@article {11827, title = {Dental care use and other population characteristics of older Americans with self-reported chronic conditions in the Health and Retirement Study.}, journal = {Journal of Public Health Dentisty}, volume = {82}, year = {2022}, pages = {40-52}, abstract = {

OBJECTIVES: To analyze relative differences in oral health care utilization, oral health, and other population characteristics of older Americans with respect to self-reported chronic conditions in the health and retirement study.

METHODS: Differences in estimated percentages of those with specific chronic conditions by selected attributes were tested for statistical significance with standardized normal Z tests and logistic regressions. All estimates were based on weighted data from 1992 to 2016 Early Release RAND HRS Longitudinal file. SE estimates for the percentages accounted for the complex sample design of the survey.

RESULTS: We establish that the strength of the associations between regular use of dental care and the absence of a chronic condition is similar in magnitude to having a college education, living in a high-income family, never smoking, not having certain functional limitations, and being under 65 years of age.

DISCUSSION: These cross-sectional findings establish the relative strength of relationships between dental care use, oral health status, and other population characteristics and eight diagnosed conditions. Further work beyond the scope of this paper is needed to confirm these results as either attributes of those with the disease or causal risk factors for the onset of the condition.

}, keywords = {Chronic condition, Dental Care, Self-reported health}, issn = {1752-7325}, doi = {10.1111/jphd.12471}, author = {John F Moeller and Richard J. Manski and Chen, Haiyan and Meyerhoefer, Chad and John V Pepper and Terrin, Michael} } @article {11710, title = {Dental Care Use, Edentulism, and Systemic Health among Older Adults.}, journal = {Journal of Dental Research}, volume = {100}, year = {2021}, pages = {1468-1474}, abstract = {

Past research suggests there are systematic associations between oral health and chronic illness among older adults. Although causality has not yet been credibly established, periodontitis has been found to be associated with higher risk of both heart disease and stroke. We advance this literature by estimating the direct association between dental care use and systemic health using multiple waves of the 1992 to 2016 Health and Retirement Study. Through the inclusion of individual fixed effects in our regression models, we account for unobservable time-invariant characteristics of individuals that might otherwise bias estimates of the association between dental care use and health. We find statistically significant negative associations between dental care use and the number of health conditions, self-reported overall health, the incidence of heart disease, and the incidence of stroke. In particular, the use of dental care within the past 2 y is associated with a 2.7\% reduction in the likelihood of being diagnosed with a heart condition and a reduction in the likelihood of a stroke diagnosis of between 5.3\% and 11.6\%. We also find large positive correlations between edentulism and the measures of chronic illness. Associations from models estimated separately for men and women are qualitatively similar to one another. These findings provide additional motivation for the consideration of a Medicare dental benefit.

}, keywords = {Cancer, Chronic conditions, Dental Care, Heart disease, Oral Health, Stroke}, issn = {1544-0591}, doi = {10.1177/00220345211019018}, author = {Meyerhoefer, C D and John V Pepper and Richard J. Manski and John F Moeller} } @article {8192, title = {Dental use and expenditures for older uninsured Americans: the simulated impact of expanded coverage.}, journal = {Health Serv Res}, volume = {50}, year = {2015}, note = {Times Cited: 0 0}, month = {2015 Feb}, pages = {117-35}, publisher = {50}, abstract = {

OBJECTIVE: To determine if providing dental insurance to older Americans would close the current gaps in dental use and expenditure between insured and uninsured older Americans.

DATA SOURCES/STUDY SETTING: We used data from the 2008 Health and Retirement Survey (HRS) supplemented by data from the 2006 Medical Expenditure Panel Survey (MEPS).

STUDY DESIGN: We compared the simulated dental use and expenditures rates of newly insured persons against the corresponding rates for those previously insured.

DATA COLLECTION/EXTRACTION METHODS: The HRS is a nationally representative survey administered by the Institute for Social Research (ISR). The MEPS is a nationally representative household survey sponsored by the Agency for Healthcare Research and Quality (AHRQ).

PRINCIPAL FINDINGS: We found that expanding dental coverage to older uninsured Americans would close previous gaps in dental use and expense between uninsured and insured noninstitutionalized Americans 55 years and older.

CONCLUSIONS: Providing dental coverage to previously uninsured older adults would produce estimated monthly costs net of markups for administrative costs that comport closely to current market rates. Estimates also suggest that the total cost of providing dental coverage targeted specifically to nonusers of dental care may be less than similar costs for prior users.

}, keywords = {Aged, Dental Health Services, Female, Health Expenditures, Humans, Insurance, Dental, Male, Medically Uninsured, Middle Aged, Surveys and Questionnaires, United States}, issn = {1475-6773}, doi = {10.1111/1475-6773.12205}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and John V Pepper and Patricia A St Clair} } @article {8160, title = {The effect of dental insurance on the use of dental care for older adults: a partial identification analysis.}, journal = {Health Econ}, volume = {24}, year = {2015}, note = {Export Date: 6 August 2014 Article in Press}, month = {2015 Jul}, pages = {840-58}, publisher = {24}, abstract = {

We evaluate the impact of dental insurance on the use of dental services using a potential outcomes identification framework designed to handle uncertainty created by unknown counterfactuals-that is, the endogenous selection problem-and uncertainty about the reliability of self-reported insurance status. Using data from the health and retirement study, we estimate that utilization rates of adults older than 50 years would increase from 75\% to around 80\% under universal dental coverage.

}, keywords = {Aged, Dental Care, Female, Humans, Insurance Coverage, Insurance, Dental, Male, Middle Aged, Models, Econometric, Reproducibility of Results}, issn = {1099-1050}, doi = {10.1002/hec.3064}, author = {Kreider, Brent and Richard J. Manski and John F Moeller and John V Pepper} } @article {8153, title = {A Research Note on Transitions in Out-of-Pocket Spending on Dental Services.}, journal = {Res Aging}, volume = {37}, year = {2015}, month = {2015 Aug}, pages = {646-66}, publisher = {37}, abstract = {

OBJECTIVE: We analyze correlates of the direction and magnitude of changes in out-of-pocket (OOP) payments for dental care by older Americans over a recent 4-year period.

METHODS: We analyzed data from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of the direction and linear regression models of the amounts of OOP changes over survey periods.

RESULTS: Financial-based factors were more strongly associated with the direction and magnitude of changing self-payments for dental care than were health factors.

DISCUSSION: Findings suggested that dental coverage, income, and wealth and changes in these financial factors were more strongly correlated with the persistence of and changes in OOP payments for dental care over time than were health status and changes in health status. The sensitivity to dental coverage changes should be considered as insurance and retirement policy reforms are deliberated.

}, keywords = {Aged, Aged, 80 and over, Dental Care, Female, Health Expenditures, Humans, Insurance, Dental, Longitudinal Studies, Male, Middle Aged, United States}, issn = {1552-7573}, doi = {10.1177/0164027514552681}, url = {http://roa.sagepub.com/content/early/2014/10/03/0164027514552681.abstract}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel Hyde and John V Pepper and Patricia A St Clair} } @article {7992, title = {Dental usage under changing economic conditions.}, journal = {J Public Health Dent}, volume = {74}, year = {2014}, note = {Times Cited: 1}, month = {2014 Winter}, pages = {1-12}, publisher = {74}, abstract = {

OBJECTIVE: The purpose of this article is to examine the relationship between changes in household finances (wealth and income) and changes in dental utilization at the onset of the recent recession in a population of older Americans.

METHODS: Data from the Health and Retirement Study (HRS) were analyzed for U.S. individuals aged 51 years and older during the 2006 and 2008 waves of the HRS. We estimated logistic models of (a) starting and (b) stopping dental use between 2006 and 2008 survey periods as a function of changes in household wealth and income, controlling for other potentially confounding covariates.

RESULTS: We found that only when household wealth falls by 50 percent or more were older adults less likely to seek dental care. Changes in household income and other changes in household wealth were not associated with changes in dental utilization among this population.

CONCLUSIONS: Older Americans{\textquoteright} dental care utilization appeared to be fairly resilient to changes in household finances; only when wealth fell by 50 percent or more did individuals decrease dental use. This finding might extend to other health-care services that are preventive, routine, and relatively inexpensive.

}, keywords = {Dental Health Services, Financing, Personal, Humans, Middle Aged, United States}, issn = {1752-7325}, doi = {10.1111/j.1752-7325.2012.00370.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and Patricia A St Clair and John V Pepper} } @article {7825, title = {Patterns of older Americans{\textquoteright} health care utilization over time.}, journal = {Am J Public Health}, volume = {103}, year = {2013}, month = {2013 Jul}, pages = {1314-24}, publisher = {103}, abstract = {

OBJECTIVES: We analyzed correlates of older Americans{\textquoteright} continuous and transitional health care utilization over 4 years.

METHODS: We analyzed data for civilian, noninstitutionalized US individuals older than 50 years from the 2006 and 2008 waves of the Health and Retirement Study. We estimated multinomial logistic models of persistent and intermittent use of physician, inpatient hospital, home health, and outpatient surgery over the 2004-2008 survey periods.

RESULTS: Individuals with worse or worsening health were more likely to persistently use medical care and transition into care and not transition out of care over time. Financial variables were less often significant and, when significant, were often in an unexpected direction.

CONCLUSIONS: Older individuals{\textquoteright} health and changes in health are more strongly correlated with persistence of and changes in care-seeking behavior over time than are financial status and changes in financial status. The more pronounced sensitivity to health status and changes in health are important considerations in insurance and retirement policy reforms.

}, keywords = {Aged, Aged, 80 and over, Ambulatory Surgical Procedures, Delivery of Health Care, Female, Health Services, Health Status, Health Surveys, Home Care Services, Hospitalization, Humans, Income, Insurance Coverage, Logistic Models, Longitudinal Studies, Male, Middle Aged, Office Visits, Patient Acceptance of Health Care, Time Factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2012.301124}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Jody Schimmel and Patricia A St Clair and John V Pepper} } @article {7678, title = {The influence of changes in dental care coverage on dental care utilization among retirees and near-retirees in the United States, 2004-2006.}, journal = {Am J Public Health}, volume = {101}, year = {2011}, note = {Times Cited: 0 Manski, Richard J. Moeller, John F. St Clair, Patricia A. Schimmel, Jody Chen, Haiyan Pepper, John V.}, month = {2011 Oct}, pages = {1882-91}, publisher = {101}, abstract = {

OBJECTIVES: We examined dental care utilization transition dynamics between 2004 and 2006 in the context of changing dental coverage status.

METHODS: We used data from the Health and Retirement Study for persons aged 51 years and older to estimate a multivariable model of dental care use transitions with controls for dental coverage and retirement transitions and other potentially confounding covariates.

RESULTS: We found that Americans aged 51 years and older who lost dental coverage between the 2004 and 2006 survey periods were more likely to stop dental care use between periods, and those who gained coverage were more likely to start dental care use between periods, than those without coverage in both periods.

CONCLUSIONS: Dental coverage transitions and status have a strong effect on transitions in dental care use. Given that retirement is a time when many experience a loss of dental coverage, older adults may be at risk for sporadic dental care and even stopping use, leading to worse dental and potentially overall health.

}, keywords = {Age Factors, Aged, Dental Care, Employment, Female, Health Care Surveys, Humans, Insurance, Dental, Male, Medically Uninsured, Middle Aged, Retirement, Socioeconomic factors, United States}, issn = {1541-0048}, doi = {10.2105/AJPH.2011.300227}, author = {Richard J. Manski and John F Moeller and Patricia A St Clair and Jody Schimmel and Haiyan Chen and John V Pepper} } @article {7536, title = {Dental care coverage and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, month = {2010 Winter}, pages = {1-12}, publisher = {70}, abstract = {

OBJECTIVES: To examine the convergence of an aging population and a decreased availability of dental care coverage using data from the Health and Retirement Study (HRS).

METHODS: We calculate national estimates of the number and characteristics of those persons age 51 years and above covered by dental insurance by labor force, retirement status, and source of coverage. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: We show that being in the labor force is a strong predictor of having dental coverage. For older retired adults not in the labor force, the only source for dental coverage is either a postretirement health benefit or spousal coverage.

CONCLUSIONS: Dental care, generally not covered in Medicare, is an important factor in the decision to seek dental care. It is important to understand the relationship between retirement and dental coverage in order to identify the best ways of improving oral health and access to care among older Americans.

}, keywords = {Aged, Employment, ethnicity, Female, Humans, Income, Insurance, Dental, Male, Middle Aged, Models, Statistical, Multivariate Analysis, Retirement, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00137.x}, author = {Richard J. Manski and John F Moeller and Jody Schimmel and Patricia A St Clair and Haiyan Chen and Larry S. Magder and John V Pepper} } @article {7535, title = {Dental care expenditures and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, month = {2010 Spring}, pages = {148-55}, publisher = {70}, abstract = {

OBJECTIVES: To examine the relationship of dental care coverage, retirement, and out-of-pocket (OOP) dental expenditures in an aging population, using data from the Health and Retirement Study (HRS).

METHODS: We estimate OOP dental expenditures among individuals who have dental utilization as a function of dental care coverage status, retirement, and individual and household characteristics. We also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: Overall, mean OOP dental expenditures among those with any spending were substantially larger for those without coverage than for those with coverage. However, controlling for coverage shows that there is little difference in spending by retirement status.

CONCLUSIONS: Although having dental coverage is a key determinant of the level of OOP expenditures on dental care; spending is higher among those without coverage than those who have dental insurance. We also found that while retirement has no independent effect on OOP dental expenditures once controlling for coverage, dental coverage rates are much lower among retirees.

}, keywords = {Age Factors, Aged, Dental Care, Educational Status, ethnicity, Female, Financing, Personal, Humans, Income, Insurance Coverage, Insurance, Dental, Male, Marital Status, Middle Aged, Mouth, Edentulous, Retirement, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00156.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {7545, title = {Dental care utilization and retirement.}, journal = {J Public Health Dent}, volume = {70}, year = {2010}, note = {Manski, Richard J Moeller, John Chen, Haiyan St Clair, Patricia A Schimmel, Jody Magder, Larry Pepper, John V R01 AG026090-01A2/AG/NIA NIH HHS/United States R01 AG026090-03/AG/NIA NIH HHS/United States U01AG009740/AG/NIA NIH HHS/United States Research Support, N.I.H., Extramural United States Nihms172468 J Public Health Dent. 2010 Winter;70(1):67-75.}, month = {2010 Winter}, pages = {67-75}, publisher = {70}, abstract = {

OBJECTIVE: The authors examine the relationship of dental care coverage, retirement, and utilization in an aging population using data from the Health and Retirement Study (HRS).

METHODS: The authors estimate dental care use as a function of dental care coverage status, retirement, and individual and household characteristics. They also estimate a multivariate model controlling for potentially confounding variables.

RESULTS: The authors show that that the loss of income and dental coverage associated with retirement may lead to lower use rates but this effect may be offset by other unobserved aspects of retirement including more available free time leading to an overall higher use rate.

CONCLUSIONS: The authors conclude from this study that full retirement accompanied by reduced income and dental insurance coverage produces lower utilization of dental services. However, they also show that retirement acts as an independent variable, whereas income, coverage, and free time (unobserved) act as intervening variables.

}, keywords = {Aged, Confounding Factors, Epidemiologic, Dental Care, Employment, ethnicity, Female, health policy, Humans, Income, Insurance, Dental, Leisure activities, Logistic Models, Male, Middle Aged, Multivariate Analysis, Odds Ratio, Retirement, Socioeconomic factors, United States}, issn = {0022-4006}, doi = {10.1111/j.1752-7325.2009.00145.x}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {7376, title = {Dental care coverage transitions.}, journal = {Am J Manag Care}, volume = {15}, year = {2009}, month = {2009 Oct}, pages = {729-35}, publisher = {15}, abstract = {

OBJECTIVE: To examine dental insurance transition dynamics in the context of changing employment and retirement status.

STUDY DESIGN: Data from the Health and Retirement Study (HRS) were analyzed for individuals 51 years and older between the 2004 and 2006 waves of the HRS.

METHODS: The primary focus of the analysis is the relationship between retirement and transitions in dental care coverage. We calculate and present bivariate relationships between dental coverage and retirement status transitions over time and estimate a multivariable model of dental coverage controlling for retirement and other potentially confounding covariates.

RESULTS: Older adults are likely to lose their dental coverage on entering retirement compared with those who remain in the labor force between waves of the HRS. While more than half of those persons in the youngest group (51-64 years) were covered over this entire period, two-thirds of those in the oldest group (>or=75 years) were without coverage over the same period. We observe a high percentage of older persons flowing into and out of dental coverage over the period of our study, similar to flows into and out of poverty.

CONCLUSIONS: Dental insurance is an important factor in the decision to seek dental care. Yet, no dental coverage is provided by Medicare, which provides medical insurance for almost all Americans 65 years and older. This loss of coverage could lead to distortions in the timing of when to seek care, ultimately leading to worse oral and overall health.

}, keywords = {Aged, Career Mobility, Female, Health Benefit Plans, Employee, Humans, Insurance Coverage, Insurance, Dental, Interviews as Topic, Male, Middle Aged, United States}, issn = {1936-2692}, author = {Richard J. Manski and John F Moeller and Haiyan Chen and Patricia A St Clair and Jody Schimmel and Larry S. Magder and John V Pepper} } @article {5530, title = {Disability and Employment: Reevaluating the Evidence in Light of Reporting Errors}, number = {2002-06}, year = {2003}, note = {ProCite field 22 : 4 ProCite field 24 : 4}, institution = {Employee Benefits, Compensation and Pension Law}, abstract = {Long-standing debates about relationships between labor supply behavior and health status among persons nearing retirement age have centered largely on disagreements about the reliability of self-reported health indicators. In light of reporting errors in work capacity, this paper considers the problem of predicting how employment rates vary with disability status when true disability is unobserved. Rather than imposing the strong assumptions required to obtain point identification, we take a step back to evaluate what can be inferred under a variety of assumptions that are weaker but arguably more credible than those imposed in the existing literature. Although these assumptions do not identify the conditional employment rates except in special cases, nonparametric bounds for these parameters can be obtained. Using data from the Health and Retirement Study, we estimate a set of bounds that formalize the identifying power of a number of different assumptions that appear to have broad consensus in the literature. Our results suggest that models estimated under the assumption of fully accurate reporting lead to biased inferences. In particular, it appears that nonworkers tend to overreport disabilities.}, keywords = {Employment and Labor Force, Health Conditions and Status, Methodology}, doi = {http://dx.doi.org/10.2139/ssrn.337224}, author = {Kreider, Brent and John V Pepper} } @article {5467, title = {Inferring Disability Status from Corrupt Data}, year = {2001}, institution = {Iowa State University, Dept. of Economics}, abstract = {We investigate what can be learned about the prevalence of work disability using self-reported assessments of work capacity. Although health status is widely recognized as a crucial determinant of labor supply behavior and participation in public transfer programs, there is a long-standing debate about the reliability of self-reported indicators. Anderson and Burkhauser (1985), in fact, labeled the appropriate use of health controls the major unsettled issue in the empirical literature on the labor supply of older workers, and the debate has only grown stronger over time. Rather than focus on assumptions required to obtain point identification, we take a step back to evaluate what can be inferred about disability rates under a variety of assumptions that are weaker but arguably more credible than those imposed in the existing literature. Extending the work on corrupt samples developed by Horowitz and Manski (1995), we develop a set of nonparametric bounds that, in the most basic setting, require only prior information restricting the fraction of persons who might misreport disability. These bounds inform the ongoing debate by effectively constraining the range of uncertainty regarding the effects of inaccurate reporting on inferences. The results clearly show that the strength of the conclusions one can draw depend directly on the strength of the assumptions one is willing to impose. Under minimal assumptions, the bounds are nearly uninformative. Tighter bounds can be obtained with additional assumptions. Under the assumption that the true disability rate is nondecreasing with age, our results imply that conventional participation models which presume valid self-reports may be misspecifed.}, keywords = {Disabilities, Methodology}, author = {Kreider, Brent and John V Pepper} }