Trends in Employment by Dual Sensory Impairment Status

The Disability Statistics Annual Report, based on the American Community Survey, demonstrates that employment rates in 2016 among people with self-reported vision and hearing disabilities were 33.3% and 24.9% lower than people without disabilities in the United States, respectively.¹ While this report assessed employment rates by sensory impairment, by design, the American Community Survey only captures the most severe impairment and the report fails to present data on those with dual sensory impairment (DSI), defined as concurrent vision impairment (VI) and hearing impairment (HI), a group that may be more vulnerable to unemployment. With the aging of the US population, the number of people with DSI is expected to increase, magnifying the public health significance of this subset. However, to our knowledge, there is limited cross-disciplinary research examining how DSI affects health, functioning, and well-being and little rehabilitation focus to accommodate needs specific to these individuals. In this article, we compare employment rates by VI, HI, and DSI status using data from the National Health Interview Survey (NHIS) from the 2008 to 2017 cycles.

The institutional review board of the National Center for Health Statistics approved the protocols for the conduct of NHIS and interviewers obtained informed verbal consent from all participants. The NHIS data are publicly available and deidentified. Analyses were limited to respondents aged 18 to 75 years. Participants were categorized as employed or not employed in the previous week based on self-report. Unemployed participants not looking for work were further categorized as retired, disabled, laid off, or busy with family/school. Self-reported VI was defined as difficulty seeing despite wearing eyeglasses/contact lenses. Self-reported HI was defined as difficulty hearing without using hearing aids.² Sensory impairment was coded: no sensory impairment, VI only, HI only, and DSI. Multivariable survey logistic regression models were used to examine the associations between sensory impairment and employment. All P values were 2-tailed, and statistical significance was set at P < .01. All analyses were conducted using Stata, version 15 (StataCorp).

Of the 277 251 adults included in this analysis (Table), the DSI group had the lowest rates of employment for each year (Figure). In the regression analysis adjusted for age, year, sex, race/ethnicity, education, diabetes, and general health, VI only (odds ratio [OR], 0.81; 99% CI, 0.77-0.86), HI only (OR, 0.82; 99% CI, 0.78-0.85), and DSI (OR, 0.61; 99% CI, 0.56-0.67) groups had lower odds of employment than the group with no sensory impairment. Inferences were unchanged in sensitivity analyses restricted to participants younger than 65 years.

American adults with any sensory impairment were less likely to report employment compared with those without sensory impairment. Adults with DSI were especially vulnerable. This corroborates evidence from previous studies that have shown lower employment rates among those with sensory impairments,^1,3 possibly because they face greater difficulties entering or remaining in the workforce. Individuals with DSI may be especially susceptible given an inability to rely on sensory substitution to overcome impairment.

Prior research has also shown that there is a marked association between health and productivity, and individuals not employed have worse mental and physical health and are less socially integrated.⁴ To our knowledge, this is the first description of DSI and employment in a nationally representative population and highlights the need for understanding barriers for employment in people with DSI, focusing on strategies for engaging them, and addressing their specific needs in the workforce.

While the sensory impairment data analyzed may be subject to self-reporting biases, it remains valuable in capturing individuals’ perspectives on their disability and function. The self-reported sensory impairment questions mirror those in national disability reports¹ and are informed by established biopsychosocial models of disability (rather than the medical model) that take into account features of the person and the overall context in which the person lives.⁵ Nevertheless, future studies should also examine the association of objective measures of vision and hearing with employment. Further research examining improved access to eyeglasses, use of low-vision rehabilitation, use of hearing aids, and integration of vision and hearing interventions may affect employment rates in individuals with sensory impairments. These results lend support for the US Americans with Disabilities Act and better inclusion of adults with sensory impairment in the workforce.⁶

Corresponding Author: Bonnielin K. Swenor, PhD, Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Wilmer 116, Baltimore, MD 21287 (bswenor@jhmi.edu).

Published Online: December 5, 2019. doi:10.1001/jamaophthalmol.2019.4955

Author Contributions: Dr Varadaraj had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Varadaraj, Swenor.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Varadaraj, Wang, Swenor.

Critical revision of the manuscript for important intellectual content: Reed, Deal, Lin, Swenor.

Statistical analysis: Varadaraj, Wang, Swenor.

Administrative, technical, or material support: Lin, Swenor.

Supervision: Swenor.

Conflict of Interest Disclosures: Dr Reed reported being a member of the scientific advisory board for SHOEBOX, Inc. Dr Lin reported personal fees from Boehringer Ingelheim, Amplicon, and Caption Call and nonfinancial support from Cochlear Ltd outside the submitted work. Dr Varadaraj directs a research center at the Johns Hopkins Bloomberg School of Public Health that is funded in part by a philanthropic gift from Cochlear Ltd. No other disclosures were reported.

Funding/Support: This work was supported by the National Institutes of Health/ National Institute on Aging (grant K01AG052640; Dr Swenor and grant K01AG054693; Dr Deal).

Role of the Funder/Sponsor: The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.