@article {12168, title = {Differential trends in disability among rich and poor adults in the US and England from 2002 to 2016.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {S189-S198}, abstract = {

OBJECTIVE: Disability in the US has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the US and England, would inform public policy aimed at reducing disparities in disability.

METHODS: Using the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimated annual percent change from 2002 to 2016 in disability among community dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with five instrumental activities of daily living (IADLs) and six activities of daily living (ADLs). We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design.

RESULTS: The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002--2016. For ages 55-64 and 65-74, disability prevalence was unchanged in the US but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55-64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC=-3.60 95\% CI [-6.57,-0.63] for the US; AAPC=-6.06 95\% CI [-8.77,-3.35] for England).

DISCUSSION: Improvements in disability were more widespread in England than in the US between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries.

}, keywords = {ADL limitation, Disability trend, ELSA, health disparity, IADL limitation}, issn = {1758-5368}, doi = {10.1093/geronb/gbac029}, author = {Choi, Hwa Jung and Robert F. Schoeni and Andrew Steptoe and Cho, Tsai-Chin and Kenneth M. Langa} } @article {10901, title = {Comparison of Health Outcomes Among High- and Low-Income Adults Aged 55 to 64 Years in the US vs England}, journal = {JAMA Intern Med}, year = {2020}, month = {2020}, abstract = {Socioeconomic differences in life expectancy, health, and disability have been found in European countries as well as in the US. Identifying the extent and pattern of health disparities, both within and across the US and England, may be important for informing public health and public policy aimed at reducing these disparities.To compare the health of US adults aged 55 to 64 years with the health of their peers in England across the high and low ranges of income in each country.Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) for 2008-2016, a pooled cross-sectional analysis of comparably measured health outcomes, with adjustment for demographic characteristics and socioeconomic status, was conducted. The analysis sample included community-dwelling adults aged 55 to 64 years from the HRS and ELSA, resulting in 46 887 person-years of observations. Data analysis was conducted from September 17, 2019, to May 12, 2020.Residence in the US or England and yearly income.Sixteen health outcomes were compared, including 5 self-assessed outcomes, 3 directly measured outcomes, and 8 self-reported physician-diagnosed health conditions.This cross-sectional study included 12 879 individuals and 31 928 person-years from HRS (mean [SD] age, 59.2 [2.8] years; 51.9\% women) and 5693 individuals and 14 959 person-years from ELSA (mean [SD] age, 59.3 [2.9] years; 51.0\% women). After adjusting for individual-level demographic characteristics and socioeconomic status, a substantial health gap between lower-income and higher-income adults was found in both countries, but the health gap between the bottom 20\% and the top 20\% of the income distribution was significantly greater in the US than England on 13 of 16 measures. The adjusted US-England difference in the prevalence gap between the bottom 20\% and the top 20\% ranged from 3.6 percentage points (95\% CI, 2.0-5.2 percentage points) in stroke to 9.7 percentage points (95\% CI, 5.4-13.9 percentage points) for functional limitation. Among individuals in the lowest income group in each country, those in the US group vs the England group had significantly worse outcomes on many health measures (10 of 16 outcomes in the bottom income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the bottom income decile ranged from 7.6\% (95\% CI, 6.0\%-9.3\%) vs 3.8\% (95\% CI, 2.6\%-4.9\%) for stroke to 75.7\% (95\% CI, 72.7\%-78.8\%) vs 59.5\% (95\% CI, 56.3\%-62.7\%) for functional limitation. Among individuals in the highest income group, those in the US group vs England group had worse outcomes on fewer health measures (4 of 16 outcomes in the top income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the top income decile ranged from 36.9\% (95\% CI, 33.4\%-40.4\%) vs 30.0\% (95\% CI, 27.2\%-32.7\%) for hypertension to 35.4\% (95\% CI, 32.0\%-38.7\%) vs 22.5\% (95\% CI, 19.9\%-25.1\%) for arthritis.For most health outcomes examined in this cross-sectional study, the health gap between adults with low vs high income appeared to be larger in the US than in England, and the health disadvantages in the US compared with England are apparently more pronounced among individuals with low income. Public policy and public health interventions aimed at improving the health of adults with lower income should be a priority in the US.}, keywords = {Demographics, ELSA, Income, socioeconomic status}, isbn = {2168-6106}, doi = {10.1001/jamainternmed.2020.2802}, author = {Choi, Hwajung and Andrew Steptoe and Michele M Heisler and Philippa J Clarke and Robert F. Schoeni and Jivraj, Stephen and Cho, Tsai-Chin and Kenneth M. Langa} } @article {11328, title = {Trends in Disability Among Adults 55-64 in the United States and England From 2002 to 2016}, journal = {Innovation in Aging}, volume = {4}, year = {2020}, pages = {303}, abstract = {The paper{\textquoteright}s goal is to assess whether and, if so, the extent to which prevalence in disability of adults near retirement ages in the US increased over time compared to their peers in England and examine income group differences in the relative trends. This study uses 2002-2016 Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA) focusing on adults aged 55-64. Annual percent changes over the period of 2002-2016 for limitations in instrumental activities of daily living (IADL) and activities of daily living (ADL) are estimated for each survey (HRS and ELSA) using multivariable logistic regressions to adjust for individual-level characteristics While disability prevalence of adults ages 55-64 in England improved over the years of 2002-2016 (annual \% change= -2.01 for IADL; - 2.53 for ADL), disability prevalence of US adults has not improved and in fact even worsened in terms of IADL (annual \% change= +1.35). There are substantial variations in the IADL/ADL trends by income groups. In the US, the adverse trends in disability were more pronounced among the lowest income groups (annual \% change in IADL=1.76 for bottom 20\% vs. -2.08 for top 20\%; annual \% change in ADL=1.08 for bottom 20\% vs. -2.08 for top 20\%). In England, the disability status improved over time for all but the lowest income group. We will examine further to identify specific factors contributing to divergent/convergent trends in disability between the US and England.}, keywords = {Disability, ELSA}, isbn = {2399-5300}, doi = {10.1093/geroni/igaa057.970}, author = {Choi, Hwajung and Robert F. Schoeni and Cho, Tsai-Chin and Kenneth M. Langa} } @article {9590, title = {Trends in the Prevalence and Disparity in Cognitive Limitations of Americans 55-69 Years Old.}, journal = {Journals of Gerontology Series B: Psychological Sciences \& Social Sciences}, volume = {73}, year = {2018}, pages = {S29-S37}, abstract = {

Objectives: To determine whether the prevalence of cognitive limitation (CL) among Americans ages 55 to 69 years changed between 1998 and 2014, and to assess the trends in socioeconomic disparities in CL among groups defined by race/ethnicity, education, income, and wealth.

Method: Logistic regression using 1998-2014 data from the biennial Health and Retirement Study, a nationally representative data set. CL is defined as a score of 0-11 on a 27-point cognitive battery of items focused on memory. Socioeconomic status (SES) measures are classified as quartiles.

Results: In models controlling for age, gender, and previous cognitive testing, we find no significant change over time in the overall prevalence of CL, widening disparities in limitation by income and, in some cases, wealth, and improvements among non-Hispanic whites but not other racial/ethnic groups.

Discussion: Among people 55-69, rates of CL are many times higher for groups with lower SES than those with higher SES, and recent trends show little indication that the gaps are narrowing.

}, keywords = {Cognitive Ability, Functional limitations}, issn = {1758-5368}, doi = {10.1093/geronb/gbx155}, author = {Choi, Hwajung and Robert F. Schoeni and Linda G Martin and Kenneth M. Langa} } @article {9607, title = {Health Of Americans Who Must Work Longer To Reach Social Security Retirement Age}, journal = {Health Affairs}, volume = {36}, year = {2017}, month = {Jan-10-2017}, pages = {1815 - 1819}, abstract = {To receive full Social Security benefits, Americans born after 1937 must claim those benefits at an older age than earlier birth cohorts. Additionally, proposals to improve the fiscal position of Social Security typically include increasing the age at which workers can receive full benefits. Birth cohorts required to work longer are in worse health at ages 49{\textendash}60, based on multiple measures of morbidity, than cohorts who could retire earlier.}, keywords = {Retirement Planning and Satisfaction, Social Security, Working Longer}, issn = {0278-2715}, doi = {10.1377/hlthaff.2017.0217}, url = {http://content.healthaffairs.org/lookup/doi/10.1377/hlthaff.2017.0217https://syndication.highwire.org/content/doi/10.1377/hlthaff.2017.0217}, author = {Choi, Hwajung and Robert F. Schoeni} } @article {8925, title = {Older Adults{\textquoteright} Residential Proximity to Their Children: Changes After Cardiovascular Events.}, journal = {Journals of Gerontology Series B: Psychological Sciences and Social Sciencess}, volume = {70}, year = {2015}, month = {2015 Nov}, pages = {995-1004}, abstract = {

OBJECTIVES: To assess changes in family residential proximity after a first cardiovascular (CV) event among older adults and to identify families most likely to experience such moves.

METHOD: Using a nationally representative longitudinal study of older adults in the United States, we identified respondents with no prior diagnosis of CV disease (CVD). We examined subsequent development of stroke, heart attack, and/or heart failure among these older adults and examined changes in their residential proximity to their closest child before and after the CV event. We then compared the likelihood of changes in proximity between families with and without CV events. Finally, we determined which types of families are most likely to relocate following a CV event.

RESULTS: Having a first CV event increases the 2-year predicted probability of children and adult parents moving in with and closer to each other (relative risk ratio = 1.61 and 1.55, respectively). Families are especially likely to move after a first CV event if the older person experiencing the event is spouseless or has a daughter.

DISCUSSION: CVD is a leading cause of disability, which in turn creates a significant need for personal care among older adults. Assessment of changes in family residential proximity responding to CV events is important to fully understand the consequences of older adults{\textquoteright} CV events including the cost of caregiving.

}, keywords = {Cardiovascular health, Heart disease, Older Adults, Proximity, Social Support}, issn = {1758-5368}, doi = {10.1093/geronb/gbu076}, author = {Choi, Hwajung and Robert F. Schoeni and Kenneth M. Langa and Michele M Heisler} } @article {8166, title = {Spouse and Child Availability for Newly Disabled Older Adults: Socioeconomic Differences and Potential Role of Residential Proximity.}, journal = {J Gerontol B Psychol Sci Soc Sci}, volume = {70}, year = {2015}, month = {2015 May}, pages = {462-9}, publisher = {70}, abstract = {

OBJECTIVES: To examine the potential role of child and spousal availability in facilitating community-based care for disabled older adults.

METHOD: We used the Health and Retirement Study, a nationally representative longitudinal study of older adults. The analysis sample included older adults who were nondisabled at baseline, but who then developed at least one activity of daily living (ADL) limitation over the subsequent 2-year period (N = 2,094). Using multivariate, multinomial logistic regression, we examined the association of child and spouse availability prior to disablement of the older adults with ADL care receipt status after the onset of disablement, after adjusting for other sociodemographic and clinical characteristics.

RESULTS: Lower socioeconomic status (SES) was associated with less availability of a spouse but greater availability of children at baseline. Compared with older adults who had no children nearby (i.e., all children lived further than 30 miles), older adults who had at least one child living with or near them prior to the onset of the ADL limitation were less likely to go to a nursing home (adjusted odds ratio [AOR]: 0.26 for coresident; AOR: 0.44 for 1- 30 miles) and less likely to depend on formal care (AOR: 0.39 for coresident; AOR: 0.51 for 1-30 miles) after the onset of new ADL limitation/s.

DISCUSSION: Understanding SES variations in the informal care resources, and potential role of child geographic availability, may inform the development of cost-effective community-based care programs and policies.

}, keywords = {Activities of Daily Living, Adult children, Aged, Aged, 80 and over, Aging, Disabled Persons, Female, Home Nursing, Humans, Male, Middle Aged, Nursing homes, Residence Characteristics, Social Class, Spouses}, issn = {1758-5368}, doi = {10.1093/geronb/gbu015}, url = {http://psychsocgerontology.oxfordjournals.org/content/early/2014/03/06/geronb.gbu015.abstract}, author = {Choi, Hwajung and Robert F. Schoeni and Kenneth M. Langa and Michele M Heisler} } @article {7819, title = {Trends in late-life activity limitations in the United States: an update from five national surveys.}, journal = {Demography}, volume = {50}, year = {2013}, month = {2013 Apr}, pages = {661-71}, publisher = {50}, abstract = {

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65-84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Disabled Persons, Female, Health Surveys, Humans, Male, Mobility Limitation, Models, Statistical, United States}, issn = {0070-3370}, doi = {10.1007/s13524-012-0167-z}, author = {Vicki A Freedman and Brenda C Spillman and Patricia Andreski and Jennifer C. Cornman and Eileen M. Crimmins and Kramarow, Ellen and Lubitz, James and Linda G Martin and Sharon S. Merkin and Robert F. Schoeni and Teresa Seeman and Timothy A Waidmann} } @article {7214, title = {Declines in late-life disability: the role of early- and mid-life factors.}, journal = {Soc Sci Med}, volume = {66}, year = {2008}, month = {2008 Apr}, pages = {1588-602}, publisher = {66}, abstract = {

Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2\% in 1995 to 26.0\% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother{\textquoteright}s education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations.

}, keywords = {Activities of Daily Living, Aged, Aged, 80 and over, Aging, Chronic disease, Cross-Sectional Studies, Disabled Persons, Female, Frail Elderly, Health Behavior, Health Status, Health Surveys, Humans, Life Style, Logistic Models, Male, Morbidity, Population Surveillance, Socioeconomic factors, United States}, issn = {0277-9536}, doi = {10.1016/j.socscimed.2007.11.037}, author = {Vicki A Freedman and Linda G Martin and Robert F. Schoeni and Jennifer C. Cornman} } @article {6944, title = {Resolving inconsistencies in trends in old-age disability: report from a technical working group.}, journal = {Demography}, volume = {41}, year = {2004}, month = {2004 Aug}, pages = {417-41}, publisher = {41}, abstract = {

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1\%-2.5\% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Aged, 80 and over, Chronic disease, Disabled Persons, Female, Health Surveys, Homemaker Services, Humans, Male, Models, Statistical, Self-Help Devices, United States}, issn = {0070-3370}, doi = {10.1353/dem.2004.0022}, author = {Vicki A Freedman and Eileen M. Crimmins and Robert F. Schoeni and Brenda C Spillman and Aykan, Hakan and Kramarow, Ellen and Land, Kenneth and Lubitz, James and Kenneth G. Manton and Linda G Martin and Shinberg, Diane and Timothy A Waidmann} }