%0 Journal Article %J The Journals of Gerontology, Series A %D 2022 %T Deaths, Disparities, and Cumulative (Dis)Advantage: How Social Inequities Produce an Impairment Paradox in Later Life. %A Heide Jackson %A Michal Engelman %K Disablement Process %K Minority aging %K socio-economic issues %X

BACKGROUND: Research on health across the life course consistently documents widening racial and socioeconomic disparities from childhood through adulthood, followed by stabilization or convergence in later life. This pattern appears to contradict expectations set by cumulative (dis)advantage (CAD) theory. Informed by the punctuated equilibrium perspective, we examine the relationship between midlife health and subsequent health change and mortality and consider the impact of earlier socioeconomic exposures on observed disparities.

METHODS: Using the Health and Retirement Study, we characterize the functional impairment histories of a nationally-representative sample of 8,464 older adults between 1994-2016. We employ non-parametric and discrete outcome multinomial logistic regression to examine the competing risks of mortality, health change, and attrition.

RESULTS: Exposures to disadvantages are associated with poorer functional health in midlife and mortality. However, a higher number of functional limitations in midlife is negatively associated with the accumulation of subsequent limitations for white men and women and for Black women. The impact of educational attainment, occupation, wealth, and marriage on later life health differs across race and gender groups.

CONCLUSIONS: Observed stability or convergence in later-life functional health disparities is not a departure from the dynamics posited by CAD, but rather a result of the differential impact of racial and socioeconomic inequities on mortality and health at older ages. Higher exposure to disadvantages and a lower protective impact of advantageous exposures lead to higher mortality among Black Americans, a pattern which masks persistent health inequities later in life.

%B The Journals of Gerontology, Series A %V 77 %P 392-401 %G eng %N 2 %R 10.1093/gerona/glab181 %0 Journal Article %J Demography %D 2019 %T Gradual Change, Homeostasis, and Punctuated Equilibrium: Reconsidering Patterns of Health in Later Life %A Michal Engelman %A Heide Jackson %K Aging %K Demography %K Equilibrium %K health %K Health problems %K Homeostasis %K Inequality %K Life stage transitions %K Life Tables %K Longitudinal analysis %K Multistate %K Older people %K Psychology %K Sequence analysis %K Statistical models %K trajectory %X Longitudinal methods aggregate individual health histories to produce inferences about aging populations, but to what extent do these summaries reflect the experiences of older adults? We describe the assumption of gradual change built into several influential statistical models and draw on widely used, nationally representative survey data to empirically compare the conclusions drawn from mixed-regression methods (growth curve models and latent class growth analysis) designed to capture trajectories with key descriptive statistics and methods (multistate life tables and sequence analysis) that depict discrete states and transitions. We show that individual-level data record stasis irregularly punctuated by relatively sudden change in health status or mortality. Although change is prevalent in the sample, for individuals it occurs rarely, at irregular times and intervals, and in a nonlinear and multidirectional fashion. We conclude by discussing the implications of this punctuated equilibrium pattern for understanding health changes in individuals and the dynamics of inequality in aging populations. %B Demography %V 56 %P 2323-2347 %8 12 %@ 00703370 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/31713126 %0 Journal Article %J Journal of Aging and Health %D 2019 %T Robust Respondents and Lost Limitations: The Implications of Nonrandom Missingness for the Estimation of Health Trajectories. %A Heide Jackson %A Michal Engelman %A Bandeen-Roche, Karen %K Health Trajectories %K Survey Methodology %X

OBJECTIVE: We offer a strategy for quantifying the impact of mortality and attrition on inferences from later-life health trajectory models.

METHOD: Using latent class growth analysis (LCGA), we identify functional limitation trajectory classes in the Health and Retirement Study. We compare results from complete case and full information maximum likelihood (FIML) analyses, and demonstrate a method for producing upper- and lower-bound estimates of the impact of attrition on results.

RESULTS: LCGA inferences vary substantially depending on the handling of missing data. For older adults who die during the follow-up period, the widely used FIML approach may underestimate functional limitations by up to 20%.

DISCUSSION: The most commonly used approaches to handling missing data likely underestimate the extent of poor health in aging populations. Although there is no single solution for nonrandom missingness, we show that bounding estimates can help analysts to better characterize patterns of health in later life.

%B Journal of Aging and Health %V 31 %P 685-708 %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/29254422?dopt=Abstract %R 10.1177/0898264317747079 %0 Report %D 2015 %T The Role of Occupations in Differentiating Health Trajectories in Later Life %A Michal Engelman %A Heide Jackson %K Demographics %K Employment and Labor Force %K Health Conditions and Status %K Healthcare %X This study characterizes heterogeneous trajectories of health among older Americans and investigates how employment histories differentiate them. Using the 1998-2010 waves of the Health and Retirement Study, we examine the impact of longest-held occupations on patterns of limitations in activities of daily living. We use latent class growth analysis to identify distinct health trajectory classes and linear growth curve analysis to model the pattern of limitation accumulation for individuals. All analyses are stratified by sex and race, to account for differential labor markets and health experiences of these demographic groups. A limitation of this analysis is its reliance on broad occupational categories rather than specific measures of working conditions. In future work, we plan to incorporate data on specific occupations and merge them with detailed information on occupational characteristics available in the O NET database (an online repository that has updated the Dictionary of Occupational Titles used in previous research on aging and retirement and occupational epidemiology: http://www.onetonline.org/). The paper found that: White respondents (both male and female) are substantially more likely to be in the healthiest class compared to black respondents. Certain occupations are protective against membership in poor health classes, but the list of protective occupational categories differs substantially by sex and race. The impact of occupations on health trajectories was diminished when we controlled for educational attainment and smoking, suggesting the important role of education in sorting individuals into occupations that differ in physical and cognitive demands that likely influence health. The policy implications of the findings are: Life expectancy alone does not capture all the health information that would be relevant for assessing the capacity of American workers to stay on the job beyond traditional retirement ages. Legislators should consider differences in health and in the trajectories of functional decline across demographic groups defined by sex, race, and occupational exposures when debating further increases in the Social Security retirement age. %I Boston College %G eng %4 health trajectories/health trajectories/ADL and IADL Impairments/occupation/labor force participation/employment history/O NET/educational attainment %$ 999999 %0 Journal Article %J Research on Aging %D 2013 %T Moving Considerations: A Longitudinal Analysis of Parent-Child Residential Proximity for Older Americans %A Zhang, Yiduo %A Michal Engelman %A Emily M. Agree %K Adult children %K Demographics %K Event History/Life Cycle %K Expectations %K Health Conditions and Status %K Healthcare %K Retirement Planning and Satisfaction %X Residential proximity is an important indicator of family members' availability to provide assistance to each other. We investigate proximity-enhancing moves by older parents and their children and the reasons for such moves. Using the 2000-2004 waves of the Health and Retirement Study, we fit multinomial logit models examining 2-year residential transitions for parents and children living 10 or more miles apart at baseline. Our results show that family members collectively adjust intergenerational proximity to facilitate mutual support. Despite the common assumption that older parents move closer to their children to receive assistance, more than two thirds of all proximity-enhancing moves are made by adult children. While greater anticipated longevity raises the probability that older parents will move closer to their children, parents' anticipated longevity does not influence children's moving decisions. Including individual variability in anticipated longevity in the life course framework helps account for relocation that precedes declines in health or increases in the need for support. %B Research on Aging %I 35 %V 35 %P 663-687 %G eng %N 6 %4 Anticipated Longevity/Caregiving/Intergenerational Relations/Life Course Migration/Residential Mobility/Subjective Life Expectancy/Adult Children/Elderly Parents/Living Arrangements/Mobility/Retirement %$ 999999 %R 10.1177/0164027512457787