Centre for Disability Research

Estimating the Number of People with Co-Occurring Vision and Hearing Impairments in the UK 

Janet Robertson & Eric Emerson

CeDR Research Report 2010:1

April 2010
 
Contents
Summary	
Introduction & Aims	
Method	
The Data	
Estimating Prevalence	
Estimating Numbers	
Findings	
Lower Estimate: UK	
Upper Estimate: UK	
Local Variation	1
Country of Residence	
Ethnicity	
Socio-Economic Deprivation	
Population Age Profile	
Discussion	
Strengths & Limitations	
Implications	
Database Citations	
References	
Appendix 1: National Surveys Included in the Analyses	
Appendix 2: National Surveys Excluded from the Analyses	
Appendix 3: Health Conditions Associated with Lower Limit Estimate	

Acknowledgements: The research described in this report was funded by SENSE. However, the views expressed are the sole responsibility of the authors. Data were obtained from the UK Data Archive (www.data-archive.ac.uk).  However, the original data creators, depositors or copyright holders, the funders of the Data Collections, and the UK Data Archive bear no responsibility for the further analysis or interpretation of data included within this report.
 
Summary

The work described in this report builds on that described in the SENSE 2008 briefing paper ‘The number of deafblind people in the UK’. In this project we have derived more robust estimates of: (1) the age and gender-specific prevalence of co-occurring vision and hearing impairments among children and adults in the UK; (2) the current number (and demographic profile) of people with co-occurring vision and hearing impairments in the UK; and (3) changes in the number (and demographic profile) of people with co-occurring vision and hearing impairments in the UK between 2010 and 2030. 

Our method involved a four step process.

First, we identified existing national data sources from which estimates of the age and gender-specific prevalence of co-occurring vision and hearing impairments could be derived. 

Second, for each survey we determined the prevalence (proportion) of co-occurring vision and hearing impairments by gender and age (in 10 year age bands). 

Third, we derived overall prevalence estimates (by gender and age) by pooling information across multiple surveys. After closer inspection of the data we decided to calculate two estimates for each age/gender group; a lower estimate (more severe impairment) and an upper estimate (more severe and less severe impairment). 

Finally, we combined our prevalence estimates with population estimates from the Office of National Statistics in five yearly intervals from 2010 to 2030 to estimate the number and demographic profile of people with co-occurring vision and hearing impairments among children and adults in the UK.

We estimate that in 2010 approximately 132,000 people in the UK have more severe impairments of both hearing and vision (66,000 women and 65,000 men; equivalent to 212 people per 100,000 of the general population) and that approximately 356,000 people in the UK have impairments of both hearing and vision (193,000 women and 163,000 men; 572 per 100,000). Nearly three quarters of all people with more severe impairments of both hearing and vision are aged 70 or over. 

We estimate that, if age and gender specific prevalence rates remain constant, the number of people with more severe impairments of both hearing and vision will rise to approximately 245,000 by 2030 (343 per 100,000) and the number of people with impairments of both hearing and vision will rise to approximately 569,000 (806 per 100,000). These increases over the next 20 years will be driven by general demographic change, in particular the marked increase in the number of more elderly people aged 70+ in the population. 

Health and social care agencies will need to ensure that they provide services and support to meet current levels of need, and plan for significant growth in provision over the coming decades. 
Introduction & Aims

The work described in this report builds on the work described in the SENSE 2008 briefing paper ‘The number of deafblind people in the UK’. In this project we have sought to derive more robust estimates of:

1.	the age and gender-specific prevalence of co-occurring vision and hearing impairments among children and adults in the UK;

2.	the current number (and demographic profile) of people with co-occurring vision and hearing impairments in the UK;

3.	changes in the number (and demographic profile) of people with co-occurring vision and hearing impairments in the UK between 2010 and 2030. 

We hope that this information will be of value to organisations responsible for either the commissioning or provision of educational, health and social care services for disabled children and adults. 

Method

UK governments invest substantial sums in collecting information through a number of relatively large and representative surveys. Some of these surveys collect information on the presence and sometimes nature and severity of impairments of vision and hearing. This project used these data, which had already been collected, to derive age and gender specific estimates of the prevalence of co-occurring impairments of vision and hearing. We did not undertake any new fieldwork. Our method involved a four step process.

The Data 

First, we identified existing national data sources from which estimates of the age and gender-specific prevalence of co-occurring vision and hearing impairments could be derived. The surveys that yielded usable information are listed below, with further details of each survey being given in Appendix 1. 

Health Survey for England 2000, 2003-2007 (HSE)

Scottish Health Survey 2003 (SHS)

General Household Survey 2007 (GHS)

Disability Follow-Up of the Family Resources Survey 1996-97 (DFUFRS)

Annual Population Survey 2008 (APS)
	
English Longitudinal Study of Aging (Wave 1: 2002 (ELSA) 

Families and Children Study (Wave 7: 2005 (FACS)

Family Resources Survey 2007/8 (FRS)

Living In Wales Survey 2007 and 2008 (LIW)

Scottish Household Survey (SHoS) 2005-2006 (SHoS)

Millennium Cohort Survey (Wave 3: 2006) (MCS)

DCSF Spring 2008 School Census (SC)

Surveys which were examined but excluded from the analyses are presented in Appendix 2.

Estimating Prevalence

Second, for each survey we determined the prevalence (proportion) of co-occurring vision and hearing impairments by gender and age (in 10 year age bands). 

Third, we derived overall prevalence estimates (by gender and age) by pooling information across a number of surveys. Pooling information across surveys allowed us to significantly increase the size of the sample of people surveyed, and therefore the confidence that we have in the prevalence estimates. This is particularly relevant to deriving estimates for older age groups. The difficulty with pooling information across surveys is that there is relatively little consistency across surveys with regard to the specific questions used to identify vision or hearing impairments (an issue that is currently being addressed by the Office for National statistics and the Office for Disability Issues). The specific wording and order of questions can have an impact on estimates of the prevalence of disability.1 2 However, when we inspected the data we did find a fair degree of consistency across surveys. Figure 1 illustrates this point by presenting the estimates of co-occurring impairments of vision and hearing among 
men aged 80-89 across eight surveys.
 

Figure 1: Estimated Prevalence of Hearing and Vision Impairments in Men Aged 80-89 (CH: Care Homes sample of HSE)

The following text has been added by Sense to describe figure 1

HSE.   2.8% point estimate with range 1.9% to 3.7%

SHS.  1.8% with range 0% - 3.8%

GHS.  point 1.9% with range 0.2% to 3.1%

DFFRS.  point 2.1% with range 0.9% to 3.8%

HSE (CH).  point 3.1% with range 1.1% to 5.2%

APS.  point 3.8% with range 3.2% to 4.2%

SHoS. point 2.2% with range 1.4% to 3.2% 

ELSA.  point 3.1% with range 1.2% to 4.9%

The diamond shows the estimated prevalence rate (point estimate). The lines above and below show the range within which we can be 95% confident that the ‘true’ rate lies. These confidence limits reflect the size of the survey sample. Larger surveys (e.g., APS) have much narrower confidence limits. While there is variation in the point estimates, there is also overlap in the confidence limits across all surveys. 

After closer inspection of the data we decided to calculate two estimates for each age/gender group; a lower estimate (more severe impairment) and an upper estimate (more severe and less severe impairment). 

Lower Estimate

Four of the surveys (HSE, SHS, GHS, DFUFRS) used identical methods to code specific health conditions (e.g., conductive/nerve/noise induced deafness, detached/scarred retina) into a category of more severe impairment (a full list of conditions is given in Appendix 3). We used this method to define our lower estimate and pooled data across these four surveys weighting them for the sample size used in each survey (thereby giving greater weight to the results of larger surveys). 

Upper Estimate

We used data from the APS to determine our upper estimate. The APS asks informants whether they ‘have any health problems or disabilities that you expect will last for more than a year?’. If people say yes, they are then asked to select as many items as necessary from a list to identify the nature of their disability. The list includes the items ‘difficulty hearing (without the use of a hearing aid)’ and ‘difficulty seeing (while wearing spectacles or contact lenses)’. We chose to use the APS data primarily due to the very large size of the survey. It should be noted, however, that other approaches to defining an upper estimate (e.g., from HSE, SHS, GHS, DFUFRS) would have given higher upper estimates. We therefore consider that this upper estimate is likely to err on the side of caution. 

Adjusting for Sampling Bias 

Two important aspects of bias are present in (virtually) all of the data we used. First, some people are more likely to agree to participate in surveys than others. For example, younger people and poorer people are much less likely to agree to participate.3 4 Fortunately, the effects of these well known predictors of non-participation can be addressed by weighting the data to compensate for this type of bias. However, it is possible (or even likely) that people with co-occurring impairments of vision and hearing may also be less likely to agree to participate in surveys. It is not possible to adjust for this potential effect. As such, our estimates may underestimate the true prevalence rates of co-occurring impairments of vision and hearing. 
 

Second, all but one of the surveys (HSE 2000 being the exception) were based on samples of people living in ‘general’ households. As such, they excluded from the initial sampling frame people who are homeless and people living in various types of institutional settings (e.g., prisons, military barracks, residential care and nursing homes). The latter omission is potentially important as the presence of co-occurring impairments of vision and hearing may (especially among more elderly people) be a significant factor in their entry to residential care. We adjusted our estimates to take account of this type of bias. Specifically:

1.	We used data from HSE 2000 (which contained a sub-sample of elderly people living in residential care and nursing homes) to determine (for lower and upper estimates and for each age/gender group) how much more likely it was that people living in care homes would have co-occurring impairments of vision and hearing.

2.	We used these ‘inflation factors’ to uprate our prevalence estimates for the sub-population of people living in care homes. 

3.	We used data made available to us from the Personal Social Services Research Unit to estimate the number and age/gender structure of people living in care homes, nursing homes and hospitals in (337,190 in England in 2007). 

4.	We estimated the age and gender profile of this population from HSE 2000 data.

5.	We combined prevalence estimates derived from the general household and care homes sub samples to create new total population estimates.

Our final estimates are presented in Table 1.

Table 1: Estimated Prevalence of Impairments of Both Hearing and Vision by Age and Gender
	Upper Estimate	Lower Estimate

	Men	Women	Men	Women

0-9	0.334%	0.085%	0.052%	0.020%

10-19	0.110%	0.047%	0.016%	0.029%

20-29	0.063%	0.034%	0.036%	0.124%

30-39	0.066%	0.056%	0.009%	0.013%

40-49	0.128%	0.223%	0.020%	0.029%

50-59	0.498%	0.316%	0.053%	0.043%

60-69	1.253%	0.471%	0.499%	0.073%

70-79	1.064%	1.445%	0.413%	0.628%

80-89	4.029%	4.419%	1.770%	1.305%

90+	12.623%	13.405%	12.757%	5.571%

 
This text has been added by Sense to describe the table above.  

The upper estimated prevalence of impairments of both hearing and vision for each age group is as follows: 

in the 0-9 age group for Men it is 0.334% and for Women it is 0.085%; 

in the 10-19 age group for Men it is 0.110% and for Women it is 0.047%; 

in the 20-29 age group for Men it is 0.063% and for Women it is 0.034%; 

in the 30-39 age group for Men it is 0.066% and for Women it is 0.056%; 

in the 40-49 age group for Men it is 0.128% and for Women it is 0.223%;

in the 50-59 age group for Men it is 0.498% and for Women it is 0.316%; 

in the 60-69 age group for Men it is 1.253% and for Women it is 0.471%;

in the 70-79 age group for Men it is 1.064% and for Women it is 1.445%;

in the 80-89 age group for Men it is 4.029% and for Women it is 4.419%;

in the 90+ age group for Men it is 12.623% and for Women it is 13.405%.

The lower estimated prevalence of impairments for both hearing and vision for each age group is as follows: 

in the 0-9 age group for Men it is 0.052% and for Women it is 0.020%; 

in the 10-19 age group for Men it is 0.016% and for Women it is 0.029%; 

in the 20-29 age group for Men it is 0.036% and for Women it is 0.124%; 

in the 30-39 age group for Men it is 0.009% and for Women it is 0.013%; 

in the 40-49 age group for Men it is 0.020% and for Women it is 0.029%;

in the 50-59 age group for Men it is 0.053% and for Women it is 0.043%; 

in the 60-69 age group for Men it is 0.499% and for Women it is 0.073%;

in the 70-79 age group for Men it is 0.413% and for Women it is 0.628%;

in the 80-89 age group for Men it is 1.770% and for Women it is 1.305%;

in the 90+ age group for Men it is 12.757% and for Women it is 5.571%.

Estimating Numbers

Finally, we combined our prevalence estimates with population estimates from the Office of National Statistics in five yearly intervals from 2010 to 2030 to estimate the number and demographic profile of people with co-occurring vision and hearing impairments among children and adults in the UK.5 
 
Findings

In the following two sections we present our overall results for the UK as a whole and for an average area with a population of 250,000 people. We then discuss the extent to which these overall estimates will vary with local socio-demographic circumstances. For national projections figures are rounded to the nearest 1,000. For local projections figures are rounded to the nearest 100.

Lower Estimate: UK

We estimate that in 2010 approximately 132,000 people in the UK will have more severe impairments of both hearing and vision. This is equivalent to 212 people per 100,000 in the general population and includes 66,000 women and 65,000 men. Figure 2 gives a breakdown of the estimated number of people with more severe impairments of both hearing and vision by age.
 

Figure 2: Lower Level 2010 Estimates by Age Group

The following text has been added by Sense to describe the pie chart above.

A pie chart showing age range 0-19 at 3%; age range 20-59 at 10%; age range 60-69 at 14%; age range 70+ at 73%.

As can be seen, we estimate that nearly three quarters of all people with more severe impairments of both hearing and vision are aged 70 or over.

In an average area of the UK with a total population of 250,000 people we would expect there to be 1,100 people with more severe impairments of both hearing and vision.

We estimate that, if age and gender specific prevalence rates remain constant, the number of people with more severe impairments of both hearing and vision will rise to approximately 242,000 by 2030. This is equivalent to 343 people per 100,000 in the general population. This 86% increase over the next 20 years will be driven by general demographic change, in particular the marked increase in the number of more elderly people. In an average area of the UK with a total population of 250,000 people we would expect in 2030 there to be 1,700 people with more severe impairments of both hearing and vision.

Figure 3 and Table 2, show the age profile of the estimated population of people with more severe impairments of both hearing and vision at five-yearly intervals from 2010 to 2030.
 
Figure 3: Age Profile of Lower Estimate 2010-2030

Table 2: Estimated Number of People with More Severe Impairments of Both Hearing and Vision 2010-2030 (Lower Estimate)
	2010	2015	2020	2025	2030

0-19	4,000	4,000	5,000	5,000	5,000

20-59	14,000	14,000	14,000	14,000	14,000

60-69	19,000	19,000	19,000	22,000	23,000

70+	95,000	113,000	136,000	163,000	200,000

Total	132,000	151,000	174,000	203,000	242,000

 

The following text has been added by Sense to describe the table above.

The estimated prevalence of people with more severe impairments of both a hearing and vision (lower estimate) for each age group by year is as follows:

In the 0-19 age group in 2010 it is 4,000, in 2015 it is 4,000, in 2020 it is 5,000, in 2025 it is 5,000 and in 2030 it is 5,000;

In the 20-59 age group in 2010 it is 14,000, in 2015 it is 14,000, in 2020 it is 14,000, in 2025 it is 14,000 and in 2030 it is 14,000;

In the 60-69 age group in 2010 it is 19,000, in 2015 it is 19,000, in 2020 it is 19,000, in 2025 it is 22,000 and in 2030 it is 23,000;

In the 70+ age group in 2010 it is 95,000, in 2015 it is 113,000, in 2020 it is 136,000, in 2025 it is 163,000 and in 2030 it is 200,000;

The total number for 2010 is 132,000, for 2015 it is 151,000, for 2020 it is 174,000, for 2025 it is 203,000 and for 2030 it is 242,000.

As can be seen, virtually all of the estimated growth in the number of people with more severe impairments of both hearing and vision over the projected period occurs in the 70+ age group.

Figure 4 gives a breakdown of the estimated number of people with more severe impairments of both hearing and vision by age in 2030.
 
Figure 4: Lower Level 2030 Estimates by Age Group
 

The following text has been added by Sense to describe the pie chart above.

This is a pie chart showing age range 0-19, 2%; age range 20-59, 6%; age range 60-69, 10%; age range 70+, 82%.

As can be seen, by 2030 we estimate that 82% (over four out of five) of all people with more severe impairments of both hearing and vision will be aged 70 or over.

Upper Estimate: UK

We estimate that in 2010 approximately 356,000 people in the UK will have impairments of both hearing and vision. This is equivalent to 572 people per 100,000 in the general population and includes 193,000 women and 163,000 men. Figure 5 gives a breakdown of the estimated number of people with impairments of both hearing and vision by age.
 
Figure 5: Upper Level 2010 Estimates by Age

The following text has been added by Sense to describe the pie chart above.

A pie chart showing age range 0-19, 6%; age range 20-59, 16%; age range 60-69, 16%; age range 70+, 62%.

As can be seen, we estimate that nearly two-thirds of all people with impairments of both hearing and vision are aged 70 or over.

In an average area of the UK with a total population of 250,000 people we would expect there to be 2,900 people with impairments of both hearing and vision.
 

We estimate that, if age and gender specific prevalence rates remain constant, the number of people with impairments of both hearing and vision will rise to approximately 569,000 by 2030. This is equivalent to 806 people per 100,000 in the general population. Again, this 60% increase over the next 20 years will be driven by general demographic change, in particular the marked increase in the number of more elderly people. In an average area of the UK with a total population of 250,000 people we would expect in 2030 there to be 4,000 people with impairments of both hearing and vision.

Figure 6 and Table 3 show the age profile of the estimated population of people with more severe impairments of both hearing and vision at five-yearly intervals from 2010 to 2030.
 
Figure 6: Age Profile of Upper Estimate 2010-2030


Table 3: Estimated Number of People with Impairments of Both Hearing and Vision 2010-2030 (Upper Estimate)
	2010	2015	2020	2025	2030

0-19	21,000	22,000	23,000	23,000	23,000

20-59	56,000	59,000	60,000	59,000	58,000

60-69	57,000	59,000	59,000	66,000	71,000

70+	222,000	254,000	298,000	348,000	418,000

Total	356,000	394,000	440,000	496,000	569,000


 
The following text has been added by Sense to describe the table above.


The estimated prevalence of people with impairments of both hearing and vision (upper estimate) for each age group by year is as follows:

In the 0-19 age group in 2010 it is 21,000, in 2015 it is 22,000, in 2020 it is 23,000, in 2025 it is 23,000 and in 2030 it is 23,000;

In the 20-59 age group in 2010 it is 56,000, in 2015 it is 59,000, in 2020 it is 60,000, in 2025 it is 59,000 and in 2030 it is 58,000;

In the 60-69 age group in 2010 it is 57,000, in 2015 it is 59,000, in 2020 it is 59,000, in 2025 it is 66,000 and in 2030 it is 71,000;

In the 70+ age group in 2010 it is 222,000, in 2015 it is 254,000, in 2020 it is 298,000, in 2025 it is 348,000 and in 2030 it is 418,000;

The total number for 2010 is 356,000, for 2015 it is 394,000, for 2020 it is 440,000, for 2025 it is 496,000 and for 2030 it is 569,000.

As can be seen, virtually all of the estimated growth in the number of people with more severe impairments of both hearing and vision over the projected period occurs in the 70+ age group.

Figure 7 gives a breakdown of the estimated number of people with more severe impairments of both hearing and vision by age in 2030.
 
Figure 7: Lower Level 2030 Estimates by Age Group

The following text has been added by Sense to describe the pie chart above.

A pie chart showing age range 0-19, 4%; 20-59, 10%; 60-69, 12%; 70+,74%.

As can be seen, by 2030 we estimate that nearly three quarters of people with impairments of both hearing and vision will be aged 70 or over.

Local Variation

We attempted to examine the extent to which these projections would vary as a result of: (1) country; (2) ethnic composition of the local population; (3) age profile of the local population; (4) socio-economic circumstances of the local population. Our results are presented in the following four sections.

Country of Residence

We used data from the largest survey (APS) to examine the relationship between country and the age-specific prevalence of impairments of both hearing and vision. Unfortunately even in this very large survey of over 275,000 people the sample size was insufficient to examine the association between country and age-specific prevalence for men and women separately. As a result we combined data across men and women. Age–specific prevalence rates are shown in Figure 8.

When compared to prevalence rates in England:

Prevalence rates in Wales were significantly higher among people in the 30-39, 50-59 and 60-69 age groups, but significantly lower in the 80-89 age group 

Prevalence rates in Scotland were significantly higher among people in the 50-59 age groups 

Prevalence rates in Northern Ireland were significantly lower among people in the 70-79 age group 
 
Figure 8: Age Specific Prevalence Rates by Country

The following text has been added by Sense based on original data supplied by the researchers to describe figure 8.

The prevalence of Deafblindness for each age group by Country is as follows:

In the 10-19 age group in England it is 0.09%, in Wales it is 0.00%, in Scotland it is 0.02% and in Northern Ireland it is 0.00%; 

In the 20-29 age group in England it is 0.05%, in Wales it is 0.02%, in Scotland it is 0.04% and in Northern Ireland it is 0.00%; 

In the 30-39 age group in England it is 0.06%, in Wales it is 0.17%, in Scotland it is 0.06% and in Northern Ireland it is 0.00%; 

In the 40-49 age group in England it is 0.18%, in Wales it is 0.15%, in Scotland it is 0.23% and in Northern Ireland it is 0.00%; 

In the 50-59 age group in England it is 0.35%, in Wales it is 0.66%, in Scotland it is 0.82% and in Northern Ireland it is 0.34%; 

In the 60-69 age group in England it is 0.52%, in Wales it is 0.79%, in Scotland it is 0.63% and in Northern Ireland it is 0.42%; 

In the 70-79 age group in England it is 1.08%, in Wales it is 1.15%, in Scotland it is 1.08% and in Northern Ireland it is 0.16%; 

In the 80-89 age group in England it is 4.07%, in Wales it is 2.33%, in Scotland it is 4.09% and in Northern Ireland it is 2.30%; 

In the 90+ age group in England it is 11.36%, in Wales it is 9.38%, in Scotland it is 10.38% and in Northern Ireland it is 3.68%. 

Ethnicity

We also used data from the APS to examine the relationship between ethnicity and the age-specific prevalence of impairments of both hearing and vision. Unfortunately even in this very large survey of over 275,000 people the sample size was insufficient to examine the association between age/gender specific prevalence and membership of specific minority ethnic groups. It was possible, however, to compare age-specific prevalence rates (i.e., combining men and women) and membership or not of any British Minority Ethnic Community. While combining data across British Minority Ethnic Communities is far from ideal, it was the only option given the limitations of the data. The results (see Figure 9) suggest that statistically significant differences in prevalence rates occur at just two age groups (50-59, 70-79). In both instances prevalence rates were higher among people from British Minority Ethnic Communities. 
 

Figure 9: Prevalence Rates by Ethnicity

The following text has been added by Sense based on original data supplied by the researchers to describe figure 9.

The prevalence of Deafblindness for each age group by Ethnicity is as follows:

In the 10-19 age group for White British it is 0.09% and for British Minority Ethnic Communities (BMEC) it is 0.03%;


In the 20-29 age group for White British it is 0.05% and for BMEC it is 0.02%;In the 30-39 age group for White British it is 0.06% and for BMEC it is 0.12%;

In the 40-49 age group for White British it is 0.18% and for BMEC it is 0.22%;

In the 50-59 age group for White British it is 0.39% and for BMEC it is 0.68%;

In the 60-69 age group for White British it is 0.54% and for BMEC it is 0.57%;

In the 70-79 age group for White British it is 1.03% and for BMEC it is 1.89%;

In the 80-89 age group for White British it is 3.94% and for BMEC it is 3.76%;

In the 90+ age group for White British it is 11.01% and for BMEC it is 14.37%.

Socio-Economic Deprivation

We used two child surveys to examine the association between socio-economic circumstances and the prevalence of impairments of both hearing and vision.

In the UK’s Millennium Cohort Study informants were asked when their child was five years old whether the child had ever had problems with vision or problems with hearing. Of the 15,142 families interviewed, 267 (1.8%) reported that their child had had problems with both vision and hearing. There were no statistically significant associations between prevalence of impairments of both hearing and vision and measures of social or area deprivation. However, there were relatively consistent minor increases in prevalence on all measures of deprivation. For example, information as collected on whether children had been exposed to material hardship at age 9 months, 3 years and 5 years. 

Prevalence rates were lowest among children never exposed to hardship (1.6%), slightly raised if exposed to hardship once (1.7%) and slightly raised again if exposed to hardship more than once (1.8%).

In the DWP’s Families and Children Study 19 (0.3%) of the 7,159 families were raising a child with problems with vision and problems with hearing. There were no statistically significant associations between prevalence and social deprivation. Again, however, there were consistent increases in prevalence associated with exposure to material hardship (0.2% among families in no/low hardship, 0.4% among families in moderate hardship, 0.7% among families in severe hardship). 

Population Age Profile 

Given the strong association between prevalence and age, the number (and overall prevalence) of people with impairments of both hearing and vision will vary considerably in line with the age-profile of the local population. We have illustrated this by estimating overall prevalence rates for two Local Authorities (Daventry and East Dorset). These two areas have a similar size of total population (80-85,000), but very different age-profiles. 

Table 4 shows the expected number of people with impairments of both hearing and vision for each of these areas. 

Table 4: Expected Number of People with Impairments of Both Hearing and Vision for Two Contrasting Local Authorities of Similar Size 

	Lower Estimate			Upper Estimate

Age	Daventry	East Dorset	Daventry	East Dorset

0-9	3		3		9		8

10-19	2		2		5		5

20-29	6		5		3		2

30-39	1		1		11		9

40-49	3		3		7		6

50-59	5		6		14		15

60-69	26		36		38		52

70-79	26		54		35		72

80-89	36		94		51		135

90+	29		77		32		83

Total	139		281		205		386

 
The following text has been added by Sense to describe the table above.


The lower estimated prevalence of people with impairments of both hearing and vision by age group in Daventry and East Dorset are as follows:

In the 0-9 age group it is 3 for Daventry and 3 for East Dorset;

In the 10-19 age group it is 2 for Daventry and 2 for East Dorset;

In the 20-29 age group it is 6 for Daventry and 5 for East Dorset;

In the 30-39 age group it is 1 for Daventry and 1 for East Dorset;

In the 40-49 age group it is 3 for Daventry and 3 for East Dorset;

In the 50-59 age group it is 5 for Daventry and 6 for East Dorset;

In the 60-69 age group it is 26 for Daventry and 36 for East Dorset;

In the 70-79 age group it is 26 for Daventry and 54 for East Dorset;

In the 80-89 age group it is 36 for Daventry and 94 for East Dorset;

In the 90+ age group it is 29 for Daventry and 77 for East Dorset;

The overall totals are 139 for Daventry and 281 for East Dorset.

The upper estimated prevalence of people with impairments of both hearing and vision by age group in Daventry and East Dorset are as follows:

In the 0-9 age group it is 9 for Daventry and 8 for East Dorset;

In the 10-19 age group it is 5 for Daventry and 5 for East Dorset;

In the 20-29 age group it is 3 for Daventry and 2 for East Dorset;

In the 30-39 age group it is 11 for Daventry and 9 for East Dorset;

In the 40-49 age group it is 7 for Daventry and 6 for East Dorset;

In the 50-59 age group it is 14 for Daventry and 15 for East Dorset;

In the 60-69 age group it is 38 for Daventry and 52 for East Dorset;

In the 70-79 age group it is 35 for Daventry and 72 for East Dorset;

In the 80-89 age group it is 51 for Daventry and 135 for East Dorset;

In the 90+ age group it is 32 for Daventry and 83 for East Dorset;

The overall totals are 205 for Daventry and 386 for East Dorset.

Discussion

 Strengths & Limitations

The modelling presented in this report has a number of strengths and limitations. The main strengths of the study are the use of multiple, large population-based nationally representative surveys to estimate the age and gender specific prevalence of co-occurring impairments of hearing and vision. 

The main limitation of the study is the sole reliance on self-report survey data to identify co-occurring impairments of hearing and vision. A number of issues are relevant here. First, as noted above, it is possible (or even likely) that people with co-occurring impairments of vision and hearing may be less likely to agree to participate in surveys. It is not possible to estimate the size of (or adjust for) this potential effect. As such, our estimates may underestimate the true prevalence rates of co-occurring impairments of vision and hearing. Second, most surveys used a general question about the presence of disability/long-standing illness, with specific questions about vision and hearing only being presented if the person answered in the affirmative to the general question. It is likely that some more elderly respondents with co-occurring impairments of hearing and vision may have not stated that they had a disability (and therefore been screened out), viewing their difficulties in terms of ageing, 
rather than disability. Again, it is not possible to estimate the size of (or adjust for) this potential effect and, as such, our estimates may underestimate the true prevalence rates.  Finally, self-report data cannot be as precise as clinical data in establishing a clear demarcation between the presence/absence of impairment.  

Two other limitations are of note. First, the very small numbers of people from minority British ethnic communities who participated in the surveys made it virtually impossible to address the association between prevalence and ethnicity. Second, our model includes an assumption that the age/gender-specific prevalence of co-occurring impairments of hearing and vision will remain static over the next 20 years. This is almost certainly not the case. For example, some factors may lead to an increase in prevalence (e.g., increased survival rates of very severely disabled children), while others may lead to a decrease (e.g., more ‘healthy’ ageing).  However, we could find no basis on which we could estimate the overall direction or magnitude of likely future changes in prevalence.  

Implications

The main implications of our modelling are rather clear. First, a significant minority (132,000-356,000) of people in the UK currently have co-occurring impairments of hearing and vision. Second, the vast majority of these people are over the age of seventy. Third, this number will grow substantially over the next two decades, growth driven by the changing demographic profile of the UK population. Health and social care agencies will need to ensure that they provide services and support to meet current levels of need, and plan for significant growth in provision over the coming decades. 
 

Database Citations

Department for Work and Pensions, Office for National Statistics. Social and Vital Statistics Division and National Centre for Social Research, Family Resources Survey, 2007-2008 and Households Below Average Income, 2007/08: Special Licence Access [computer file]. Colchester, Essex: UK Data Archive [distributor], August 2009. SN: 6253.

Department of Social Security. Social Research Branch, Disability Follow-up to the 1996/97 Family Resources Survey [computer file]. Colchester, Essex: UK Data Archive [distributor], March 2000. SN: 4090.

Ipsos MORI Scotland, TNS Social Research and Scottish Government, Scottish Household Survey, 2005-2006 [computer file]. 2nd Edition. Colchester, Essex: UK Data Archive [distributor], January 2008. SN: 5608. 

Joint Health Surveys Unit, University College London and Medical Research Council. Social and Public Health Sciences Unit, Scottish Health Survey, 2003 [computer file]. Colchester, Essex: UK Data Archive [distributor], February 2006. SN: 5318.

Marmot, M. et al., English Longitudinal Study of Ageing: Wave 0 (1998, 1999 and 2001) and Waves 1-4 (2002-2009) [computer file]. 13th Edition. Colchester, Essex: UK Data Archive [distributor], January 2010. SN: 5050.

National Centre for Social Research and Department for Work and Pensions, Families and Children Study: Waves 1-7, 1999-2005 [computer file]. 7th Edition. Colchester, Essex: UK Data Archive [distributor], May 2007. SN: 4427. 

National Centre for Social Research and University College London. Department of Epidemiology and Public Health, Health Survey for England, 2000 [computer file]. Colchester, Essex: UK Data Archive [distributor], April 2002. SN: 4487.

National Centre for Social Research and University College London. Department of Epidemiology and Public Health, Health Survey for England, 2003 [computer file]. Colchester, Essex: UK Data Archive [distributor], March 2005. SN: 5098.

National Centre for Social Research and University College London. Department of Epidemiology and Public Health, Health Survey for England, 2004 [computer file]. Colchester, Essex: UK Data Archive [distributor], July 2006. SN: 5439.

National Centre for Social Research and University College London. Department of Epidemiology and Public Health, Health Survey for England, 2005 [computer file]. Colchester, Essex: UK Data Archive [distributor], July 2007. SN: 5675.

National Centre for Social Research and University College London. Department of Epidemiology and Public Health, Health Survey for England, 2006 [computer file]. 2nd Edition. Colchester, Essex: UK Data Archive [distributor], May 2008. SN: 5809.

National Centre for Social Research and University College London. Department of Epidemiology and Public Health, Health Survey for England, 2007 [computer file]. Colchester, Essex: UK Data Archive [distributor], February 2009. SN: 6112.

Office for National Statistics. Social and Vital Statistics Division, General Household Survey, 2007: Special Licence Access [computer file]. 3rd Edition. Colchester, Essex: UK Data Archive [distributor], February 2010. SN: 6263.

Office for National Statistics. Social and Vital Statistics Division, Annual Population Survey, January - December 2008: Special Licence Access [computer file]. Colchester, Essex: UK Data Archive [distributor], September 2009. SN: 6281.

University of London. Institute of Education. Centre for Longitudinal Studies, Millennium Cohort Study: Third Survey, 2006 [computer file]. 3rd Edition. Colchester, Essex: UK Data Archive [distributor], March 2009. SN: 5795. 

Welsh Assembly Government. Statistical Directorate, Living in Wales: Household Survey, 2007 [computer file]. 2nd Edition. Colchester, Essex: UK Data Archive [distributor], December 2009. SN: 6132. 

Welsh Assembly Government. Statistical Directorate, Living in Wales: Household Survey, 2008 [computer file]. Colchester, Essex: UK Data Archive [distributor], January 2010. SN: 6351.

References 

1. Mont D. Measuring Disability Prevalence. Washington, DC, USA: The World Bank, 2007.

2. Bajekal M, Harries T, Breman R, Woodfield K. Review of Disability Estimates and Definitions. London: HMSO, 2004.

3. Groves RM. Nonresponse rates and nonresponse bias in household surveys Public Opinion Quarterly 2006;70:646-675.

4. Groves RM, Couper MP. Nonresponse in Household Interview Surveys. New York: Wiley, 1998.

5. Office for National Statistics. 2008-Based National Population predictions http://www.statistics.gov.uk/downloads/theme_population/NPP2008/NatPopProj2008.pdf. London: Office for National Statistics, 2009.


 

Appendix 1: National Surveys Included in the Analyses 

Survey Annual Population Survey (APS)
 
Filter Questions Do you have any health problems or disabilities that you expect will last for more than a year?(if “yes” further information collected)	

Hearing Impairment Lower n/a	

Vision Impairment Lower	n/a

Hearing Impairment Upper Difficulty hearing (without the use of a hearing aid). Comparable to SHoS 2005-06.	

Vision Impairment Upper	Difficulty seeing (while wearing spectacles or contact lenses). Comparable to SHoS 2005-06.

Inclusion decision APS Jan-Dec 2008 Special Licence Version obtained. Proxy interviews were conducted.

Analysis Special licence data obtained. Over 16s only. 

		

Survey Disability follow up of Family Resources Survey (DFUFRS) 1996/97 (updates OPCS Surveys of Disability 1985)

Filter Questions Longstanding illness filter for ICD categories. (Also additional vision and hearing questions)	

Hearing Impairment Lower ICD plus as per HSE 2000	

Vision Impairment Lower ICD plus as per HSE 2000	

Hearing Impairment Upper  ICD categories as per HSE plus additional hearing questions (comparable to HSE 2000)	

Vision Impairment Uppder ICD categories as per HSE plus additional vision questions (comparable to HSE 2000)	

Inclusion decision 7623 people followed up from FRS sample who eg had LLI, aged over 75, received disability benefit. Proxy interviews appear to have been conducted	

Analysis Data extracted for both ICD categories and additional questions comparable to HSE 2000

Survey English Longitudinal Study of Aging (ELSA)	

Filter Questions n/a	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper Is hearing (using a hearing aid if use one): excellent; very good; good; fair; or poor. ‘Yes’ if rated ‘poor’., 	

Vision Impairment Uppder Is eyesight (using glasses or lenses if use them): excellent; very good; good; fair; or poor. ‘Yes’ if rated ‘poor’ or spontaneously stated that they were registered blind or legally blind. 	

Inclusion decision Include. Proxy interviews were conducted.

Analysis  Data extracted from Wave 1 (cross sectional analysis)

Survey Families and Children Study (FACS)	

Filter Questions Does [name of child] have any long-standing illness or disability? By longstanding I mean anything that has troubled [name of child] over a period of time or that is likely to affect
[childs name] over a period of time?	

Hearing Impairment Lower n/a	

Vision Impairment Uppder n/a	

Hearing Impairment Upper Difficulty in hearing	

Vision Impairment Upper Difficulty in seeing	

Inclusion Decision Include.	

Analysis Data extracted age 0-18 only


Survey Family Resources Survey (FRS)	

Filter Questions Do you have any long-standing illness, disability or infirmity? By 'long-standing' I mean anything that has troubled you over a period of at least 12 months or that is likely to affect you over a period of at least 12 months.

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper Whether registered deaf with LA/SS	

Vision Impairment Upper Whether registered blind or partially sighted with LA/SS	

Inclusion Decision Age variable only available in Special Licence version – 2007-2008 version applied for. Information could be collected by proxy.

Analysis SL version obtained. Numerous zero cells.

Survey General Household Survey (GHS)	

Filter Questions ICD	

Hearing Impairment Lower ICD	

Vision Impairment Lower ICD	

Hearing Impairment Upper ICD	

Vision Impairment Upper ICD	

Inclusion Decision Most recent GHS (2007) Special Licence version only available. Applied for. Whilst proxy interviews were carried out these excluded items on vision and hearing.	

Analysis SL version obtained. Data extracted. 

Survey Health Survey for England (HSE) years 2003 to 2007	

Filter Questions Has limiting long standing illness or disability 	

Hearing Impairment Lower ICD	

Vision Impairment Lower ICD

Hearing Impairment Upper ICD	

Vision Impairment Upper ICD	

Inclusion Decision HSE years 2003-2007 included. Proxy interviews not conducted over age 13; HSE contact emailed to clarify situation for respondents who may have difficulty with interview -people who would be unable to hear interviewer would not be included.	

Analysis Data extracted for last 5 years.

Survey Health Survey for England (HSE) 2000	

Filter Questions Has limiting long standing illness or disability plus additional questions.	

Hearing Impairment Lower ICD plus additional questions

Vision Impairment Lower ICD plus additional questions

Hearing Impairment Upper ICD plus additional questions

Vision Impairment Upper ICD plus additional questions

Inclusion Decision HSE 2000 included in view of use of a sample of those aged 65+ living in care homes. Proxy interviews allowed in care homes.	

Analysis Data extracted. 

Survey Labour Force Survey (LFS)	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper Difficulty hearing – see APS	

Vision Impairment Upper Difficulty seeing – see APS	

Inclusion Decision Subsumed within Annual Population Survey (APS). 	

Analysis See APS

Survey Living In Wales (LIW) Survey 2007 and 2008	

Filter Questions: Do you or does anyone in your household have any long-term illness or disability or infirmity? By long-term illness, I mean anything that has troubled you or them over a period of time or that is likely to affect you or them over a period of time?	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper Nature of disability – hearing (yes/no)	

Vision Impairment Upper Nature of disability – vision (yes/no)	

Inclusion Decision Include. Interview with household reference person gives age and vision and hearing impairment for each person in household so effectively proxy responses obtained. 
	
Analysis Data provided for 2007 and 2008 by Huw Jones, National Surveys Branch, Welsh Assembly Government. NB asked to flag up that cells <5000 statistically unreliable

Survey Millenium Cohort Study (MCS)	

Filter Questions n/a	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper Has child ever had problems with hearing? (asked at age 5)	

Vision Impairment Upper Has child ever had problems with vision? (asked at age 5)	

Inclusion Decision Include	

Analysis Data extracted

Survey Scottish Health Survey (SHS) 2003	

Filter Questions Longstanding illness or disability	

Hearing Impairment Lower ICD	

Vision Impairment Lower ICD	

Hearing Impairment Upper ICD	

Vision Impairment Upper ICD	

Inclusion Decision Include. No use of proxy interviews for those aged 13 or over. 	

Analysis Data extracted. 

Survey Scottish Household Survey (SHoS) 2005-2006	

Filter Questions Could you tell me whether each of the people in the household has any longstanding illness, health problem or disability that limits your/their daily activity or the kind of work that you/they can do? 	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper List of conditions includes: Difficulty hearing (no mention of hearing aids).

Vision Impairment Upper Comparable to APS.	List of condition includes: Difficulty seeing (even when wearing glasses/lenses). Comparable to APS. 	

Inclusion Decision Reference person completes items on VI/HI for all household members so proxy interviews not an issue.	

Analysis Data extracted. 

Survey Welsh Health Survey (WHS) 2007 (2008 version has just been released) 	

Filter Questions 2 questions : main illness currently treated for; & main illness limits activity/work. Additional questions on vision/hearing	

Hearing Impairment Lower As per HSE but asks for MAIN illness (though variables to cover 4) - ICD	

Vision Impairment Lower As per HSE but asks for MAIN illness (though variables to cover 4) - ICD.

Hearing Impairment Upper  As per HSE but asks for MAIN illness (though variables to cover 4) - ICD

Vision Impairment Upper As per HSE but asks for MAIN illness (though variables to cover 4) - ICD	

Inclusion Decision Include. Many zero cells for ICD categories. Proxy interviews not conducted but respondents allowed some help with self-completion questionnaire. Asked to enter only one (main) LLSI. 	

Analysis 2007 data extracted. 

 
Appendix 2: National Surveys Excluded from the Analyses 

Survey British Crime Survey
	
Filter Questions n/a	

Hearing Impairment Lower n/a	

Vision Impairment Lower	n/a

Hearing Impairment Upper n/a	

Vision Impairment Upper	n/a

Inclusion decision No information on vision and hearing: excluded	

Analysis 	n/a

Survey British Household Panel Survey	

Filter Questions n/a	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper Difficulty hearing (note - no instructions regarding use of hearing aids)	

Vision Impairment Upper Difficulty seeing (other than needing glasses to read normal size print )	

Inclusion Decision Initially included. However, subsequently excluded as vision item would potentially include those with short sight corrected by glasses.	

Analysis Wave 17 data extracted Over 16s only (cross sectional analysis) but subsequently excluded. 

Survey Census 2001	

Filter Questions n/a	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper n/a	

Vision Impairment Upper n/a	

Inclusion Decision No information on type of longstanding illness or disability:excluded	

Analysis n/a

Survey Continuous Household Survey Northern Ireland	

Filter Questions Longstanding illness or disability	

Hearing Impairment Lower Cannot locate in SPSS database	

Vision Impairment Lower Cannot locate in SPSS database	

Hearing Impairment Upper Cannot locate in SPSS database	

Vision Impairment Upper Cannot locate in SPSS database	

Inclusion Decision Questionnaire appears to ask about type of longstanding illness but variable does not appear in SPSS dataset . Excluded.	

Analysis n/a

Survey Expenditure and Food 

Filter Questions n/a

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper n/a	

Vision Impairment Upper n/a	

Inclusion Decision No mention of health/disability as topic. Excluded.	

Analysis n/a

Survey ONS Omnibus Survey	

Filter Questions Longstanding illness or disability	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper n/a	

Vision Impairment Upper n/a	

Inclusion Decision Asks about longstanding illness or disability but does not ask to describe. Excluded.	

Analysis n/a

Survey PPRU Surveys of Disability 1989-1990 (Northern Ireland)

Filter Questions n/a	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper Difficulty hearing someone talking in quiet room. Great difficulty following conversation if background noise. 	

Vision Impairment Upper Difficulty recognising friend across road. Difficulty reading ordinary newspaper print. (Both even with glasses/contact lenses)	

Inclusion Decision Sample adults & children from private households & communal establishments. Excluded due to survey being too old.	

Analysis n/a

Survey Survey of Personal Incomes	

Filter Questions n/a	

Hearing Impairment Lower n/a	

Vision Impairment Lower n/a	

Hearing Impairment Upper No information on hearing impairment	

Vision Impairment Upper Information on blindness	

Inclusion Decision No information on hearing: excluded	

Analysis n/a

 
Appendix 3: Health Conditions Associated with Lower Limit Estimate

Hearing Impairment: lower limit estimate
	
Poor hearing/deafness

Conductive/nerve/noise induced deafness

Deaf mute/deaf and dumb

Heard of hearing, slightly deaf

Otosclerosis

Vision Impairment: lower limit estimate

Poor hearing after mastoid operation

Cataract/poor eye sight/blindness
Incl. operation for cataracts, now need glasses

Bad eyesight, restricted vision, partially sighted

Bad eyesight/nearly blind because of cataracts

Blind in one eye, loss of one eye

Blindness caused by diabetes

Blurred vision

Detached/scarred retina

Hardening of lens

Lens implants in both eyes

Short sighted, long sighted, myopia

Trouble with eyes, eyes not good

Tunnel vision