPP	in 1997	and	are	not	comparable	to	earlier years ;	thus	the	time	period	covered is	1997	to	2010. Household	statistics for	hearing	impairment	include members ages 6	and	older.**Mobility Device**  **Use**

The	SIPP	has	asked	about use	of	mobility	devices,	including wheelchairs, scooters, canes,	crutches,	and	walkers, among	all	adults	since	1990	and	for	all	persons	ages	6 and	over	since	1997. 1 From	1990	to	2010,	the	household	rate	of	wheelchair	use	doubled from	1.5	to	3 percent (Figure	1). This	reflects	the growth	in use of	wheelchairs that we	have observed previously for individual s (2)
. If	past	trends	continue,	a linear extrapolation	to	2025	suggests	a	rate	of just	above	4 percent	of	households with wheelchair using	members. The rate	of	wheelchair	use for	adults	has	also	doubled from	0.8	percent	in	1990	to	1.6 percent in	2010	(Table	1). Ten percent	of	households	had a member who	used a ny mobility	device

— including wheelchairs , scooters, canes,	crutches,	and	walkers

— in	2010 (Figure	2)
. The household rate	of	using	mobility	devices has	grown	by	about	67	percent	from	1990 to	2010 with	a	trend	that	is close	to	linear
. If	past	trends	continue,	a	linear extrapolation	to	2025	suggests	a	rate	of	about	13	percent	of	households	with members	using mobility	device s . These	statistics	are	ba sed	on	just	the	adult	members	of	the	household. Starting	in 1997,	children	ages	6	and	older	have	also	been	asked	about	mobility	device	use. However,	the	number	of	children using	mobility	devices	is small	compared	to	adults. Including	these	children	increases	the	household	rate	by only 2
- 5	percent, depending	on	the	year	(Table	1) and has no effect	on	the	trend	or	its	extrapolation.

1 In	this	report,	data	on	wheelchair	use	includes	scooter	use.Note: Author’s	analysis	of	the	Survey	of	Income	and	Program	Parti cipation. Includes

adult	house hold	members	ages	18	and	older. 0 2 4 6 8 10 12 14

1990 1995 2000 2005 2010 2015 2020 2025Percent **Figure 1. Rates**  **of households with members**  **who use mobility**  **devices, 1990**  **– 2010 and extrapolated**  **to 2025**
Any mobility device use Wheelchair use**Hearing Impairments** 

Several	national	surveys attempt	to measure	hearing	loss,	but	measurement is	not standardized, with	large variability in	question	wording and	consequently estimates
. Audiometric	testing	is	considered	the	best	way	to	assess	hearing	loss. The National	Health	and	Nutrition Examination	Survey	(NHANES)	is	the	only	survey	to include	audiometric	testing for hearing	loss	of	25	dB	of	the	pure
- tone	average	of hearing	thresholds	at	speech	frequencies. Audiometric	results from	NHANES show that	about	9	percent	of	men	and	about	4	percent	of	women	20
- 69	years	old	have hearing	loss (3)
. A	comparison	of	su rvey	reports	from	NHANES, the National	Health Interview	Survey	(NHIS),	the	Medical	Expenditure	Panel	Survey	(MEPS),	and	the SIPP against	audiometric	test	results found,	for	adults	ages	20
- 69,	that both	the MEPS	and	the	SIPP underreported	hearing	impairment and	that	the	NHANES	and the	NHIS	produced	substantial	overreporting,	with	up	to	25	percent	of	men reporting some	trouble hearing	in	NHANES (3)
. Survey	questions in NHANES and the	NHIS are based	on	a	four p oint	rating scale of	hearing	trouble	(n o	trouble,	a little,	a	lot,	deaf). In	contrast,	the	SIPP	questions	ask	whether	a	person	uses	a hearing	aid, and whether	a	person	has	difficulty	hearing	what	is	said	in	a	normal conversation ( even	when	wearing	a	hearing	aid) or	is	deaf
. This	appears	to	be a more	objective approach than	using	a	rating	scale	of	hearing	difficulty although	it results	in	some underreporting compared	to	audiometric testing
. In	this	report,	we present	results	from the SIPP	based	on	a	positive	response to either	question	for the prevalenc e	of any hearing	impairment. 2 For the	prevalence	of	severe	hearing impairment, we	present	results	based	on a	positive	response if	the person use s a hearing	aid	or the person	is	deaf
. About	4
- 5	percent	of	households	have	a	member	who	uses	a	hea ring	aid	or	is	deaf. Unlike	for	mobility	devices,	no	consistent trend over	time is apparent (Figure	2)
. The	rate	among	individuals	aged	6	and	older	is	approximately	2	percent	(Table	2). From 8
- 10	percent	of	households	have	a	member	with any	hearing	impai rment (Figure	1) .		Among	individuals	aged 6	and	older,	the	rate	was	about	4	percent. While	some	analysts have suggested an	increase	in	hearing	difficulty	due	to	the aging	of	the	population,	two	studies	have	noted	a	decline	in	hearing	difficulty	since 1990 that	has	appeared	to	level	off	after	2000 (1,	3)
. In	the	absence	of	any	clear trends ,	the	best	estimate	for	the	prevalence	of	hearing impairments in	households by 2025	is the	current	rate	of 8
- 9	percent.

2 P erson s	who respond ed positively	to	uses	a	hearing	aid	and	has	difficulty	hearing	what	is	said	in	a normal	conversation	even	when	wearing	a	hearing	aid are	counted	once.Note:	Author’s	analysis	of	the	Survey	of	Income	and	Program	Participation.	Includes

adult	household	members	ages	6	and	older.

**References:** 1. Kaye	HS.	Disability	rates	for	working
- age	adults	and	for	the	elderly	have stabilized,	but	trends	for	each	mean different	results	for	costs.	Health	Aff (Millwood).	2012	Jan;32(1):127
- 34. 2. LaPlante	MP,	Kaye	HS.	Demographics	and	trends	in	wheeled	mobility equipment	use	and	accessibility	in	the	community.	Assistive	Technology. 2010;22(1):3
- 17. 3. Ikeda	N,	Murray	CJ, Salomon	JA.	Tracking	population	health	based	on	self
reported	impairments:	Trends	in	the	prevalence	of	hearing	loss	in	US	adults,	1976
- 2006.	Am	J	Epidemiol.	2009	Jul	1;170(1):80
- 7.

0 1 2 3 4 5 6 7 8 9 10

1997 1999 2001 2003 2005 2007 2009Percent **Figure 2. Rates**  **of households with members**  **who have**

**hearing impairments,**  **1997 –**  **2010**

Any hearing impairment Deaf or uses hearing aid