The distribution of work disabilities by the conditions causing the disability has changed greatly over the last decades. The leading causes in 1960, circulatory diseases and nervous system disorders, have given way to two new sets of disabling disorders, musculo- skeletal and mental. To better understand this trend it may be helpful to look briefly at the ailments associated with each of the diagnostic groups listed.
Musculoskeletal system disorders are all those related to the muscles and bones as well as the ligaments and tendons which link these structures together within the human body. The most common forms of disorders in this category are joint problems often related to arthritis, soft tissue ailments, fractures, disorders of the spine, and repetitive strain injuries like carpal tunnel syndrome. Ailments in this category are the leading cause of work disabilities.
Mental disorders are the second leading cause of work disabilities and include a full range of impairments from severe retardation and autism to personality or anxiety-related disorders and substance addiction disorders.
Circulatory diseases are all those related to the heart and vascular system — the movement of blood through the body. Examples of such conditions include heart disease, diabetes, peripheral vascular disease, hemophilia, and thrombosis.
Neoplastic diseases are all those resulting from malignant tumors. These are, in short, cases of cancer.
Nervous system disorders are all those involving the nervous system. Disorders in this category include such things as epilepsy, spinal cord lesions, cerebral palsy, muscular dystrophy, peripheral neuropathies, and multiple sclerosis.
Respiratory diseases include asthma, bronchiectasis, lung infections, chronic pulmonary insufficiency, as well as all other serious breathing impairments.
The final category, All other disorders and diseases, includes digestive system diseases; infectious diseases; endocrine diseases (ailments resulting from over or underproduction of hormones); genitourinary system diseases (disorders of the genital or urinary organs); skin diseases and congenital anomalies which together accounted for 11.26% of all new disability awards in 2000.
If one looks at the bottom two segments of each of the columns in the graph it is easy to see how the rising numbers of musculoskeletal disorders and mental disorders account for much of the annual increase in number of new beneficiaries. Between 1990 and 2000 alone, the number of disability beneficiaries resulting from musculoskeletal disorders more than doubled, from 74,500 to 153,600 cases. Much of this rise is attributable to arthritic conditions and to the rising numbers of repetitive strain injuries; many of these are the result of working with keyboards.
Personal computers and computers terminals have become ubiquitous in the workplace. Programmers and others who key for long stretches of time are particularly susceptible to carpal tunnel syndrome. It is a treatable condition but can disable a person for long periods of time if not treated early. And carpal tunnel syndrome is only one of a growing number of repetitive strain injuries.
In the case of mental disorders, the largest rise occurred between 1981 (36,318 new cases) and 1990 (105,173 new cases), an almost three fold increase. The number of cases in this category continued to rise during the 1990 but at a somewhat slower pace, reaching 143,200 cases in 2000. Why exactly is difficult to say.
One reason for this dramatic rise may have to do with changes made to the medical manual published by the American Psychiatric Association called the Diagnostic and Statistical Manual of Mental Disorders. This book is the main reference used by mental health professionals in the United States. In 1980 it was updated to include many mood disorders which had not previously been listed as clinical disorders.
In 2000, more men than women receive disability benefits based on mental disorders, but 34% of female beneficiaries have clinically diagnosed mental disorders compared to 33% of males.
The diagnostic category that led all others in 1960 was circulatory system diseases with 31.1% of all cases. This category saw a 60% decline in its representation as a category, accounting in 2000 for only 10.44% of new cases. The likely reason for this decline is increasingly successful medical treatments for circulatory system ailments. These treatments include cardiac catheterization and other similar procedures that clean out obstructed arteries and blood vessels.
These procedures, apart from saving many lives, make many circulatory conditions suffered less likely to disable a person for a long period of time. According to a paper published by Duke University Medical Center in early 2000, an estimated 600,000 angioplasty procedures (one form of cardiac catheterization) are performed in the United States annually. Our circulatory health, if not improving, is being managed more successfully and thus fewer people are being kept from gainful employ due to poor circulatory health.
The data in this panel show trends in new disability beneficiaries. The next panel will look at all beneficiaries as of the year 2000.
Source: U. S. Social Security Administration, Annual Statistical Report on the Social Security Disability Insurance Program, 2000, Table 18, "Awards to Disabled Workers by Diagnostic Group, 1960-2000," September 2001, p. 56. Twombly, Renee. Inside Duke University Medical Center 2000, "Duke's Other ACC — Also a Winner," April 2000, Vol. 9, Number 7, available online at http://www.inside.mc.duke.edu/archives/2000/20000403/5.html.
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