Chapter 2 - The demographics of disability in Ireland

Introduction

As a background to the chapters which follow, this chapter sets out information on the prevalence of disability, and on demographic characteristics such as age, gender and type of disability.

Incidence of disability

Between 10 and 20% of adults have a disabling condition

Estimates of the prevalence of disability among adults range from about 10% to about 20%, depending on the definition used.

Six principal data sources were used in this report to look at different aspects of participation in society. Each source uses somewhat different definitions to distinguish people with disabilities, with a number covering chronic ill health as well as disability. The prevalence of disability which they record differs accordingly.

The Census of 2002 was the first one to measure the number of people with disabilities in Ireland. Using questions derived from the corresponding ones used in the US Census, it estimated a total of 324,000 people with a disability, with little difference between the prevalence rate in urban and rural areas. It showed 8.3% of the total population and 10.4% of adults had a disability (long-term ill-health is not explicitly covered).[1]

Three sources that used definitions involving disability or chronic ill-health which hampers daily life in some way - the Living in Ireland, SLÁN, and the European Social Surveys - agree on a prevalence rate for adults of the order of 15%. The prevalence rate found in the Living in Ireland Survey rises to slightly over 20% when illness or disability which doesn’t hamper daily life is included into the definition.

The Quarterly National Household Survey also covered long-standing illness or disability, but for the working age population only. The incidence it records is about half as high again as in the Census for the corresponding age group.

Appendix A gives details of the precise questions used in each data source. Table 2.1 below summarises the nature of the questions, the population covered, and the incidence of disability recorded for the relevant population.

Table 2.1 - Definitions of disability and prevalence
  Question Coverage Sample size Prevalence
Disability only
Census 2002

Long-lasting conditions:

Severe sight/hearing

Physical disability

Learning/remembering

Difficulty dressing

Difficulty leaving home

Difficulty working

Whole population; self-completion Whole population 8.3%
NDA 2004

A significant ongoing:

sight, hearing or speech disability

physical disability

intellectual disability

mental health difficulty

Aged 15 +; phone survey 500 in disabled sample; 809 in non-disabled sample 19.8%
Disability or long-term ill health
Living in Ireland Survey 2001 Chronic physical or mental health problem, illness or disability Aged 16+; private households 2,865 households; 9,131 individuals 21.6%
QNHS disability modules, Q2 2002, Q1 2004 Any long-standing health problem or disability Aged 15-64; private households 39,000 households 10.9%
Disability, ill-health, and hampered in activity
SLÁN Health and Lifestyles Survey 2002 Is your work or activity affected by long-term illness or disability Adults aged 18+; postal survey 5,992 13.9%
European Social Survey 2002/3 Are you hampered in daily activities by illness/ disability/ infirmity or mental problem

Adults aged

15+; private households

2,046 individuals 14.8%

Disability and ill health

Disability and ill health often co-exist, but many people with disabilities enjoy good general health, where their health status should not constitute a barrier to participation in society.

The general picture is that about 40% of people in the long-term illness or disability category describe their health as good or very good; while the numbers in bad or very bad health is in the region of 10 - 18%. In the NDA survey, where ill health was not specifically covered, over half of people with disabilities described their health as good (Table 2.2). For the non-disabled population, all the surveys suggest the proportion with good or very good health is around 90%, with the proportion with bad or very bad health about 0.1%.

Table 2.2 - Disability and poor health
Survey Covers

Good or very good

%

Bad or very bad

%

Living in Ireland Survey 2001 (age 15-64 only) Disability or ill-health 43 11
SLÁN 2002 Hampering disability or ill-health 42 14
European Social Survey, 2002/3 Hampering disability or ill-health 38 17
NDA 2004 Disability only 56 9

Healthy lifestyles

The NDA survey showed that over twice the proportion of disabled respondents as non-disabled (38% v. 15%) did not take regular exercise – such as walking, swimming, gardening, going to the gym or playing a sport at least once a week. In terms of smoking, there was no difference found, with about a quarter of disabled and non-disabled people alike being smokers.

Prevalence of different disabling conditions

Census 2002

The first Census question in 2002 asked whether people had severely impaired or absent hearing or vision; or whether they had conditions that limited one or more basic physical activities. The second Census question asked about functional difficulties in key areas. These two questions yielded six broad categories of disability with about 60% of people with a disability having more than one disability. (For further detail on the precise questions asked, see Appendix A). The incidence of these different types of disability is outlined in Table 2.3.

Table 2.3 - Number of people with a disability, by disability type
  Number % of population % of those with a disability
Blindness, deafness or a severe vision or hearing impairment 78,000 2.0 24
A condition that substantially limits one or more basic physical activities 176,000 4.5 54
Difficulty learning, remembering or concentrating 106,000 2.7 33
Difficulty dressing, bathing or getting around inside the house 86,000 2.2 27
Difficulty in going outside the home alone 118,000 3.0 36
Difficulty in working at a job or business 181,000 4.6 56

Source: Census of Population 2002, vol. 10 table 1A

Pending the first National Disability Survey to be conducted in autumn 2006, there is some limited information from other sources on the prevalence of different kinds of impairments, and on the degree to which impairments affect everyday life.

Estimates based on UK data

Some rough estimate of the proportion of people in Ireland likely to experience different kinds of functional difficulties can be derived by applying age-specific incidence of such difficulties in Britain to the Irish population distribution. Table 2.4 presents the results of such an exercise. These figures suggest that walking difficulties would be the most widespread category of impairment in Ireland, followed by hearing loss. Up to 150,000 people may require assistance with personal care.

Table 2.4
Functional difficulty Estimated nos.
Locomotion 257,000
Hearing 153,000
Personal care 150,000
Behaviour 110,000
Dexterity 104,000
Seeing 96,000
Intellectual functioning 93,000
Communication 82,000
Continence 75,000
Reaching and stretching 74,000
Consciousness 22,000
Eating, drinking, digesting 16,000

Age-specific disability prevalence of disability in Britain from OPCS Surveys of Disability in Great Britain, 1985,[2] applied to corresponding age distribution in Ireland from Census 2002

Estimates from other Irish sources

QNHS data on the working age population

As part of EU-wide data collection on disability and the workforce, special modules in the Quarterly National Household Surveys (QNHS) of Q2 2002 and Q1 2004 collected information on long-standing illness and disability of those aged 15 to 64. The prevalence rate of 10.9% with this definition compares with a prevalence rate in the Census of 6.4% for the same age group.[3] The QNHS data on impairments were collected to a common template devised by Eurostat, with the focus more on the part of the body affected than on the functional impairment. Table 2.4 shows the percentage breakdown of the adult population aged under 65 by type of impairment for 2002 and 2004. Minor differences between the two years are likely to reflect sampling error.

Table 2.5 - Proportion of people aged 15-64 with a long-standing illness or disability, by principal type of illness or disability
  2002 2004
  % %
Arms or hands 0.60 0.68
Back or neck 1.54 1.58
Chest or breathing 1.65 1.51
Diabetes 0.49 0.53
Epilepsy 0.23 0.24
Hearing difficulty 0.22 0.17
Heart, blood pressure 1.59 1.70
Legs or feet 0.84 0.98
Mental, nervous or emotional difficulty 1.14 1.12
Seeing difficulty 0.19 0.18
Skin conditions 0.18 0.14
Speech impediment 0.05 0.06
Stomach, liver, kidney or digestive 0.47 0.54
Other progressive illness 0.62 0.58
Other longstanding problem(s) 1.05 0.90
Total 10.87 10.93

Source: QNHS, 2002, 2004

Living in Ireland Survey 2000

Data from the Living in Ireland Survey 2000, cited in Gannon and Nolan, 2004, gives details of the principal conditions reported by the working-age population with a chronic illness or disability, classified according to the World Health Organisation’s International Classification of Diseases. About one in eight reported multiple conditions. The most frequently occurring conditions were respiratory, musculo-skeletal and circulatory conditions which together accounted for accounted for about a third of reported illness or disability.

Disability databases

Registers maintained by the Health Research Board for service planning purposes also give some details on the prevalence of particular kinds of impairments.

Prevalence of intellectual disability

The National Intellectual Disability Database records people with a disability in receipt of or awaiting intellectual disability services. As the database is primarily a service planning tool, it is now policy that people with a mild intellectual disability are only included or retained on the database where they have a requirement for an intellectual disability service. The total number of people with intellectual disabilities registered on the database in 2004 was just over 25,000, representing a prevalence rate of 6.49 per 1,000.

Physical and sensory disability

Almost 21,000 people aged under 65 are registered on the physical and sensory disability database, although this database is acknowledged as not complete – with some former Health Board areas yet to participate on any scale, and registration well short of complete in some other former Health Boards. Coverage is voluntary, and there is very limited coverage of pre-school children. On the basis of piloting, it is expected that a complete database of eligible people under 65 would have roughly double those numbers. 83% of those registered on the database have physical disabilities only, 7% have hearing problems only, 6% have visual problems only, and the remaining 4% have both sensory and physical impairments.

Mobility restrictions

In the Census of 2002, 176,000 people were recorded with a physical disability, and 118,000 said they had problems leaving home alone.

Other estimates of the number of people with different types of restricted mobility have been derived from data from the Living in Ireland Survey 2001; the range shown in Table 2.6 allows for sampling error in that data. These figures are for people aged 16 or over living in private households. In addition, it is expected that a high proportion of the 16,000 or so people living in residential care centres or who are long-stay hospital patients would also have severe mobility difficulties. As can be seen from the figures in Table 2.6, the number of adults whose mobility is restricted goes well beyond the number of adults who are wheelchair users.

Table 2.6 - Adults (aged 16+) with restricted mobility, living in private households
  Estimated numbers
Confined to bed 2,500 to 5,500
Wheelchair users 16,000 to 26,000
Other restricted mobility 132,000 to 168,000
Total 151,000 to 200,000

Source: Living in Ireland Survey 2001

Calculations based on table 2.8, Gannon and Nolan (2005), applied to Census 2002 population age distribution; 95% confidence intervals

Mental health difficulties

Most of the available data in this area refers to episodes of treatment rather than to individuals. In 2003, there were around 3,700 people resident in psychiatric hospitals or units, and about 3,000 people living in low, medium or high support residences in the community for people with mental health difficulties. Depressive illnesses, schizophrenia and alcohol problems in that order are the three most common causes of in-patient admissions, and account for about two thirds of all such admissions.

Effect on daily life

About three quarters of adults with a chronic illness or disability report they are hampered in daily activities, with about a fifth of disabled adults reporting they are severely hampered.

The gap between the experience of people with disabilities and others on various indicators of social inclusion – education, having a job, earnings level, poverty, and social life – is strongly linked to the degree of restriction on daily activities. (Gannon and Nolan, 2004, 2005). The “severely hampered” group experience a degree of exclusion which is above the average shown in this report.

For people whose condition does not restrict their daily activities, most of these differences in their situation compared to non-disabled people are attributable to their age, gender or education level rather than to their disability (Gannon and Nolan, 2005)

Disability and age

Most disability is acquired

The incidence of disability accelerates with age. Up to 3% of children have a disability, and the rate has doubled to around 6% by age 40. At age 50, about one in ten people has a disability, rising to one in five by age 70. After that the incidence of disability accelerates sharply. 40% of people aged 80, and a majority of over-80s have a disability (Census 2002). Table 2.7 gives the details. These figures show that relatively few disabled people have had a disability since childhood, and therefore most disability is acquired over the course of life. Research shows that someone aged 65 or over is nine times more likely to acquire a disability or chronic illness than someone aged 15 to 24 (Gannon and Nolan 2005a).

Table 2.7 - Incidence of disability at different ages
Age % of the age group
15[4] 3.1
20 3.2
30 4.2
40 6.0
50 9.0
60 14.8
70 20.0
80 42.0
80+ 58.8

Source: Census 2002

Age and gender

Reflecting the rising incidence of disability with age, over 40% of people with disabilities are aged 65 or over, although people over 65 are only 11% of the total population. Children under 18 represent under 10% of people with disabilities.

There are a slightly higher number of disabled women than men, 172,000 women and girls compared to 152,000 men and boys, according to the 2002 Census.

Among the under 20s, disabled boys outnumber disabled girls by about 50%. There are slightly more disabled men than disabled women in the working age groups, but there are over 30,000 more disabled women than disabled men aged 65 or over. Half of all disabled women are aged 65 or more (Table 2.8).

Table 2.8 - Numbers of disabled people, by age group and gender
Age Men Women
0-19 16,000 10,000
20-64 84,000 78,000
65+ 52,000 84,000
Total 152,000 172,000

Source: Census 2002, rounded

Disability rises with age and women live longer than men, which may account for some of the higher numbers recorded of disabled women. To explore underlying gender differences in the incidence of disability, the charts below, using the Census data, map the rate of disability by single year of age.

Chart 2.1 shows there is a broadly similar pattern in the incidence of disability for men and women by age. When the information is mapped in terms of the gender gap (Chart 2.2) it shows that boys under 20 and men in late middle age (50-70) have somewhat higher disability rates than women of the same age, but women aged over 70 experience a significantly higher disability rate than their male peers.

Chart 2.1: Disability rate (%) by age and gender
Census 2002

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Chart 2.2: Gap between proportion of men and women with a disability
- difference between male and female rates (M-F) per 1,000, Census 2002

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Chart 2.3 shows the gender gap by type of disability, using categories of disability distinguished in the 2002 Census.[5] The chart shows that physical disabilities and to a lesser extent learning/remembering disabilities account for most of the higher incidence of disability found in older women than in older men.

When do gender gaps emerge

Looking at the age at which significant (over 20%) gender differences emerge, it is around age 70 for physical disabilities and difficulty leaving the home; around age 75 for difficulties in personal care and daily living activities such as dressing or bathing; and around age 80 for learning/remembering difficulties. There is no systematic difference by gender in the incidence of sensory disability.

Chart 2.3:

Gender gap (M - F) in the disability rate per 1,000, by disability type

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Disability and socioeconomic status

Data from Census 2002 shows a clear class gradient in the incidence of disability. Over 11% of those from an unskilled background have a disability, compared to 4% of employers and managers. While it is difficult to disentangle from the Census whether differences in social status preceded the onset of disability, the figures for young people under 15, whose socio-economic status derives from their parents, point to a higher incidence of childhood disability by social class. The incidence is 2.6% for unskilled versus 1.6% for employers and managers (Chart 2.4).

Chart 2.4

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The national and international evidence points to the higher risk that people from lower income or social groups face of acquiring a disability. Burchardt (2003) in an analysis of the onset of disability in the UK states:

“The onset of disability is by no means a random occurrence. On the contrary, those who are already disadvantaged are at significantly greater risk of becoming disabled. There are strong associations between being poor, being out of work, having low qualifications, and the risk of developing a long-term health problem or impairment”

Research by Gannon and Nolan on the dynamics of disability onset in Ireland shows that someone who already experiences low income (below 60% of median income) is 1.7 times more likely to experience the onset of a disability or chronic illness, other things being equal (Gannon and Nolan 2005a).

As Burchardt points out, risk factors such as poverty and poor education are amenable to policy intervention. In this sense she argues that the prevalence and distribution of disability and ill-health should be regarded as something more like a phenomenon we have chosen not to minimise, rather than as akin to a natural disaster (Burchardt 2003:2)

Summary

Over 8% or about one in twelve Irish people has a disability. The incidence of disability increases steadily with age, with most disability being acquired in adulthood. Fewer than 10% of those with a disability are aged under 18. Over 40% of people with a disability are aged 65 or over. Mobility difficulties, hearing loss, and difficulties with personal care would seem the most widespread impairments, going on British experience. At younger ages, men are at higher risk of disability, while among the over 70s, women experience a higher disability rate. People who are poorer or from lower social backgrounds are at higher risk of acquiring a disability.


1 The Census Pilot Survey of 2004, using somewhat amended questions, found a disability prevalence rate of 10.6% compared to 8.3%. The pilot survey of 8,000 households tested a somewhat extended range of questions which will be asked in the 2006. In addition to the questions used in the 2002 Census, the Census Pilot 2004 asked about presence of a learning or intellectual disability; a psychological or emotional condition; or other disability, including any chronic illness; and whether the person has difficulties participating in other activities, for example leisure or using transport. On a like for like basis with Census 2002, the prevalence rate found in the Pilot Survey was 9.2%.

2 Derived from Martin, Meltzer and Elliot (1988), "The prevalence of disability among adults" - OPCS surveys of disability in Great Britain. London: HMSO. Table 3.14; Bone and Meltzer (1989) "The prevalence of disability among children" - OPCS surveys of disability in Great Britain. London: HMSO.

3 This may reflect differences in the questions asked; in the underlying concept (illness and disability v. disability) and differences in how the questions were asked (interviewer v. self-completion)

4 The full suite of disability questions was not asked in respect of people under 15. Delays in identifying whether very young children have a disability may also distort the available figures for the incidence of disability in the very young age groups.

5 The labels are shortened. “Dressing” is used for people who have difficulty dressing, bathing or getting around inside the home, and “housebound” for people who have difficulty going outside the home alone.