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Social Security in Review

Program Operations

ONTHLY benefits being paid under the old-age and sur- vivors insurance program at

the end of April totaled $224.3 mil- lion. About 5.4 million persons were receiving these benefits—95,900 more than at the end of March. The in- creases in the number of old-age and wife’s benefits were smaller than those in March, while for all types of survivor monthly benefits they were larger. The over-all increase was slightly smaller than that in March.

Since September 1952 there has been a continuous rise in the amount of the average old-age benefit. The April increase of 15 cents brought the average payment up to $50.11. For all other types of benefits except mother’s benefits, the average amounts have shown a similar upward trend since September 1952. The increases in the 7-month period since September 1952 range from $1.32 for old-age benefits (from $48.79 to $50.11) to six cents for aged widow’s benefits (from $40.65 to $40.71). The increases are due chiefly to the progressively rising pro- portion of beneficiaries whose benefits were computed under the new-start formula. This computation method uses only earnings after 1950 and, on the whole, produces higher benefits than those obtained by using earnings after 1936 and the conversion table.

The average for mother’s benefits decreased for several months follow- ing the enactment of the 1952 amend- ments. This decline was due to the transfer to current-payment status, with a small benefit amount payable, of mother’s benefits that had previ-

ously been completely suspended be- cause the mother was working for wages in excess of the exempt amount. Since January 1953, however, the average mother’s benefit has in- creased each month.

Monthly benefits were awarded to 134,700 persons in April, slightly fewer than in March but 85 percent more than the number awarded a year earlier. Lump-sum death pay- ments totaling $8.0 million were awarded in April to 49,700 persons, more than in any other month since the beginning of the program.

PUBLIC ASSISTANCE PAYMENTS and the number of persons aided by these programs declined during April. Ex- penditures for public assistance to- taled $201 million—a net decrease from March of $1 million.

The declines in the number of re- cipients were concentrated in the pro- grams of old-age assistance, aid to dependent children, and general as- sistance. Continuing the downward trend that began in October 1950, the number of persons receiving old- age assistance dropped 6,400 or 0.2 percent. The number of families re- ceiving aid to dependent children, which had increased somewhat dur- ing the winter months, showed a small decline (2,200 families, or 0.4 per- cent). Following a seasonal increase during December and January in the general assistance caseload, the num- ber of cases receiving this type of assistance has dropped for three con- secutive months, and in April there were 8,000 fewer cases on the rolls than in the previous month. The pro- gram for aid to the permanently and

totally disabled in April added 2,600 persons—a rise about equal to the average monthly increase over the past 12 months.

The average payments for the Na- tion changed little from March to April in the four special types of as- sistance. Differences among the States in the amount of change in average payments were generally small, but there were some excep- tions. Arizona reported the largest increases for three programs—old-age assistance ($1.55), aid to dependent children ($4.08), and aid to the blind ($3.31). These increases occurred when the State began meeting 100 percent of the needs of certain In- dians living on reservations.

Utah had sizable increases in aver- age payments in old-age assistance, aid to the blind, and aid to the per- manently and totally disabled—the result of a change in the maximums from $63 to $68 for one-person cases. Payments to families receiving aid to dependent children were not affected, since the increased maximum applied only to one-person cases.

In Illinois a reduction in the food allowance—based on a February price survey—was made in 75 counties. In addition, in order to conserve limited funds for old-age assistance and aid to dependent children, special allow- ances for clothing in time of emer- gency and for moving expenses, stor- age of furniture, and other items of a temporary nature were not given without approval by the State’s fleld staff.

In the State of Washington, aver- age payments decreased more than $2.00 in old-age assistance and about

$1.50 in aid to the blind and aid to the permanently and totally disabled when responsibility for the costs of medical and nursing care of aged, blind, and disabled persons in nurs- ing homes was assigned to the State public health agency. The assistance agency continues to have responsi- bility for meeting the cost of board and room for such recipients.

INITIAL CLAIMS FILED in April for bene- fits under the State unemployment imsurance programs increased moder- ately (6.2 percent) to 835,300, mainly because of administrative factors. With the beginning of a new uniform benefit year in five States and the availability of a new quarter’s wage credits for benefit purposes in most of the other States, many workers filed claims who had earlier ex- hausted their benefit rights or whose wage credits had been insufficient to entitle them to benefits. Seasonal factors were most important in the continuance of the downward trend in the number of weeks of unemploy- ment claimed, which represent con- tinuing unemployment; with a de- cline of 4.9 percent, the total dropped to 4.3 million.

The number of claimants receiving benefits in an average week declined again in April. The total of 840,400 was 9.6 percent less than the number in March, as all but five States reported fewer beneficiaries. The amount of benefits paid to unem- ployed workers declined 10.1 percent to about $83.0 million. For the first time since January the average week- ly check received by beneficiaries for total unemployment rose slightly, to $23.27.

FEDERAL CREDIT UNION membership and assets showed greater gains in 1952 than in any other year since the passage of the Federal Credit Union Act in 1934. Undoubtedly the most important factor in this growth was the Nation’s general economic con- dition; national income and total per- sonal income were the highest on record, and there was little unemploy- ment. More widespread interest in the credit union movement and knowledge of its nature and purpose

(Continued on page 25)

Selected current statistics

(Corrected to June 2, 1953) _ - | Calendar year arch April a ee item 1053 1053 | | thee 1952 1951 Labor Force | (in thousands)

ET Sree 62, 810 63, 134 | 61. 744 62, 966 2, B84 Siibnennababnennneoeingudinds 61, 228 61, 460 | 60. 132 61, 293 61, 005 Covered by old-age and survivors insur- | :

| MG eee Pe Se 45, 900 44, 800 Covered by State unemployment insur- eae emedebhichweandenabthmndanetsaatet 37, 300 37, 200 | 35. 35, 717 4, Sia ERT Te aE 1, 582 167 e714 1, 673 1, 879 Personal Income ¢ (in billions; seasonally adjusted at annual rates)

CO a $283.1 | $282.8 | 22.5 $268.4 | $254.1 Employees’ income ¢_-..................-- 195.3 | 194.3 | a | 181.9 170.1 Proprietors’ and rental income_._..-_____- 52.2 | 53.0 51.2 | 52.5 50.6 Personal interest income and dividends.__. 21.8 21.7 | 21.5 21.1 | 20.4 TT SN a 2.5 2.5 | 23 2.4 2.3 Social insurance and related payments *- _- 8.9 8.8 7.7) 7.9 7.0 Veterans’ subsistence allowances*® and |

at Ee. ES | 5 8 7 1.2

Miscellaneous income payments '______. 2.2 2.3 22 2.2 | 2.5 Old-Age and Survivors Insurance Monthly benefits: yment status: !!

Number (in thousands). - - - . 5, 401 5, 305 | 4, 549 nal

t (in Dy ahiac mena =e $219,585 | $160,445 | $2,228,969 | $1, 884, Sal

age se 1 | $49.9 RASS ee Awards (in thousands) _— $9.65 | EPS nae 135 138 73 1, 053 1, 3% es Se tic $6, 118 $6, 449 $2, 310 $42, 750 $42, 2 Unemployment Insurance *

Initial claims (in thousands) ................

Weeks of unemployment claimed (in thou- 835 787 1. 037 11,174 10, 8% SESS RTT, SEE eee | 4. 332 4, 555 5, 150 54,311 50, 3%

Weeks compensated (in thousands)... .--_. 3, 698 4, 001 4, 368 45, 777 41,

Weekly averege beneficiaries (in thousands). | S40 930 993 874 nu

Benefits paid (in millions) ............_... $3 $92 | $94 Sys $4)

Aperage weekly payment for total unemploy-

NE A eae $23.27 £23.24 | £22.87 £22.79 $21.08 Public Assistance Recipients (in thousands): Old-age assis patie bhibthiginecoiddace 2, 604 2,611 | 2, 672 |.--- Aid to dependent children: patitiibeddiseese paddhebcsticneiens 572 574 | 598 a nasal iEilae clititatiic 1, 513 1, 517 1, 546 |--... CS ES Ee as as 97 Aid tothe permanently and totally disabled _| 170 168 EE EEE General assistance.___..__.._. iniidiiiaieisiniatiasie 275 283 320 Average payments: | | CE £48.85 £48.86 | £44.95 Aid to dependent children (per family) _..... | 82.44 82.34 | SEL bo ccoceccucl=onoenn Aid to the blind. ___. Se ae | 53.74 | 53.71 49.83 Aid to the permanently and totally disabled _ - 48.36 48.59 46.11 Rie ts TEI 48.29 | 49.26 47.28

1 Continental United States only. Estimated by the Bureau of the Census, except as noted. Monthly employment figures represent specific week and an- nual figures, average week (unem ens insurance data re nt pay a ins week),

3 ted by the Bureau of Old-Age and Sur- vivors Insurance; excludes joint coverage under the railroad retirement and old-age and survivors insur- once ~ . Data for 1953 and April 1952 not a

3 Data from the Bureau of Employment Security, De ment of Labor. from the Office of Business Economics, Department of Commerce. Continental United States, except for employees’ income, which includes pay of Federal civilian and military personnel in all

areas. § Beginning January 1952, social insurance contri- butions from the self-employed excluded from total but not deducted from proprietors’ income. * Civilian and mili in cash in kind,

ts of enlisted . Excludes em Sotrtatons under sal insurance and ated grams

7 Payments to recipients under the 4 special public assistance programs and general assistance.

* Includes old-age and survivors insurance benefits; railroad, Federal, State, and local retirement benefits; veterans’ nsions and compensation; workmen's compensation; State and railroad unemployment insurance and temporary disability benefits; unemployment allowances to veterans under the Servicemen’s Readjustment Act and the Veterans’ Readjustment Assistance Act.

* Under the Servicemen’s Readjustment Act and under the Veterans’ Readjustment Assistance Act.

Includes payments under the Government life insurance, national service life insurance, and mili- tary and naval insurance programs, the Government contribution to nonprofit organizations, busines transfer payments, and recoveries under the Em ployer’s Liability Act for raflroad workers and

seamen. 1! Benefit in current-payment status is subject @ no deduction or only to deduction of fixed amount that than the current month’s calendar year figures represent payments cert 3 13 Monthly amounts, gross; annual amounts justed for voided benefit checks and benefit refunds.

Social Security







Aid to the Permanently and Totally Disabled: Recipients With Heart Disease

In mid-1951 the Bureau of Public Assistance, in cooperation with State public assistance agencies, made a survey to obtain information on the social and medical characteristics of the men and women receiving aid to the permanently and totally dis- abled. The foilowing article analyzes the findings with respect to recipients with a disease of the heart; it is the first of several

articles based on the study.

totally disabled persons receiy- ing aid in the early summer of 1951, diseases of the heart were found

. MONG needy permanently and

| more frequently than any other group

of diseases or impairments. One- fourth of the recipients of this type of aid had a disease of the heart re- ported as the sole or major impair- ment resulting in permanent and total disability. Because of the wide- spread interest in heart disease and because of its prevalence in this group of recipients of public assistance, the article is focused on the character- istics of only those recipients for whom a disease of the heart was found to constitute the major im- pairment.

The Federal-State program of aid

| to the permanently and totally dis-

abled was inaugurated in October 1950, under the 1950 amendments to the Social Security Act. Previously, there had been relatively little expe- rience with programs limited to per- sons whose disabilities were both total and permanent. A Statewide program for such persons had operated for a humber of years in Wisconsin, and a few counties or cities in other States had similar programs. In some States the general assistance programs were 80 limited in scope that eligibility for aid was virtually synonymous with permanent and total disability. A few of these programs were, in fact, designated as aid for handicapped or disabled persons.

There were in many States, among the recipients of general assistance, sizable numbers of persons who were

* Division of Program Statistics and Analysis, Bureau of Public Assistance.

Bulletin, July 1953

severely disabled; there were also in- capacitated parents in families re- ceiving aid to dependent children whose disabilities were permanent and total and whose needs were not met by the payments under that pro- gram. As States developed programs of aid to the permanently and totally disabled, persons who had been re- ceiving general assistance or aid to dependent children and who met eli- gibility requirements for the new pro- gram were transferred to it. Such persons comprised a large part of all recipients under this program during its early months of operation. Dis- abled recipients who were in receipt of aid to the needy blind and the dis- abled aged who were receiving old-age assistance were not usually trans- ferred to the new program.

Method of Study

From the beginning of the program it was planned to collect data on the social and medical characteristics of recipients of aid. Under the State plans for aid to the permanently and totally disabled, the determination that a disability of permanent and total character did or did not exist had to be made by a physician and a trained social worker acting on be- half of the State agency.! This pro- cedure ensured that there were care- fully recorded and evaluated medical as well as social data for each re- cipient of aid.

By early 1951 it was apparent that the collection of data on the charac- teristics of recipients could be ac- complished better by a sample study

1In a few States that accepted only persons who were completely helpless, medical certification alone was used.

by Cuartes E. Hawkins *

of a cross section of recipients in a given month than by data obtained as the recipients were added to the rolls. Accordingly, a study was under- taken,? with each State that had a program in operation choosing either May or June 1951 as the month in which a representative sample of re- cipients would be studied. Thirty States had programs in operation at the time of the study, and the total number of recipients was between 90,000 and 100,000.

The sample represented a different proportion of the caseload in the various States; the State proportion was determined by the relationship of the number of recipients in the State to the number needed in the sample to provide reasonably valid detail on the characteristics of the recipients. In 17 States the number of recipients was large enough to pro- vide a sample that warranted tabula- tion. In the other 13 States this was not the case, and the small numbers of recipients scheduled appear only in the national totals. The recipients in the samples in the 30 States totaled 13,200, representing 93,359 recipients. Two States, Michigan and Wisconsin, chose to include all their recipients. In each of the other 28 States the number of recipients included in the sample was inflated to represent the total number of recipients in the State before national totals were prepared.

Obviously, the prevalence of a dis- ease among recipients of aid to the permanently and totally disabled is not of necessity closely related to the prevalence of the same disease or condition among the general popula- tion. By the nature of the assistance program, recipients of aid must be in need and must have a permanent im- pairment that substantially precludes them from engaging in any useful occupation. Thus the recipients with

2See Characteristics of Recipients of Aid to the Permanently and Totally Dis- abled, Mid-1951 (Public Assistance Re- port No. 22), April 1953.

whom this article is concerned had a disease of the heart that resulted in severe disability, had insufficient re- sources to support themselves, and had no one on whom they could de- pend for support. These qualifications are certainly not applicable to all persons in the population with heart disease, and their application may r¢- sult in quite different distributions of age, sex, and diagnosis from what would be obtained from a random sample of all persons who have heart disease.


Heart disease was the major im- pairment of 2,946 recipients in the State samples, representing 23,809 or 25.5 percent of all recipients of aid to the permanently and totally disabled. The total excludes more than 5,200 recipients for whom a diagnosis of heart disease was reported as a sec- ondary impairment but not as the major impairment. It also excludes diseases of the vascular and nervous systems, frequently associated with heart disease, where there was no diagnosed disease of the heart itself.

In this latter group were hyperten- sion without mention of heart in- volvement, which was the major im- pairment for 3.8 percent of all recipients; general arteriosclerosis, which was the major impairment for 1.0 percent; and cerebral paraly- sis, which was the major impairment for 6.6 percent and which probably resulted in most instances from vas- cular accidents. If these impairments were considered in conjunction with

diseases of the heart, the combined total would represent 37 percent of the major impairments of recipients as compared with the 25.5 percent accounted for by diseases of the heart alone.

The study findings provide no data regarding recipients with heart dis- ease of syphilitic origin except the negative information that their num- ber is relatively small. When a syphi- litic etiology was established or pre- sumed, the impairment was classified as a late effect of syphilis rather than as a separate disease or condition. The total number of recipients with syphilis and its sequelae was not large enough to warrant further analysis, and the recipients with syphilitic heart disease as their major impair- ment are accordingly excluded from this analysis.

Thyrotoxic heart disease and con- genital heart disease are also excluded because neither of these conditions was reported in a significant number of cases.

Classification.—In classifying the medical diagnoses reported in the study, the International Statistical Classification of Diseases, Injuries, and Causes of Death, 1948 was used. Persons coding the diagnoses were trained under a program that had been worked out with the Morbidity and Health Statistics Branch, Divi- sion of Public Health Methods, of the Public Health Service. Diseases of the heart, as described here, refer to codes 400-443 of the international list. For purposes of presentation and to secure groups sufficiently large

Chart 1.—Median number of years since onset of diseases of the heart among recipients of aid to the permanently and totally disabled, by type of disease,









to permit analysis, these codes hay been combined into five broad classe. These classes are designated g chronic rheumatic heart disea» (codes 400-416), arteriosclerotic hear; disease (code 420), chronic endocar. ditis and other myocardial degenerg. tion (codes 421 and 422), hypertep. sion with heart disease (codes 44. 443), and the remaining codes (439. 434) grouped in a class designated a “other” diseases of the heart.

Of these five classes, hypertensiog with heart disease was the largest, accounting for almost half (49.3 per. cent) of all recipients who had any disease of the heart as their majo impairment. Most of them (41.3 per. cent of all recipients with heart dis. ease) were classified under hyperten.- sion (unspecified type) with hear disease, while 4.1 percent had hyper. tensive heart disease with arteriolar nephrosclerosis, and 3.9 percent had hypertension (specified type) with heart disease.

The second largest class was ar. teriosclerotic heart disease, which in- cluded 27.3 percent of all recipient with heart disease. Third in numeri- cal importance was chronic rheumatic heart disease, which accounted fo the major impairment of 8.8 percent of the group. In this class, only tw types of heart disease occurred fre- quently—diseases of the mitral valve, and chronic rheumatic heart diseas of unspecified type. These classes in- cluded 4.0 and 3.4 percent, respective ly, of the recipients with any type of heart disease as 2 major impairment.

The class including chronic endo carditis and other myocardial de generation ranked fourth and at counted for 8.1 percent of the total with 2.1 percent originally classified as chronic endocarditis (not specified as rheumatic) and 6.0 percent # other myocardial degeneration. The fifth class, designated as other dis eases of the heart, represented 65 percent of the group and consisted primarily of such conditions as con- gestive heart failure, cardiac asthma, and cardiac decompensation.

Most of the recipients with hear disease as a major impairment al» had other diagnosed impairment Nearly two-thirds of the group haé at least one other impairment. Whik these diseases and impairments weft

Social Securit






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proadly distributed among practically all possible classifications, the most frequent was arthritis, which was reported as the secondary impair- ment for 13.1 percent of the group.

Duration of disease—The length of time since the onset of the impair- ment was established for 83.6 percent of the recipients with a disease of the heart. It is probable that the group for whom the impairment’s duration could not be determined would in- crease the number of recipients in the longer time intervals and would increase the median time elapsed since the onset of the disease. The impairment had begun within the year for only 3.4 percent of the re- cipients. For the largest group, 30.0 percent, the impairment had started 2, 3, or 4 years previously; for 22.0 percent it had lasted 10 or more years.

The median length of time since onset varied for different diseases of the heart (chart 1). The per- centage of recipients who had had a disease of the heart for 10 years or longer varied with the different types of the disease. Of those with chronic rheumatic heart disease, 37.0 percent were in the “10 or more years”’ classi- fication; for the other four types of heart disease the percentages ranged from 17.0 to 22.2.

Mobility of recipients.—Of the re- cipients with diseases of the heart, 13.8 percent were confined to their homes or other places of abode (table 1); 21 percent of all recipients of aid to the permanently and totally dis- abled were similarly handicapped. Recipients with chronic rheumatic heart disease were confined to their homes most often, and those with hypertensive heart disease least often.

The recipients capable of activity outside their own homes accounted for 86.2 percent of the total with heart disease as their major impair- ment. This group included some who heeded the help of another person and others who used a cane, crutch, or other device in order to get about. More than three-fourths required no help in activities outside their homes. A larger percentage of the recipients with hypertensive heart disease than of those with other types of heart disease were able to engage in activity outside their homes, but proportion- ately more of them required the serv-

Bulletin, July 1953

Chart 2.—Age distribution of recipients of aid to the permanently and totally disabled with diseases of the heart, by diagnosis, mid-1951


20 40 60 80 10c








oc i...

ices of another person or used a de- vice in moving about.

Services in connection with the es- sential activities of daily living were required by 14.0 percent of the recip- ients with heart disease. Such serv- ices included help in eating, dressing, getting about, and maintaining bodily hygiene and in activities affecting personal safety. Recipients with dif- ferent diseases of the heart needed services in about the same propor- tions. While the percentage of re- cipients with hypertensive heart dis- ease who needed no service was slightly larger than that of recipients with any other type of heart disease, services in activities affecting per- sonal safety were needed somewhat more frequently by the recipients with hypertensive heart disease.

Age of recipients.—Almost 71 per- cent of the recipients with a disease of the heart were aged 55 or over. Most of them were in the age bracket 55-64; 26.9 percent were aged 35-54, and 2.4 percent were aged 18-34. To be eligible for aid to the permanently and totally disabled, recipients must be at least age 18; very few persons receiving this type of aid are aged 65 or over because most older persons qualify for old-age assistance.

Slightly more than half the re- cipients with heart disease who were aged 55 and over were classified as having hypertensive heart disease, and almost one-third had arterio- sclerotic heart disease. Somewhat less than half of those aged 35-54 had

wij 35-54

BE 55 ao oven

hypertensive heart disease, fewer than a fourth had arteriosclerotic heart disease, and almost one-sixth had chronic rheumatic heart disease. Of the group under age 35, about two- thirds had chronic rheumatic heart disease. The age distribution of re- cipients with chronic rheumatic heart disease differed markedly from the distributions for recipients with other types of heart disease (chart 2). The frequency of chronic rheumatic heart disease among recipients under age 35, coupled with the substantial per- centage (37) of the recipients with this disease who had been disabled for 10 or more years, strongly sug- gests that in many instances the present recipients are persons who developed the disease in childhood.

Sexr.—Among all recipients of aid to the permanently and totally dis- abled, the numbers of men and women were almost equal. Of those with a disease of the heart as their major impairment, however, men ac- counted for 43.3 percent and women for 56.7 percent.

The proportions differed substan- tially with the types of heart disease. For three groups—those with arterio- sclerotic heart disease, other diseases

3 The National Health Survey in 1935-36 also found higher morbidity rates among women than among men from both heart disease and hypertension. See Selwyn D. Collins, “Iliness from Heart and Other Cardiovascular-renal Diseases in General Morbidity Surveys of Families,” Public Health Reports, Reprint No. 2978, p. 21.

Table 1.—Mobility of recipients o 7% with d

aid to the permanently and totally disabled

of the heart } Confined to home | Capable of activity outside home ; Disease of the heart | Total rary we Wen SePe | oe, Total hair | Other | Total out ridden | fast Another! A help | person device Total. 100.0}. 13.8]. 3.5| 2.3 | 8.0| 86.2) 54] 31) 77.7 Chronic rheumatic heart ee cae snl 100.0| 20.8 6.2 82) 11.3] 79.2) 4.2 2.4 72.7 heart disease_.| 100.0 14.7 3.1 2.0 9.6 85.3 5.7 2.4 77.2 Chronic endocarditis and other m era- eaten « a 100.0} 15.9 4.8 3.7 7.3) 84.1 3.3 2.4 78.4 Hypertensive heart disease...| 100.0} 11.4] 2.4| 2.2 6.8 | 88.6} 5.0) 3.9] 78.8 Other diseases of the heart....| 100.0) 17.0 8.1 1.5 7.4) 83.0 4.3 2.0 76.8 |

of the heart, and endocarditis and other myocardial degeneration—men outnumbered women about 5 to 4. For those in the other two classifica- tions—chronic rheumatic heart dis- ease and hypertensive heart disease —women outnumbered men. The dif- ference was particularly marked in the latter classification, where the ratio of women to men was more than 2 to 1. Age differences between the men and women were not striking. Slightly higher proportions of men than of women were found in the ages under 35 and 55 or over, and a larger percentage of women than of men were in the ages 35-54. Race.—Nonwhite recipients of aid to the permanently and totally dis- abled were found proportionately more often than white recipients in the groups with a disease of the heart as their major impairment.* About 3 out of 10 of all recipients were non- white; 4 out of 10 of those with .a disease of the heart were nonwhite. The heavier representation of non- white recipients occurs chiefly in the hypertensive heart disease category, where they account for more than half the total, and to a lesser extent in the group with chronic endocar- ditis or other myocardial degenera- tion, where they accounted for more than one-third of the total. Non- white recipients were underrepre- sented in the other three heart dis-

+The age-adjusted death rate from all forms of heart disease is higher for non- white than for white persons. See Mary- land Y. Pennell and Josephine L. Leh- mann, “Mortality From Heart Disease Among Negroes as Compared With White Persons,” Public Health Reports, Reprint No. 3064, p. 1.

ease categories, accounting for only one-fourth of the recipients with chronic rheumatic heart disease, one- fourth of those with arteriosclerotic heart disease, and less than one- fourth of those with other diseases of the heart.

Nonwhite recipients with heart disease were found in smaller propor- tions than white recipients in the ages under 35 and at ages 55 and over. On the other hand, almost twice as many of the nonwhite re- cipients as of the white recipients were found in the age bracket 35-54. The extent to which the greater fre- quency of nonwhite recipients in this age group is influenced by the some- what lower life expectancy of the nonwhite population is not known.

Employment history. Recipients with diseases of the heart as their major impairment had worked in regular paid employment in some- what larger proportions than had all recipients. This finding is consistent with the concentration of these re- cipients in the higher age brackets and with the overrepresentation of nonwhite recipients, since larger pro- portions of both older recipients and nonwhite recipients were found to have had employment. It is not en- tirely consistent, however, with the larger percentage of women than of men among the recipients with heart disease because among all recipients relatively fewer women were found to have had employment.

Whatever the reason may be, re- cipients with heart disease consti- tuted 25.5 percent of all recipients of aid but made up 29.0 percent of the recipients with a history of paid em- ployment. When corresponding per-

centages are compared for each of the five types of heart disease, it js apparent that recipients with hear disease, regardless of type, had his. tories of paid employment somewhat more frequently than recipients with other disabilities.

State variations——The proportion of recipients of aid to the perma. nently and totally disabled with heart disease varied widely among the States, accounting for the major im. pairments of 36.7 percent of all re. cipients in Louisiana but for only 44 percent of those in Michigan and 34 percent in Wisconsin. State differ. ences result primarily from differ. ences in their definitions of perma. nent and total disability and are only secondarily affected by differences ip the prevalence of heart disease in the States.

The two States that had small per- centages of recipients with heart dis. ease as a major impairment had small programs, and both were States in which most of these recipients were confined to their homes. I each there was only a small propor- tion of recipients of aid to the per- manently and totally disabled who were capable of activity outside thei own homes. Since for all States most recipients with heart disease wer able to get around outside their homes, it is not surprising that the number of such recipients in thes two States is relatively small. Th States that had high percentages of recipients with heart disease as thei major impairment were generally States that had adopted relatively broad definitions of total disability and had somewhat larger propor tions of the total population receiy- ing aid. In the 30 States operating programs, 25.5 percent of the recip- ients had heart disease. Of the !! States with enough recipients to war- rant an examination of detail, five had more than the average percent age of recipients with heart disease. Louisiana, New York, and Pennsyi- vania were among these five; together they had more than half of all th recipients of aid to the permanently and totally disabled in the Nation @ the time the study was made. Ther were, in addition to Wisconsin and Michigan, 10 States in which th proportions were below the national

Social Security


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average; in these 10, the range was 15-24 percent.


Data from the sample study of re- cipients of aid to the permanently and totally disabled show that for all States combined some form of heart disease is the most frequent major impairment and is the most impor- tant element in the disability of about one-fourth of all recipients. Among the States the percentage of recipients with a disease of the heart yaries widely—from 3.4 percent to 96.7 percent. Of all diseases of the heart, hypertensive heart disease was the most frequently reported, ac-

counting for about half the total. Arteriosclerotic heart disease ranked second and was the major impair- ment of more than one-fourth of the recipients with heart disease.

Recipients with heart disease as a major impairment usually had other diagnosed impairments. The median length of time since the onset of heart disease was 5.1 years. Only 14 percent of the recipients were con- fined to their homes. A similar per- centage needed help in one or more essential activities of daily living, such as eating or dressing.

About 70 percent of the group were aged 55 or over; most of them were between the ages of 55 and 64. Recip-

ients with chronic rheumatic heart disease, however, tended to be younger than the recipients with other types of the disease.

Heart disease was more common among women than among men re- ceiving aid to the permanently and totally disabled, and more common among nonwhite than among white recipients. More of the recipients with heart disease than of those with other disabilities had a history of employment. In comparison with all other recipients, those with heart dis- ease were generally older, less severely limited in their daily activities, and included larger percentages of women and of nonwhite recipients.

Recent Publications

Social Security Administration

BUREAU OF PUBLIC ASSISTANCE. Char- acteristics of Recipients of Aid to the Permanently and Totally Dis- abled, Mid-1951. ‘Public Assist- ance Report No. 22.) Washington: The Bureau, Apr. 1953. 99 pp. Processed.

Findings from a study of the social and medical characteristics of recip- ients of aid to the permanently and totally disabled. Limited free distri- bution; apply to the Bureau of Public Assistance, Social Security Adminis- tration, Washington 25, D. C. BUREAU OF PUBLIC ASSISTANCE. Char-

acteristics of State Public Assist-

ance Pians under the Social Secur- ity Act (Public Assistance

Report No. 21.) Washington: U.S.

Govt. Print. Off., 1953. Looseleaf.

55 cents.

CHILDREN’s BurReEAv. Recommended Standards for Services for Delin- quent Children. Washington: The Bureau, 1953. 21 pp. Processed. Limited free distribution; apply to the Children’s Bureau, Social Se- curity Administration, Washing- ton 25, D. C.

CHILDREN’s BurREAU. Some Facts about Juvenile Delinquency. (Bureau * Prepared in the Library of the De-

partment of Health, Education, and Wel-

fare. Orders for the publications listed should be directed to publishers and booksellers; Federal publications for which prices are listed should be ordered from the Superintendent of Documents, U. 8S. Government Printing Office, Wash- ington 25, D. C.

Bulletin, July 1953

Publication No. 340.) Washing- ton: U.S. Govt. Print. Off., 1953. 17 pp. 10 cents.

CHILDREN’s BurEAvV. What’s Happen- ing to Delinquent Children in Your Town? (Bureau Publication No. 342.) Washington: U. S. Govt. Print. Off., 1953. 26 pp. 15 cents. Designed as a guide for securing

facts about the community agencies

serving delinquent children.

Rice, Cart E. Determination of Per- manent and Total Disability and Provision of Necessary Services for Persons Who May Have Mental Disorders. (Public Assistance Re- port No. 23.) Washington: Bu- reau of Public Assistance, Apr. 1953. 20 pp. Processed.

Defines major mental disorders and interprets the concepts of permanence of impairment and total disability, considers the role of public assistance in rehabilitation, and outlines sug- gested procedures for obtaining data and evaluating applications. Limited free distribution; apply to the Bu- reau of Public Assistance, Social Se- curity Administration, Washington 25, D. C.


Cotm, GERHARD, and Younc, MARILYN. The American Economy in 1960: Economic Progress in a World of Tension. (Planning Pamphlets No. 81.) Washington: National Plan- ning Association, Dec. 1952. 166 pp. $2.

“Extension of Social Seafarers in Chile.”

Insurance for Industry and

Labour, Geneva, Vol. 9, Apr. 1, 1953, pp. 217-218. 25 cents.

InsE, LOUISE WOLTERS. Group Insur- ance and Employee Retirement Plans. New York: Prentice-Hall, Inc., 1953. 438 pp. $7.50. Includes chapters on the social and

economic background of group insur- ance; statutory development and gov- ernment regulations; characteristics; cost; State and Federal sickness dis- ability systems; group hospital, sur- gical, and medical expense insur- ance; group annuities; and evaluation of the group insurance movement.

LAROQUE, PIERRE. “Tendencies of So- cial Security Legislation in the Countries Which Signed the Brus- sels Pact.” Bulletin of the Inter- national Social Security Associa- tion, Geneva, Feb. 1953, pp. 3-25. $2.50 a year.