@article {13603, title = {Disability and morbidity among US birth cohorts, 1998-2018: A multidimensional test of dynamic equilibrium theory.}, journal = {SSM - population health}, volume = {24}, year = {2023}, pages = {101528}, abstract = {

A substantial body of prior research has explored patterns of disability-free and morbidity-free life expectancy among older populations. However, these distinct facets of later-life health are almost always studied in isolation, even though they are very likely to be related. Using data from the US Health and Retirement Study and a multistate life table approach, this paper explores the interactions between disability, morbidity, and mortality by sex and education among four successive US birth cohorts, born from 1914 to 1923 to 1944-1953 and compared in the periods 1998-2008 and 2008-2018. We find little compression of disability but a marked expansion of morbidity across cohorts. However, disability-free life expectancy (DFLE) among those living with chronic morbidities has increased, even though at the population-level DFLE is largely unchanged. Broadly, these patterns suggest that successive cohorts of older populations in the US are experiencing a dynamic equilibrium, where the link between chronic morbidities and disability has weakened over successive cohorts. Investigating patterns by educational attainment, we find marked disparities where the least educated individuals not only live significantly fewer years free of disabilities or chronic morbidities but also have experienced an expansion in morbidity and disability. Our findings suggest that the future trajectory of disability-free life expectancy in the US is increasingly contingent on efforts to improve disease management and control the severe consequences of chronic morbidities.

}, keywords = {Aging, Disability, Dynamic equilibrium, Health expectancy, Morbidity}, issn = {2352-8273}, doi = {10.1016/j.ssmph.2023.101528}, author = {Shen, Tianyu and Payne, Collin F} } @article {11919, title = {Changes in life expectancy and disability-free life expectancy in successive birth cohorts of older cancer survivors: a longitudinal modeling analysis of the US Health and Retirement Study.}, journal = {The American Journal of Epidemiology}, volume = {191}, year = {2022}, pages = {104-114}, abstract = {

The population of older cancer survivors in the US is rapidly growing. However, little is currently known about how the health of older cancer survivors has changed over time and across successive birth cohorts. Using data from the US Health and Retirement Study, we parameterized a demographic microsimulation model to compare partial cohort life expectancy (LE) and disability-free LE for US men and women without cancer and with prevalent and incident cancer diagnoses for four successive 10-year birth cohorts born 1918-1927 to 1948-1957. Disability was defined as being disabled in >=1 activity of daily living. These cohorts had mid-point ages of 55-64, 65-74, and 75-84 years during the periods 1998-2008 (the "early" period) and 2008-2018 (the "later" period). Across all cohorts and periods, those with incident cancer had the lowest LE, followed by those with prevalent cancer and cancer-free individuals. We observed declines in partial LE and an expansion of life spent disabled among more recent birth cohorts of prevalent cancer survivors. Our findings suggest that advances in treatments that prolong life for individual cancer patients may have led to population-level declines in conditional LE and disability-free LE across successive cohorts of older cancer survivors.

}, keywords = {Cancer, Disability, Life Expectancy, microsimulation modeling}, issn = {1476-6256}, doi = {10.1093/aje/kwab241}, author = {Payne, Collin F and Lindsay C Kobayashi} }