%0 Journal Article %J Health Serv Res %D 2015 %T Explaining Disability Trends in the U.S. Elderly and Near-Elderly Population. %A Chen, Yiqun %A Frank A Sloan %K Activities of Daily Living %K Age Distribution %K Aged %K Aged, 80 and over %K Alcohol Drinking %K Chronic disease %K Disabled Persons %K Female %K Health Behavior %K Health Surveys %K Humans %K Male %K Middle Aged %K Mobility Limitation %K Obesity %K Prevalence %K Sex Distribution %K Smoking %K Socioeconomic factors %K United States %X

OBJECTIVE: To examine disability trends among U.S. near-elderly and elderly persons and explain observed trends.

DATA SOURCE: 1996-2010 waves of the Health and Retirement Study.

STUDY DESIGN: We first examined trends in Activities of Daily Living and Instrumental Activities of Daily Living limitations, and large muscle, mobility, gross motor, and fine motor indexes. Then we used decomposition analysis to estimate contributions of changes in sociodemographic composition, self-reported chronic disease prevalence and health behaviors, and changes in disabling effects of these factors to disability changes between 1996 and 2010.

PRINCIPAL FINDINGS: Disability generally increased or was unchanged. Increased trends were more apparent for near-elderly than elderly persons. Sociodemographic shifts tended to reduce disability, but their favorable effects were largely offset by increased self-reported chronic disease prevalence. Changes in smoking and heavy drinking prevalence had relatively minor effects on disability trends. Increased obesity rates generated sizable effects on lower-body functioning changes. Disabling effects of self-reported chronic diseases often declined, and educational attainment became a stronger influence in preventing disability.

CONCLUSIONS: Such unfavorable trends as increased chronic disease prevalence and higher obesity rates offset or outweighed the favorable effects with the result that disability remained unchanged or increased.

%B Health Serv Res %I 50 %V 50 %P 1528-49 %8 2015 Oct %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/25655273?dopt=Abstract %2 PMC4600360 %4 ADL/IADL/Disabilities/sociodemographic factors/sociodemographic factors/Chronic Disease/Smoking/Alcohol/obesity %$ 999999 %R 10.1111/1475-6773.12284 %0 Journal Article %J Int J Health Care Finance Econ %D 2011 %T Education and health: evidence on adults with diabetes. %A Padmaja Ayyagari %A Grossman, Daniel %A Frank A Sloan %K Aged %K Cognition %K Cross-Sectional Studies %K Diabetes Complications %K Diabetes Mellitus %K Female %K Health Behavior %K Health Knowledge, Attitudes, Practice %K Health Services %K Humans %K Male %K Patient Education as Topic %K Self Efficacy %K Sex Factors %K Socioeconomic factors %K Time Factors %X

Although the education-health relationship is well documented, pathways through which education influences health are not well understood. This study uses data from a 2003-2004 cross sectional supplemental survey of respondents to the longitudinal Health and Retirement Study (HRS) who had been diagnosed with diabetes mellitus to assess effects of education on health and mechanisms underlying the relationship. The supplemental survey provides rich detail on use of personal health care services (e.g., adherence to guidelines for diabetes care) and personal attributes which are plausibly largely time invariant and systematically related to years of schooling completed, including time preference, self-control, and self-confidence. Educational attainment, as measured by years of schooling completed, is systematically and positively related to time to onset of diabetes, and conditional on having been diagnosed with this disease on health outcomes, variables related to efficiency in health production, as well as use of diabetes specialists. However, the marginal effects of increasing educational attainment by a year are uniformly small. Accounting for other factors, including child health and child socioeconomic status which could affect years of schooling completed and adult health, adult cognition, income, and health insurance, and personal attributes from the supplemental survey, marginal effects of educational attainment tend to be lower than when these other factors are not included in the analysis, but they tend to remain statistically significant at conventional levels.

%B Int J Health Care Finance Econ %I 11 %V 11 %P 35-54 %8 2011 Mar %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21213044?dopt=Abstract %3 21213044 %4 Cognition/Cross-Sectional Studies/Diabetes Complications/epidemiology/Diabetes Complications/epidemiology/Diabetes Mellitus/ epidemiology/ psychology/Diabetes Mellitus/ epidemiology/ psychology/Female/Health Behavior/Health Knowledge, Attitudes, Practice/Health Knowledge, Attitudes, Practice/Health Services/ utilization/Health Services/ utilization/Humans/Patient Education as Topic/ statistics/Patient Education as Topic/ statistics/numerical data/Self Efficacy/Self Efficacy/Sex Factors/Socioeconomic Factors/Time Factors %$ 62782 %R 10.1007/s10754-010-9087-x %0 Journal Article %J Milbank Q %D 2004 %T The effect of heavy drinking on social security old-age and survivors insurance contributions and benefits. %A Ostermann, Jan %A Frank A Sloan %K Accidents, Traffic %K Adolescent %K Adult %K Aged %K Aged, 80 and over %K Alcoholism %K Cost Sharing %K Female %K Health Behavior %K Humans %K Insurance Coverage %K Life Expectancy %K Male %K Middle Aged %K Old Age Assistance %K Social Security %K United States %X

This article estimates the effects of heavy alcohol consumption on Social Security Old-Age and Survivor Insurance (OASI) contributions and benefits. The analysis accounts for differential earnings and mortality experiences of individuals with different alcohol consumption patterns and controls for other characteristics, including smoking. Relative to moderate drinkers, heavy drinkers receive fewer OASI benefits relative to their contributions. Ironically, for each cohort of 25-year-olds, eliminating heavy drinking costs the program an additional $3 billion over the cohort's lifetime. Public health campaigns are designed to improve individual health-relevant behaviors and, in the long run, increase longevity. Therefore, if programs for the elderly are structured as longevity-independent defined benefit programs, their success will reward healthier behaviors but increase these programs' outlays and worsen their financial condition.

%B Milbank Q %I 82 %V 82 %P 507-46, table of contents %8 2004 %G eng %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/15330975?dopt=Abstract %4 Alcohol Drinking/Social Security %$ 12382 %R 10.1111/j.0887-378X.2004.00320.x