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Approximately 27% of adults in the United States live with a disability,* some of whom qualify for Medicare benefits. Persons with disabilities are at increased risk for severe COVID-19-associated outcomes compared with the general population (1); however, existing studies have limited generalizability† or only pertain to a specific disability (e.g., intellectual) (2). Older age is also associated with COVID-19-associated hospitalization and death, but the extent to which age might contribute to increased risk for severe COVID-19-associated outcomes among persons with disabilities is unknown (3). To describe the impact of COVID-19 on persons with disabilities and whether and how age contributes to disease rates, CDC assessed COVID-19 cases and hospitalizations during January 2020-November 2021, among Centers for Medicare & Medicaid Services (CMS) Medicare beneficiaries aged ≥18 years who were either eligible because of a disability (disability-eligible§) or only eligible because of age ≥65 years (age-eligible). COVID-19 incidence and hospitalization rates were higher in the disability-eligible group (10,978 and 3,148 per 100,000 population, respectively) throughout the study period compared with the age-eligible group (8,102 and 2,129 per 100,000 population, respectively). Both COVID-19 incidence and hospitalization rates increased with age in both disability- and age-eligible beneficiaries. American Indian or Alaska Native (AI/AN) persons had the highest disability-eligible (4,962 per 100,000) and age-eligible (5,024 per 100,000) hospitalization rates. Among all other racial and ethnic groups, hospitalization rates were higher among disability-eligible than among age-eligible patients. COVID-19 incidence and hospitalization rates among disability-eligible Medicare beneficiaries were disproportionally higher than rates among age-eligible beneficiaries. Collection of disability status as a core demographic variable in public health surveillance data and identification, as well as the addition of disability questions in other existing data sources can guide research and development of interventions for persons with disabilities. Efforts to increase access to and use of COVID-19 prevention and treatment strategies, including activities that support equitable vaccine access regardless of the substantial challenges that older adults and persons with disability face, are critical to reducing severe COVID-19-associated outcomes among these groups. [ABSTRACT FROM AUTHOR]

Estimates from the 2019 American Community Survey (ACS) indicated that 15.2% of adults aged ≥18 years had at least one reported functional disability (1). Persons with disabilities are more likely than are those without disabilities to have chronic health conditions (2) and also face barriers to accessing health care (3). These and other health and social inequities have placed persons with disabilities at increased risk for COVID-19-related illness and death, yet they face unique barriers to receipt of vaccination (4,5). Although CDC encourages that considerations be made when expanding vaccine access to persons with disabilities,* few public health surveillance systems measure disability status. To describe COVID-19 vaccination status and intent, as well as perceived vaccine access among adults by disability status, data from the National Immunization Survey Adult COVID Module (NIS-ACM) were analyzed. Adults with a disability were less likely than were those without a disability to report having received ≥1 dose of COVID-19 vaccine (age-adjusted prevalence ratio [aPR] = 0.88; 95% confidence interval [CI] = 0.84-0.93) but more likely to report they would definitely get vaccinated (aPR = 1.86; 95% CI = 1.43-2.42). Among unvaccinated adults, those with a disability were more likely to report higher endorsement of vaccine as protection (aPR = 1.29; 95% CI = 1.16-1.44), yet more likely to report it would be or was difficult to get vaccinated than did adults without a disability (aPR = 2.69; 95% CI = 2.16-3.34). Reducing barriers to vaccine scheduling and making vaccination sites more accessible might improve vaccination rates among persons with disabilities. [ABSTRACT FROM AUTHOR]

The article presents a study which investigates the screening for developmental disabilities in young children based on the National Survey of Children's Health as of 2007 in U.S. Topics discussed include early childhood development, several developmental disabilities, which include language or learning disorders, blindness, and autism spectrum disorder (ASD), and role of public health in developmental screening.

Problem/Condition: Data from a population-based, multisite surveillance network were used to determine the prevalence of autism spectrum disorders (ASDs) among children aged 8 years in 14 areas of the United States and to describe the characteristics of these children. Reporting Period: 2002. Methods: Children aged 8 years were identified as having an ASD through screening and abstraction of evaluation records at health facilities for all 14 sites and through information from psychoeducational evaluations for special education services for 10 of the 14 sites. Case status was determined through clinician review of data abstracted from the records. Children whose parent(s) or legal guardian(s) resided in the respective areas in 2002 and whose records documented behaviors consistent with the Diagnostic and Statistical Manual, Fourth Edition, Text Revision (DSM-IVTR) criteria for autistic disorder; pervasive developmental disorder, not otherwise specified; or Asperger disorder were classified as having ASDs. Results: For 2002, of 407,578 children aged 8 years in the 14 surveillance areas, 2,685 (0.66%) were identified as having an ASD. ASD prevalence per 1,000 children aged 8 years ranged from 3.3 (Alabama) to 10.6 (New Jersey), with the majority of sites ranging from 5.2 to 7.6 (overall mean: 6.6 [i.e., one of every 152 children across all sites). ASD prevalence was significantly lower than all other sites in Alabama (p<0.001) and higher in New Jersey (p<0.0001). ASD prevalence varied by identification source, with higher average prevalence for ASDs in sites with access to health and education records (mean: 7.2) compared with sites with health records only (mean: 5.1). Five sites identified a higher prevalence of ASDs for non-Hispanic white children than for non-Hispanic black children. The ratio of males to females ranged from 3.4:1.0 in Maryland, South Carolina, and Wisconsin to 6.5:1.0 in Utah. The majority of children were receiving special education services at age 8 years and had a documented history of concerns regarding their development before age 3 years. However, the median age of earliest documented ASD diagnosis was much later (range: 49 months [Utah]--66 months [Alabama]). The proportion of children with characteristics consistent with the criteria for an ASD classification who had a previously documented ASD classification varied across sites. In the majority of sites, females with an ASD were more likely than males to have cognitive impairment. For the six sites for which prevalence data were available from both 2000 and 2002, ASD prevalence was stable in four sites and increased in two sites (17% in Georgia and 39% in West Virginia). Interpretation: Results from the second report of a U.S. multisite collaboration to monitor ASD prevalence demonstrated consistency of prevalence in the majority of sites, with variation in two sites. Prevalence was stable in the majority of sites for which 2 years of data were available, but an increase in West Virginia and a trend toward an increase in Georgia indicate the need for ongoing monitoring of ASD prevalence. Public Health Actions: These ASD prevalence data provide the most complete information on the prevalence of the ASDs in the United States to date. The data confirm that ASD prevalence is a continuing urgent public health concern affecting an approximate average of one child in every 150 and that efforts are needed to improve early identification of ASDs. [ABSTRACT FROM AUTHOR]

Problem/Condition: Data from a population-based, multisite surveillance network were used to determine the prevalence of children aged 8 years with autism spectrum disorder (ASD) in six areas of the United States and to describe the characteristics of these children. Reporting Period: 2000. Methods: Children aged 8 years were identified as having an ASD through screening and abstraction of evaluation records at multiple sources, with clinician review of abstracted records to determine case status. Children whose parent(s) or legal guardian(s) resided in one of the six surveillance areas during 2000 and whose records documented behaviors consistent with the American Psychiatric Association's criteria for diagnosing 1) autistic disorder, 2) pervasive developmental disorder-not otherwise specified, or 3) Asperger disorder were classified as having an ASD. Results: For 2000, across six sites, a total of 1,252 children aged 8 years were identified as having an ASD. The overall prevalence of ASDs per 1,000 children aged 8 years ranged from 4.5 in West Virginia to 9.9 in New Jersey. With the exception of one surveillance site (Georgia), no statistically significant (p<0.05) differences were identified in the rate of ASDs between non-Hispanic black and non-Hispanic white children. The ratio of male-to-female prevalence varied (range: 2.8:1.0-5.5:1.0). The majority of children with ASDs received special education services and had a documented history of concerns regarding their development before age 3 years. The prevalence of children with a previously documented ASD classification varied across sites, but the median age of earliest documented ASD diagnosis was similar across sites (age 52-56 months). For three sites with sufficient data on intelligence quotient (IQ), cognitive impairment (i.e., IQ of ≤70) was reported for 40%-62% of children whose conditions were consistent with the case definition for ASD. Interpretation: Findings from this first U.S. multisite collaborative study to monitor ASD prevalence demonstrated consistency across the majority of sites, with prevalence statistically significantly (p<0.001) higher in New Jersey. Average ASD prevalence across all six sites was 6.7 per 1,000 children aged 8 years. These results indicate that ASDs are more common than was believed previously. Public Health Actions: Collecting data regarding prevalence of ASDs by associated characteristics (e.g., cognitive impairment, age of first documented concerns, and history of ASD diagnosis), race/ethnicity, and sex will provide important baseline standards that can be compared with follow-up surveillance data to track changes in ASD prevalence. Knowledge of these characteristics has implications for identification and intervention strategies and for medical and educational service planning for children with ASDs. [ABSTRACT FROM AUTHOR]

Problem: Autism spectrum disorders (ASDs) encompass a spectrum of conditions, including autistic disorder; pervasive developmental disorders, not otherwise specified (PDD-NOS); and Asperger disorder. Impairments associated with ASDs can range from mild to severe. In 2000, in response to increasing public heath concern regarding ASDs, CDC established the Autism and Developmental Disabilities Monitoring (ADDM) Network. The primary objective of this ongoing surveillance system is to track the prevalence and characteristics of ASDs in the United States. ADDM data are useful to understand the prevalence of ASDs and have implications for improved identification, health and education service planning, and intervention for children with ASDs. Because complete, valid, timely, and representative prevalence estimates are essential to inform public health responses to ASDs, evaluating the effectiveness and efficiency of the ADDM methodology is needed to determine how well these methods meet the network's objective. Reporting Period: 2002. Description of System: The ADDM Network is a multiple-source, population-based, active system for monitoring ASDs and other developmental disabilities. In 2002, data were collected from 14 collaborative sites. This report describes an evaluation conducted using guidelines established by CDC for evaluating public health surveillance systems and is based on examination of the following characteristics of the ADDM Network surveillance system: simplicity, flexibility, data quality, acceptability, representativeness, sensitivity, predictive value positive (PVP), timeliness, stability, data confidentiality and security, and sources of variability. Results and Interpretation: Using multiple sources for case ascertainment strengthens the system's representativeness, sensitivity, and flexibility, and the clinician review process aims to bolster PVP. Sensitivity and PVP are difficult to measure, but the ADDM methodology provides the best possible estimate currently available of prevalence of ASDs without conducting complete population screening and diagnostic clinical case confirmation. Although the system is dependent on the quality and availability of information in evaluation records, extensive quality control and data cleaning protocols and missing records assessments ensure the most accurate reflection of the records reviewed. Maintaining timeliness remains a challenge with this complex methodology, and continuous effort is needed to improve timeliness and simplicity without sacrificing data quality. The most difficult influences to assess are the effects of changes in diagnostic and treatment practices, service provision, and community awareness. Information sharing through education and outreach with site-specific stakeholders is the best mechanism for understanding the current climate in the community with respect to changes in service provision and public policy related to ASDs, which can affect prevalence estimates. Public Health Actions: These evaluation results and descriptions can be used to help interpret the ADDM Network 2002 surveillance year data and can serve as a model for other public health surveillance systems, especially those designed to monitor the prevalence of complex disorders. [ABSTRACT FROM AUTHOR]