How do disability rates differ across the island of Ireland?

Ageing populations and the resulting pressures on health and social care systems as well as social security systems are causing disability prevalence to be an increasingly salient issue in Northern Ireland (NI) and Ireland, as well as in many other developed societies. A greater understanding of disability prevalence is therefore important as policies in a number of relevant areas adapt to this changing landscape. 

The censuses in NI and Ireland and the subsequent individual level data which are available allow for side-by-side case studies of a range of economic and social issues, including disability. While this contributes to understanding of policy-relevant issues on an all-island basis, differences remain and they are not perfectly comparable. While the census questions differ between jurisdictions, the data support meaningful side-by-side comparisons and the results are interpreted with appropriate caution. 

This is the first work to examine disability rates across the island of Ireland. Disability prevalence, as measured by self-reported disability from the respective censuses amongst those aged 20–69 years, is broadly similar across Ireland and Northern Ireland, with rates of 23 per cent in Northern Ireland and 22 per cent in Ireland. 

However, severity differs. Northern Ireland has a higher proportion of individuals with severe limitations, with 10.9 per cent of individuals reporting they are ‘limited a lot’ compared to 6.2 per cent in Ireland who report being limited ‘to a great extent’. This suggests that while the headline rates appear similar, the intensity of disability is higher in Northern Ireland.

In NI, disability rates rise steadily with age. However, in Ireland, the pattern is less linear. Disability rates are higher in Ireland at younger age groups while at older age groups, it is much higher in NI. Severe disability follows a similar trend, with NI showing much higher rates among older age groups.

There is a clear relationship between disability prevalence and educational attainment, with disability rates higher amongst those with lower levels of education. And there is a steeper relationship between educational attainment and disability in NI than there is in Ireland. This suggests that education has a strong protective effect in terms of disability. However, we do not prove causality in the analysis.

Higher rates of disability are evident in the North West of the island as well as in parts of the main cities (e.g. parts of Belfast and parts of Dublin) as well as in a column down the middle of Ireland and the South East. It is likely that these rates of disability are highly correlated with higher rates of deprivation as well as local age profiles. 

There is not a consistent border pattern, i.e. we do not see lower or higher levels around the border. However, we can see that areas with lower rates in Ireland are mirrored in the NI county/council area which they meet. More specifically, higher rates are seen in Donegal and Derry and Strabane, while lower rates are seen in Monaghan and Armagh, Banbridge and Craigavon. 

Using probit models to examine the factors associated with reporting a disability, differences in observable characteristics – such as age, gender, geographic location – tend to account for a much larger share of the variation in disability rates in NI compared to Ireland and this is particularly the case for severe disability. This indicates that unmeasured factors contribute more to the observed prevalence of disability in Ireland relative to NI.

While having a third-level qualification is correlated with a lower level of being disabled in Ireland by 7 percentage points, for NI the reduction is 15 percentage points. On the other hand, whilst the probability of disability rises with age in both areas, the impacts of age on disability is much larger in NI. For example, being aged 60–69 relative to those aged 20–29 raises the likelihood of disability in NI by 38 percentage points compared to 16 percentage points in Ireland. 

Those who are unpaid carers in Ireland are 7 percentage points more likely than those who do not have unpaid caring roles to report as disabled, while this figure is 1 percentage point for NI. This is important as caring is becoming more prevalent in both jurisdictions. In both areas, those identifying as Black, Asian or other mixed ethnicities have lower levels of disability all else being equal, as does being Catholic.

Local labour market conditions exert some influence, but the marginal effects of these variables are relatively small in both regions. This is considerably different to what is found in the international literature on disability but is in line with previous findings for Northern Ireland (Devlin et al., 2023). What is interesting is that this holds in both jurisdictions despite very different health and social care systems, North and South.

In our country-specific econometric modelling, within the NI model, physical 
and mobility conditions are the strongest predictors of severe disability; mobility conditions requiring wheelchair use raises the likelihood of reporting a severe disability in NI by 21 percentage points, while mobility conditions not requiring a wheelchair raises the probability of severe disability by 16 percentage points. In contrast, having conditions that limit physical activity increases the likelihood of severe disability in Ireland by 7 percentage points.

Reporting psychological, emotional or mental health conditions is strongly associated with reporting a severe health condition in NI and Ireland. More specifically, those with psychological, emotional or mental health conditions are 7 and 10 percentage points more likely respectively to report a severe disability. Having an intellectual disability increases the likelihood of a severe disability by 8 percentage points in NI and 7 percentage points in Ireland. 

A range of policy implications arise from the insights in this study. The steeper age gradient in terms of disability in NI may be further evidence of a legacy effect from the NI conflict. Further research could examine whether this spills over in to Ireland. While the data is more comparable than was previously the case, it is not perfectly so and significant differences remain in how disability is captured. Improving data comparability on disability and in health more broadly across the island would greatly support research and information in this important area. More specifically, identical questions and aligned timing of the relevant censuses would be a helpful addition in terms of the data available for studies of disability as well as other important outcomes which shape people’s lives.

The findings underscore the importance of tailoring disability-related social security and health interventions to local contexts, particularly in regions where historical and structural factors shape outcomes.