Chapter 3 - Adults who have offset from impairment, Life Opportunities Survey - Wave Two Report, Part 1

Chapter 3 – Adults who have offset from impairment

This section provides information about adults who have experienced impairment offset; that is they reported at least one impairment at Wave One but no impairment was reported at Wave Two. Offset rates for these adults are presented by demographic characteristics as well as the types of impairments that were experienced by these adults at Wave One and the extent of severity of these impairments.

3.1 Offset rates for adults who did not report any impairment at Wave Two

Longitudinal survey data allow offset rates, or the percentage of the population who have changed from reporting at least one impairment, to not reporting any impairment, to be calculated. Approximately a third (34 per cent) of all adults who had an impairment at Wave One had no impairment at Wave Two. At Wave One 29 per cent of adults had an impairment.

Tables 3.1 and 3.2 give overall offset rates¹ within the following demographic characteristics as reported at Wave One²: sex, age, ethnicity, region of residence, tenure of residence, highest qualification attained and NS-SEC (National Statistics Socio-Economic Classification) and where the sample size permits, these are split by working age (16-64) and 65 or over. Overall offset rates by demographic characteristic will also be affected by the different types of impairment reported as offset rates by type of impairment as outlined later in this chapter.

For each category of the characteristic, the offset rate has been calculated as the percentage of adults in that category who no longer reported any impairment at Wave Two, among all adults who reported at least one impairment at Wave One. Table 3.1 shows the offset rate was 35 per cent for men. Thus, 35 per cent of all men who reported at least one impairment at Wave One no longer reported any impairment at Wave Two. The corresponding figure was 33 per cent for women.

The offset rate suggests that the likelihood of offsetting from an impairment decreases with age. Nearly half (49 per cent) of all adults aged 16 to 24 who reported at least one impairment at Wave One no longer reported any impairment at Wave Two. In contrast, only 21 per cent of those aged 75 and over who reported at least one impairment at Wave One, no longer reported any impairment at Wave Two. Overall, the offset rate is higher for all who were of working age (16 to 64), at 38 per cent, than for those 65 or over, at 25 per cent. This reflects the overall effect of age on offset rates. Across the regions, the offset rate was highest in London and lowest in Wales. These regional differences may be partly explained by differences in the age distributions across regions. Compared with other regions, there is a higher proportion of younger people living in London, and this may contribute to London’s higher overall offset rate, because offset rates tend to be higher for younger age groups.

Table 3.1, Offset rates by sex, age, ethnicity and region of residence at Wave One, and by age

Table source: Office for National Statistics

Table notes:

1. See Appendix 8 for sample size

Table 3.2 shows that the offset rate is highest for adults buying their home with the help of a mortgage or loan (43 per cent). The offset rate is lowest (19 per cent) for adults aged 65 or over who rent and highest for those of working age buying their property with the help of a mortgage or loan (45 per cent). This may reflect some influence of respondents NS-SEC status, with those in higher categories either owning their property or having a mortgage whilst those in lower categories are renting. Additionally, differences in the underlying age distributions may influence the overall offset rates seen across tenure categories. For example, people living in accommodation owned outright tend to be older than those buying their property with a mortgage or loan. This may contribute to the lower overall offset rate among people living in accommodation owned outright (32 per cent), compared with the offset rate for those living in mortgaged accommodation (43 per cent).

Higher offset rates were observed for those with higher qualifications, for example those with degree level qualifications (45 per cent), had a higher offset rate than those with no formal qualifications (28 per cent). There is much evidence of an association between education and general health³, with higher levels of educational attainment linked with positive self-reported health. This finding in part supports the notion that the likelihood of impairment offset increases with the existence rather than absence of formal qualifications.

The offset rate increases with higher levels of socio-economic classification. This may be linked with education level as higher level of education often leads to higher socio-economic levels. The offset rates are lowest for those in lower routine and semi-routine occupations (31 per cent).  For the 65 or over age group, this pattern is less pronounced. It is likely that above a certain age, it is age or the specific impairment type that is the key factor to offsetting rather than education or occupation classification.

Table 3.2, Offset rates by tenure, highest qualification and NS-SEC at Wave One, and by age

Table source: Office for National Statistics

Table notes:

1. Qualifications were asked of those aged 16 to 69.
2. Socio-economic classification is based on current occupation. Occupation was also asked of those who are not currently employed but had last worked within the past eight years.
3. *   Values suppressed due to small sample sizes.
4. See Appendix 8 for sample size.

Notes for 3.1 Offset rates for adults who did not report any impairment at Wave Two

1. Where sufficient sample size permits.
2. Wave One characteristics are used here for consistency with the onset rates presented in Chapter Four.
3. See Furnée CA, Groot W, van den Brink HM (2008). The health effects of education: a meta-analysis. Eur J Public Health 2008; 18: 417-21 doi:10.1093/eurpub/ckn028 pmid: 18434381

3.2 Impairments reported at Wave One by offset adults

LOS categorises impairments into 14 types (sight, hearing, speaking, mobility, dexterity, long-term pain, chronic health condition¹, breathing, learning, intellectual impairment, behavioural, memory, mental health condition, and ‘other’). At Wave One and Wave Two, the LOS included questions to identify the type of impairment experienced but did not collect information that would specify the underlying condition for each impairment type².

Figure 3.1 shows that for both adults of working age (16-64) and those aged 65 or over, the majority (73 per cent and 62 per cent respectively) had only one impairment at Wave One. This finding makes intuitive sense as those who have offset from impairment (having at least one impairment at Wave One to no impairments at all at Wave Two), would be more likely to be classified in this group if cessation of only one impairment was required, rather than three or more This finding was more evident for those of working age than those aged 65 or over.

Figure 3.2 shows for each impairment type, the percentage of adults with impairment offset at Wave Two who reported that impairment at Wave One³. The most commonly-reported impairments at Wave One, by adults who experienced impairment offset at Wave Two were long-term pain (54 per cent) and chronic health condition (27 per cent), followed by mobility and dexterity impairments (10 and 8 per cent respectively). Intellectual, speaking and behavioural impairments (1, 1 and 2 per cent respectively) were those least likely to be reported at Wave One by adults who no longer experienced any impairment at Wave Two.

Figure 3.3 shows that within the offset group, there is a difference in the impairments reported at Wave One between adults of working age (16-64) and adults aged 65 or over. For example a higher percentage of working age adults reported long-term pain at Wave One than adults aged 65 or over (56 per cent compared to 48 per cent). A similar pattern can be seen for mental health conditions, learning, speaking and intellectual impairments. In contrast a higher percentage of adults aged 65 or over reported mobility impairments at Wave One than adults of working age (22 per cent compared to 6 per cent) A similar pattern can be seen for chronic health conditions, dexterity and hearing impairments.

Figure 3.1 Offset: Number of impairments reported at Wave One, by age

Notes:

1. Source - LOS Wave Two Longitudinal Dataset, Office for National Statistics

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Figure 3.2 Offset: Impairment types reported at Wave One

Notes:

1. Source - LOS Wave Two Longitudinal Dataset, Office for National Statistics

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Figure 3.3 Offset: Impairment types reported at Wave One, by age

Notes:

1. Source - LOS Wave Two Longitudinal Dataset, Office for National Statistics

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Notes for 3.2 Impairments reported at Wave One by offset adults

1. Chronic Conditions are defined as long-term conditions that have lasted or are expected to last 12 months or more and that have been diagnosed by a health professional. These include but are not limited to: Asthma or severe allergies; Heart condition or disease; Kidney condition or disease; Cancer; Diabetes; Epilepsy; Cerebral Palsy; Spina Bifida; Cystic Fibrosis; Muscular Dystrophy; Migraines; Arthritis or rheumatism; Multiple Sclerosis (MS) ; Paralysis of any kind; and Depression.
2. LOS did collect further information for chronic condition and impairments reported in the ‘other’ category. Further analysis of these data will be included in the Wave Two Part II report.
3. Because respondents were able to report multiple impairments the percentages do not sum to 100.

3.3 Severity of impairment reported by offset adults at Wave One

The severity of impairment is represented by both the level of difficulty and frequency of the limitation associated with the impairment¹. Tables 3.3 to 3.6 present these measures for the four most commonly-reported impairments (at Wave One) by adults who no longer had an impairment at Wave Two: long-term pain, chronic health condition, mobility and dexterity impairments.

For each of these impairment types, the majority of adults (between 77 to 87 per cent) reported moderate difficulty, rather than higher levels of difficulty (severe or cannot do) at Wave One.

Additionally, across all four impairment types, a large proportion of adults rated the frequency of limitation to be “sometimes” (ranging from 42 per cent for mobility impairments to 52 per cent for long-term pain and dexterity impairments). However, adults who had reported a chronic health condition, mobility or dexterity impairment at Wave One were more likely to rate the frequency of limitation as “always” (17, 28 and 18 per cent respectively) compared with adults with long-term pain (8 per cent).

Adults aged 65 or over who experienced offset of a dexterity impairment were less likely to report “always” (13 per cent for adults 65 or over compared with 22 per cent for working age adults) and more likely to report “rarely” (13 per cent compared to 5 per cent) for the frequency of limitation than their working age equivalents. The reverse is true for those who experienced offset of a chronic health condition or mobility impairment.

Table 3.3, Offset: severity of long-term pain at Wave One, by age

Table source: Office for National Statistics

Table notes:

1. Level of pain for long-term pain is measured by the intensity of pain – “mild”, “moderate”, or “severe”. Under the LOS definition, those who reported moderate or severe levels of pain, and rated the frequency of limitation as “rarely” or above were identified as having long-term pain

Table 3.4, Offset: severity of chronic health condition at Wave One, by age

Table source: Office for National Statistics

Table notes:

1. Response categories for level of difficulty: 1. “No Difficulty”; 2. “Mild Difficulty”; 3. Moderate Difficulty 4; “Severe Difficulty”; and 5. “Cannot Do”; For some impairment types (chronic condition, breathing, learning, intellectual, behavioural, memory, and mental health impairments), the levels range from 1 to 4. For pain, the level of pain is measured by the intensity of the pain experienced: 1.”Mild”; 2.”Moderate”; 3. “Severe”.
2. * Value suppressed due to small sample size

Table 3.5, Offset: severity of mobility impairment at Wave One, by age

Table source: Office for National Statistics

Table notes:

1. Response categories for level of difficulty: 1. “No Difficulty”; 2. “Mild Difficulty”; 3. Moderate Difficulty 4; “Severe Difficulty”; and 5. “Cannot Do”; For some impairment types (chronic condition, breathing, learning, intellectual, behavioural, memory, and mental health impairments), the levels range from 1 to 4. For pain, the level of pain is measured by the intensity of the pain experienced: 1.”Mild”; 2.”Moderate”; 3. “Severe”.
2. * Value suppressed due to small sample size

Table 3.6, Offset: severity of dexterity impairment at Wave One, by age

Table source: Office for National Statistics

Table notes:

1. Response categories for level of difficulty: 1. “No Difficulty”; 2. “Mild Difficulty”; 3. Moderate Difficulty 4; “Severe Difficulty”; and 5. “Cannot Do”; For some impairment types (chronic condition, breathing, learning, intellectual, behavioural, memory, and mental impairments), the levels range from 1 to 4. For pain, the level of pain is measured by the intensity of the pain experienced: 1.”Mild”; 2.”Moderate”; 3. “Severe”.
2. * Value suppressed due to small sample size

Notes for 3.3 Severity of impairment reported by offset adults at Wave One

1. Response categories for level of difficulty: 1. “No Difficulty”; 2. “Mild Difficulty”; 3. Moderate Difficulty 4; “Severe Difficulty”; and 5. “Cannot Do”; For some impairment types (chronic condition, breathing, learning, intellectual, behavioural, memory, and mental health impairments), the levels range from 1 to 4. For pain, the level of pain is measured by the intensity of the pain experienced: 1.”Mild”; 2.”Moderate”; 3. “Severe”.

3.4 Offset rates by impairment type: Offset adults

Longitudinal survey data also allow the offset rate of each impairment type to be calculated. Table 3.7 shows the offset rate of each impairment for adults who no longer reported any impairment at Wave Two. The offset rate is calculated as the percentage of all adults who reported that impairment at Wave One, who no longer reported that impairment (or any other impairments or health conditions) at Wave Two. Adults with impairment at both waves can also experience an offset of a specific impairment; these adults are not included in this analysis. The offset rates by impairment types for adults with impairment at both waves can be found in Section 2.3.

Adults of working age (16 to 64) were more likely to experience offset of sight impairment and long-term pain than adults aged 65 or over. There is very little difference in the offset rates between these two age groups for mobility, dexterity and memory impairments.

The highest offset rate was found for learning impairment (31 per cent). For all impairment types  offset  may be due to a genuine cessation of impairment at Wave Two, or a change in the perception of the impairment, or a change in treatment received for the impairment. At Wave Three the LOS questionnaire will collect information about the offset from impairment and will aim to offer greater insight into the reasons for impairment offset.

Table 3.7, Offset: offset rates by impairment types and age

Table source: Office for National Statistics

Table notes:

1. See Appendix 8 for sample sizes

3.5 Offset of impairment due to a reduction in severity

According to the LOS definition, an adult is classified as having an impairment if he/she reports an impairment and experiences more than ‘mild’ difficulty and a degree of limitation as a consequence of the impairment. It is therefore possible that some instances of impairment offset identified at Wave Two may be a result of a change in the level of difficulty reported for the impairment to ‘mild’ rather than the complete cessation of an impairment between Wave One and Wave Two.

For example, an adult who reported a mobility impairment and recorded experiencing ‘severe’ difficulty at Wave One would have been classified by LOS as an adult with impairment. If at Wave Two the same adult again reported the mobility impairment but the difficulty level was reduced to ‘mild’, LOS would classify this adult as no longer having a mobility impairment at Wave Two.

It is therefore possible for impairment offset to occur as a result of a decrease in severity. Table 3.8 shows the offset rate for adults who experienced an offset of impairment at Wave Two because the difficulty level was reduced to ‘mild’ (offset to mild), as well as the offset rate for adults who experienced impairment offset at Wave Two because they no longer reported that impairment (complete offset). These figures, in Table 3.8, are presented alongside the overall offset rates from Table 3.7. The impairment types in Table 3.8 have been selected due to their high overall offset rates or high “offset to mild” rate; for this reason, the four most commonly-reported impairments, and sight impairment (for seeing close objects) are presented.

‘Offset to mild’ only explains a small proportion of the overall offset rate for both working age adults and adults aged 65 or over for long-term pain and dexterity impairment. However, adults aged 65 or over who reported a chronic health condition were twice as likely to ‘offset to mild’ (11 per cent) than experience ‘complete offset’ (5 per cent), whereas the two offset rates for chronic health condition for adults of working age were very similar (13 per cent for offset to mild and 12 per cent for complete offset). For both working age adults and adults aged 65 or over, the offset rate to ‘mild’ for those experiencing mobility offset (3 and 6 per cent respectively) was less than half of the overall offset rate (11 and 13 per cent respectively).

In contrast, the offset to mild and complete offset rates for sight impairment (for seeing close objects), a large proportion of offset can be explained by a decrease in the level of difficulty experienced: it is possible that this may arise from improvements in equipment used such as glasses, although this information is not available from LOS. Similar results were found for sight impairment (for seeing distant objects). Corresponding figures for this and other impairment or health condition types can be found in Appendix 6.

Table 3.8, Offset: offset due to mild difficulty at Wave Two, by age

Table source: Office for National Statistics

Background notes

1. Details of the policy governing the release of new data are available by visiting www.statisticsauthority.gov.uk/assessment/code-of-practice/index.html or from the Media Relations Office email: media.relations@ons.gsi.gov.uk