Epidemiology

Although exact numbers of handicapped persons cannot be determined because of differences in terms and methodology, much has been written about the large number of handicapped persons, both nationally and internationally. As far back as the 1970 census, the President's Committee on the Employment of the Handicapped concluded that one in 11 adults under age 65 had a handicap that affected employability. The census showed a total of 121 million persons in the United States in the typically employable age range of 16 to 64 years of age. (The military service and institutions were not included.) Of this number, 11,265,000 persons had handicaps that had existed for 6 months or longer. Thus over 9%, or 1 in every 11 Americans under 65, were handicapped.8 The survey examined four demographic characteristics: years of school completed, income in 1969, poverty status, and labor force status. The findings were that the handicapped had less schooling and lower earnings than the nonhandicapped; the proportion of handicapped in poverty status was twice that of the general population. The committee also noted that handicapped adults who were not working or looking for work thought job opportunities did not exist. This factor may help explain the fact that a disproportionate number of handicapped persons were unemployed.8

The Bureau of Education for the Handicapped estimated there were 3,103,000 physically handicapped children through age 19 in the United States from 1974 to 1975. Of these, 2,293,000 were speech impaired, 328.000 were crippled and otherwise health impaired, 49,000 were deaf, 228,000 were hard of hearing, 66,000 were visually handicapped, and 40,000 were deaf and blind or otherwise multihandicapped. A 1971 Department of Health, Education and Welfare study of the prevalence of "10 impairment groups" estimated there were 9,760,000'persons aged 65 or over with one or more of impairments.9 All study findings indicated their figures were conservative: however, even using conservative figures and continuing to omit the military and persons in institutions, the total number of handicapped persons is in excess of 25 million.

The growing and increasing number of severely handicapped persons is attributed to the following causes:

1. The incredible advances in medical care, both technically and in quality, as well as mechanical substitutes to perform vital bodily functions or substitutes for parts of the body. Earlier and more effective intervention in life-threatening medical complications has enabled an increasingly larger number of extensively handicapped persons to survive.

2. The increased environmental risks of urban and rural life caused by industrialization and mechanization. With increased use of technical equipment, the growth of industry, and so on, there are increased-opportunities for accidents by automobiles, farm equipment, and industrial plants. Air pollutants further increase risks, particularly in chronic pulmonary obstructive disease.

3. A rapidly aging population that is vulnerable to all the natural handicapping conditions of age (stroke, atherosclerosis, diabetes). Ironically, persons live longer as a result of advances such as antibiotic drugs and tranquilizers but then develop the usual disabilities of old age, making them vulnerable to conditions requiring rehabilitation intervention or referral to nursing homes or specialized care, all of which prolong life.

4. Increasing and more sophisticated institutional arrangements for children and adults with birth defects.

Formerly fatal conditions such as cystic fibrosis and neuromuscular, renal, and cardiopulmonary diseases have now contributed to an increase in the number of aged persons. (Note the development of hemodialysis alone and the impact on renal disease survival.)