%0 Journal Article %J Sociological Methods & Research %D Forthcoming %T How bad could it be? Worst-case bounds on bias in multistate models due to unobserved transitions %A Christian Dudel %A Daniel C Schneider %K Bias %K Disability %K Identification %K Life Expectancy %K Markov Model %X Multistate models are often used in social research to analyze how individuals move between states. A typical application is the estimation of the lifetime spent in a certain state, like the lifetime spent in employment, or the lifetime spent in good health. Unfortunately, the estimation of such quantities is prone to several biases. In this paper, we study the bias due to the often implicitly used assumption that there are no unobserved transitions between states. This assumption does often not hold for the panel data typically used to estimate multistate models, as the states occupied by individuals are only known at specific points in time, and further transitions between panel waves are not recorded. We present partially identified estimates of the lifetime spent in a state, or worse-case bounds, which show the maximum possible level of bias due to unobserved transitions. We provide two examples studying the lifetime spent in disability (disabled life expectancy; DLE). The first example applies our methods to results on cohort trends in DLE in the U.S. taken from Crimmins et al. (2009). In the second example, we replicate findings from Mehta and Myrskylä (2017), and apply our methods to data from the U.S. Health and Retirement Study (HRS) in order to estimate the effects of health behaviors on DLE. %B Sociological Methods & Research %@ 0049-1241 %G eng %R 10.1177/0049124121995540 %0 Web Page %D 2024 %T Research Spotlight: Modeling Study Shows that Policies to Reduce Wealth Inequality Could Improve Health and Life Expectancy of Americans %A Himmelstein, Kathryn %K health %K Life Expectancy %K Wealth Inequality %I Massachusetts General Hospital %G eng %U https://www.massgeneral.org/news/research-spotlight/study-shows-policies-to-reduce-wealth-inequality-could-improve-life-expectancy %0 Journal Article %J Nature Medicine %D 2023 %T Hobby engagement and mental wellbeing among people aged 65 years and older in 16 countries. %A Mak, Hei Wan %A Noguchi, Taiji %A Bone, Jessica K %A Wels, Jacques %A Gao, Qian %A Kondo, Katsunori %A Saito, Tami %A Fancourt, Daisy %K hobbies %K Life Expectancy %K Mental Health %K Self Report %X

Growing aging populations pose a threat to global health because of the social and psychological challenges they experience. To mitigate this, many countries promote hobby engagement to support and improve mental health. Yet, it remains unclear whether there is consistency in benefits across different national settings. We harmonized measures of hobby engagement and multiple aspects of mental wellbeing across 16 nations represented in five longitudinal studies (N = 93,263). Prevalence of hobby engagement varied substantially across countries, from 51.0% of Spanish respondents to 96.0% of Danish respondents. Fixed effects models and multinational meta-analyses were applied to compare the longitudinal associations between hobbies and mental wellbeing. Independent of confounders, having a hobby was associated with fewer depressive symptoms (pooled coefficient = -0.10; 95% confidence intervals (CI) = -0.13, -0.07), and higher levels of self-reported health (pooled coefficient = 0.06; 95% CI = 0.03, 0.08), happiness (pooled coefficient = 0.09; 95% CI = 0.06, 0.13) and life satisfaction (pooled coefficient = 0.10; 95% CI = 0.08, 0.12). Further analyses suggested a temporal relationship. The strength of these associations, and prevalence of hobby engagement, were correlated with macrolevel factors such as life expectancy and national happiness levels but overall, little variance in findings was explained by country-level factors (<9%). Given the relative universality of findings, ensuring equality in hobby engagement within and between countries should be a priority for promoting healthy aging.

%B Nature Medicine %V 29 %P 2233-2240 %G eng %N 9 %R 10.1038/s41591-023-02506-1 %0 Journal Article %J International Studies of Economics %D 2023 %T How do subjective mortality beliefs affect the value of social security and the optimal claiming ages? %A Dai, Tiantian %A Sun, Wei %A Webb, Anthony %K Annuity %K Life Expectancy %K Social Security %K subjective mortality beliefs %K variance of age of death %X Households that postpone claiming Social Security benefits are, in effect, making additional purchases of the Social Security annuity and acquiring valuable longevity insurance. This paper investigates the impact of plausible variations of subjective mortality beliefs on the value of delayed claiming and the optimal claiming ages of retired workers. Using the Health and Retirement Study data, we show that older individuals could, on average, predict their life expectancy correctly; however, the average variance of age of death calculated from subjective mortality tables is 6.2%–14.4% lower than that from cohort life tables. Using numerical optimization techniques, we further show that, theoretically, older households place a lower value on delaying claiming when they have greater confidence in their ability to forecast their age of death. But the magnitude of this effect is not large enough to change their optimal claiming ages, unless they hold extreme subjective mortality beliefs. As a result, we conclude that subjective mortality beliefs alone cannot explain the prevalence of early claiming behaviors. © 2023 The Authors. International Studies of Economics published by John Wiley & Sons Australia, Ltd on behalf of Shanghai University of Finance and Economics. %B International Studies of Economics %G eng %R 10.1002/ise3.69 %0 Generic %D 2023 %T Inequalities in disability-free and disabling multimorbid life expectancy in Costa Rica, Mexico, and the United States %A Anastasia A. Lam %A Katherine Keenan %A Genevieve Cezard %A Hill Kulu %A Mikko Myrskylä %K Ageing %K Chronic Diseases %K Costa Rica %K Developing Countries %K Inequality %K Life Expectancy %K Mexico %K USA %X Existing research on multimorbidity (two or more co-existing chronic diseases) has mainly been cross-sectional, prevalence-based, and from high-income countries, although rates of chronic diseases and related mortality are highest in low- and middle-income countries. There is also a lack of research comparing countries at varying levels of development to determine how multimorbidity progression might differ. This study uses longitudinal data from Costa Rica, Mexico, and the United States and an incidence-based multistate Markov approach to estimate multimorbid life expectancy (MMLE): the years someone is expected to live with multimorbidity. We disaggregate MMLE into disability-free and disabling states to understand severity progression and stratify models by gender and education to study within-country heterogeneity. Individuals from Costa Rica have the lowest MMLE, followed by those from Mexico, then the United States. Individuals from the United States spend about twice as long with disability-free MMLE compared to others. Women generally have higher MMLE than men across countries. In the United States, disability-free MMLE increases and disabling MMLE decreases with education. This study found widespread MMLE inequalities in gender, education, and disability status. More attention must be paid to the drivers of these disparities, such as life course and health system differences across contexts. %G eng %R 10.4054/MPIDR-WP-2023-002 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2023 %T Inequalities in Retirement Life Span in the United States. %A Shi, Jiaxin %A Dudel, Christian %A Monden, Christiaan %A van Raalte, Alyson %K Aged %K Educational Status %K Employment %K Female %K Humans %K Life Expectancy %K Life Tables %K Longevity %K Male %K Middle Aged %K Retirement %K United States %X

OBJECTIVES: The length of retirement life may be highly unequal due to persistent and significant discrepancies in old-age mortality. This study assesses gender and educational differences in the average retirement life span and the variation in retirement life span, taking into account individual labor force exit and reentry dynamics.

METHODS: We used longitudinal data from the Health and Retirement Study from 1996 to 2016, focusing on respondents aged 50 and older (N = 32,228). Multistate life tables were estimated using discrete-time event history models. The average retirement life span, as well as absolute and relative variation in retirement life span, were calculated analytically.

RESULTS: Among women, we found a persistent educational gradient in average retirement life span over the whole period studied; among men, the relationship between education and retirement expectancy differed across periods. Women and the lower-educated had higher absolute variation in retirement life span than men and the higher-educated-yet these relationships were reversed when examined by relative variation.

DISCUSSION: Our multistate approach provides an accurate and comprehensive picture of the retirement life span of older Americans over the past two decades. Such findings should be considered in high-level discussions on Social Security. Potential reforms such as raising the eligibility age or cutting benefits may have unexpected implications for different social groups due to their differential effects on retirement initiation and reentry dynamics.

%B J Gerontol B Psychol Sci Soc Sci %V 78 %P 891-901 %8 2023 May 11 %G eng %N 5 %R 10.1093/geronb/gbac180 %0 Journal Article %J Population Research and Policy Review %D 2023 %T Life, Longevity, and the Pursuit of Happiness: The Role of Disability in Shaping Racial and Sex Disparities in Living a Long and Happy Life %A Bardo,Anthony R. %A Cummings,Jason L. %K Activities of Daily Living %K Black People %K Black white differences %K Black women %K Business And Economics–Economic Situation And Conditions %K Data quality %K Demographers %K Demography %K Disability %K Disadvantaged %K Gender Differences %K Happiness %K health %K Inequality %K Intersectionality %K Life Expectancy %K Life span %K limitations %K Longevity %K Marital Status %K Men %K Older people %K Peers %K Quality of Life %K race %K Racial differences %K Racial inequality %K Retirement %K Severity %K Sex differences %K Subjective well-being %K Wealth %K women %X Disability-free life expectancy is a common measure used by demographers to gauge quantity and quality of life. Yet, the extent to which positive dimensions of quality of life differ by disability status remains unexplored. Using data from the Health and Retirement Study (N = 16,614), we estimated happy life expectancy by age, race, sex, and severe Activities of Daily Living (ADL) limitations. First, results show that happy life expectancy differed substantially by disability status, as older adults with severe ADL limitations experienced 50–60% fewer remaining years of their life happy compared to their more able-bodied peers. Second, healthy Black women and men at age fifty can expect to live five fewer years of their remaining life happy compared to their White peers, but there were no significant race or sex differences among individuals with severe ADL limitations. Finally, the racial gap in Happy Life Expectancy between Black and White women was largely accounted for by group differences in marital status, education, and wealth, but Black men continued to be disadvantaged compared to their White peers. Implications of this study point to a need to critically examine the intersections of race and sex to develop a clearer portrait of the pattern and underlying factors associated with social disparities in longevity and quality of life. Findings highlight the importance of considering positive dimensions of quality of life alongside measures of illness, disability, or disease when determining whether we are adding life to years or just years to life. %B Population Research and Policy Review %V 42 %P 72 %@ 01675923 %G eng %U https://proxy.lib.umich.edu/login?url=https://www.proquest.com/scholarly-journals/life-longevity-pursuit-happiness-role-disability/docview/2849184861/se-2 %0 Web Page %D 2023 %T Multiple periods of loneliness may add up to higher mortality risk %A Kim North Shine %K Life Expectancy %K Loneliness %K mortality risk %I Michigan News, University of Michigan %G eng %U https://news.umich.edu/multiple-periods-of-loneliness-may-add-up-to-higher-mortality-risk/ %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2023 %T Racial-Ethnic Disparities in Dual-Function Life Expectancy. %A Bauldry, Shawn %A Thomas, Patricia A %A Sauerteig-Rolston, Madison R %A Ferraro, Kenneth F %K Life Expectancy %X

BACKGROUND: This study develops a new concept, dual functionality, that integrates physical and cognitive function. We use the concept to define a measure of dual-function life expectancy and assess racial-ethnic inequalities in aging.

METHODS: Drawing on data from the National Health Interview Study Linked Mortality Files and the Health and Retirement Study, we define dual functionality as having no limitations in activities of daily living and being free of dementia. We use this measure and Sullivan life tables to estimate age-50 total life expectancy and age-50 dual-function life expectancy (2FLE) for women and men across four racial-ethnic and nativity groups.

RESULTS: At ages 50 to 54, between 79.0% (95% CI: 73.5, 84.5) and 87.6% (95% CI: 84.0, 91.2) of (non-Hispanic) Black, foreign-born Hispanic, and US-born Hispanic women and men remain dual functional as compared with 90.4% (95% CI: 89.3, 91.4) and 91.4% (95% CI: 90.2, 92.5) of (non-Hispanic) White women and men respectively. These and corresponding racial-ethnic disparities in dual functionality through ages 85 and older translate into substantial inequalities in 2FLE. For instance, the Black-White gap in age-50 2FLE is 6.9 years (95% CI: -7.5, -6.4) for women and 6.0 years (95% CI: -6.6, -5.4) for men.

CONCLUSIONS: Black, foreign-born Hispanic, and US-born Hispanic older adults are estimated to live a smaller percentage of their remaining years with dual functionality than White older adults. These results reveal stark racial-ethnic inequalities in aging that have significant implications for quality of life, caregiving, and health needs.

%B J Gerontol A Biol Sci Med Sci %8 2023 Feb 17 %G eng %R 10.1093/gerona/glad059 %0 Web Page %D 2023 %T Study: Mid-life loneliness serves as risk factor for death later %A Fischer, Kristen %K COVID-19 %K Life Expectancy %K Loneliness %I McKnights %G eng %U https://www.mcknights.com/news/clinical-news/study-mid-life-loneliness-serves-as-risk-factor-for-death-later/ %0 Report %D 2023 %T What Matters for Annuity Demand: Objective Life Expectancy or Subjective Survival Pessimism? %A Arapakis, Karolos %A Gal Wettstein %K Annuity %K Life Expectancy %K Survival expectation %X Objective life expectancy and subjective survival pessimism (defined as the difference between objective and subjective life expectancy) may both affect the demand for annuities. The question this project answers is: how do these two explanations contribute to annuitization decisions in practice? To explore this question, the analysis estimates regression models that include objective life expectancy, subjective survival pessimism, and other characteristics that are linked to annuitization decisions. The results show that, as one would expect, individuals with higher objective life expectancy are more likely to buy an annuity. Similarly, less pessimistic individuals are also more likely to buy an annuity. A one-year rise in objective life expectancy increases the probability of buying an annuity product by 0.20 percentage points, which is nearly nine times larger than a one-year decline in pessimism. %B Working Papers %I Center for Retirement Research at Boston College %G eng %U https://crr.bc.edu/working-papers/what-matters-for-annuity-demand-objective-life-expectancy-or-subjective-survival-pessimism/ %0 Web Page %D 2023 %T Whose Life Expectancy Views Drive Annuity Sales? %A Bell, Allison %K Annuity %K consumer spending %K Life Expectancy %I ThinkAdvisor %G eng %U https://www.thinkadvisor.com/2023/01/30/how-life-expectancy-perceptions-impact-annuity-purchases/ %0 Web Page %D 2022 %T Academic Study Finds Reparations to Black Americans Would Narrow Racial Health Gap, Increase Life Expectancy %A Himmelstein, Kathryn %K Black Americans %K health gap %K Life Expectancy %K race %K reparations %I Newswires %G eng %U https://www.einnews.com/pr_news/599990877/academic-study-finds-reparations-to-black-americans-would-narrow-racial-health-gap-increase-life-expectancy %0 Journal Article %J The American Journal of Epidemiology %D 2022 %T 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. %A Payne, Collin F %A Lindsay C Kobayashi %K Cancer %K Disability %K Life Expectancy %K microsimulation modeling %X

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.

%B The American Journal of Epidemiology %V 191 %P 104-114 %G eng %N 1 %R 10.1093/aje/kwab241 %0 Web Page %D 2022 %T If your mother was pregnant during the Great Depression, years might have been taken off your life by the economy, study says %A Prater, Erin %K Aging %K economic stress %K Great Depression %K Life Expectancy %K Pregnancy %I Fortune %G eng %U https://fortune.com/well/2022/11/10/aging-study-die-sooner-age-faster-live-shorter-study-economy-epigenetic-dna-methylation-clock-age/ %0 Journal Article %J Journal of Aging and Health %D 2022 %T The Impact of Caregiving Intensity and Religiosity on Spousal Caregivers' Health and Mortality in the US (2004-2014). %A Koumoutzis, Athena %A Mehri, Nader %K caregiver well-being %K Life Expectancy %K Religion %X

OBJECTIVES: Despite adverse physical and mental health outcomes related to caregiving, family caregivers also experience lower mortality rates compared to noncaregivers. However, research has not yet examined the role of caregiving intensity and religiosity with health and mortality among spousal caregivers.

METHODS: Data include spousal caregivers (=5,214 person-wave observations) and noncaregivers (=50,311 person-wave observations) from the Health and Retirement Study (2004-2014 waves). Multinomial logistic regression was used to explore how caregiving intensity and religiosity were associated with health and mortality among spousal caregivers, compared health and mortality between caregivers and noncaregiving peers, and examined gender differences in these mechanisms.

RESULTS: Greater religious salience and attending religious services, although dependent on gender and caregiving intensity, are protective for caregivers' health and mortality.

DISCUSSION: Religiosity may buffer adverse effects of caregiving on health and mortality for spousal caregivers. Continuation of prior religiosity may enhance positive aspects of caregiving and decrease caregiver burden.

%B Journal of Aging and Health %V 34 %P 640-652 %G eng %N 4-5 %R 10.1177/08982643211052725 %0 Web Page %D 2022 %T Life Expectancy Tool May Improve Quality of Life for Patients With Dementia %A Leigh, Suzanne %K Dementia %K Life Expectancy %K Quality of Life %B News %I University of California, San Francisco %C San Francisco, CA %G eng %U https://www.ucsf.edu/news/2022/09/423821/life-expectancy-tool-may-improve-quality-life-patients-dementia#:~:text=Life%20Expectancy%20Tool%20May%20Improve%20Quality%20of%20Life%20for%20Patients%20With%20Dementia,-UCSF%2DLed%20Study&text=A%20mortality%20pre %0 Journal Article %J Demography %D 2022 %T Loneliness at Older Ages in the United States: Lonely Life Expectancy and the Role of Loneliness in Health Disparities. %A Raymo, James M %A Wang, Jia %K health %K Health Disparities %K Life Expectancy %K Loneliness %X

We provide an empirical foundation for research on the demography of loneliness at older ages. First, we use published life tables and data from the U.S.-based Health and Retirement Study for the period 2008-2016 to calculate lonely life expectancy for Americans aged 55 or older. Using Sullivan's method, we demonstrate pronounced differences in lonely life expectancy by sex, race/ethnicity, and educational attainment that correspond to well-established patterns of stratification in other dimensions of well-being. Next, we estimate models that decompose observed sex, racial/ethnic, and educational differences in three key health outcomes into the part explained (in a statistical accounting sense) by loneliness and the part accounted for by other factors. We find little evidence of an important role for loneliness in understanding disparities in mortality and the onset of physical disability and cognitive impairment among Americans aged 55 or older, net of several established correlates of health disparities. These descriptive findings provide an empirical foundation for continued development of a demography of loneliness at older ages in response to the anticipated growth in scientific and policy emphasis on loneliness and the fundamental life changes that have accompanied the COVID-19 pandemic.

%B Demography %V 59 %P 921-947 %G eng %N 3 %R 10.1215/00703370-9937606 %0 Journal Article %J Reviews in Endocrine and Metabolic Disorders %D 2022 %T Mortality and morbidity in ageing men: Biology, Lifestyle and Environment. %A Zhao, Erfei %A Eileen M. Crimmins %K Cholesterol %K Diabetes %K Epigenetic aging %K gender %K Heart disease %K Hypertension %K Life Expectancy %K sex %K Stroke %X

Males live shorter lives than women in all countries. The universality of shorter male life expectancy is a 21st Century phenomena. It occurs with the decline in infectious diseases and the rise in cardiovascular diseases accounting for mortality. Male/female differences in morbidity are not as succinctly characterized. Men have a higher prevalence of lethal diseases, which is linked to their lower life expectancy. Women have more non-lethal conditions such as depression and arthritis; which may also be linked in part to longer survival. Men have better physical functioning and less disability which is partly explained by gender differences in diseases and also by their greater strength, size, and stamina. Gender differences in risk factors for disease have changed over time with the prevalence and treatment of risk as well as differential behavior by gender. Examination of what are seen as basic molecular and cellular measures related to aging indicates men age faster than women; however, even these basic biological measures result from a combination of biology, behavior, and social factors.

%B Reviews in Endocrine and Metabolic Disorders %V 23 %P 1285-1304 %G eng %N 6 %R 10.1007/s11154-022-09737-6 %0 Journal Article %J The Journals of Gerontology, Series B %D 2022 %T Older adults in the US have worse cardiometabolic health compared to England. %A Pongiglione, Benedetta %A Ploubidis, George %A Jennifer B Dowd %K cardiometabolic health %K Diabetes %K ELSA %K HDL cholesterol %K Inflammation %K Life Expectancy %X

Explanations for lagging life expectancy in the US compared to other high-income countries have focused largely on "deaths of despair," but attention has also shifted to the role of stalling improvements in cardiovascular disease and the obesity epidemic. Using harmonized data from the US Health and Retirement Study (HRS) and English Longitudinal Study of Ageing (ELSA), we assess differences in self-reported and objective measures of health, among older adults in the U.S. and England and explore whether the differences in Body Mass Index (BMI) documented between the US and England explain the US disadvantage. Older adults in the US have a much higher prevalence of diabetes, low HDL cholesterol, and high inflammation (CRP) compared to English adults. While the distribution of BMI is shifted to the right in the US with more people falling into extreme obesity categories, these differences do not explain the cross-country differences in measured biological risk. We conclude by considering how country differences in health may have impacted the burden of Covid-19 mortality in both countries.

%B The Journals of Gerontology, Series B %V 77 %P S167-S176 %G eng %N Supplement_2 %R 10.1093/geronb/gbac023 %0 Book Section %B New Models for Managing Longevity Risk: Public-Private Partnerships %D 2022 %T Perceptions of Mortality: Individual assessment of longevity risk %A Kathleen McGarry %A Olivia S. Mitchell %K Life Expectancy %K Mortality %K Survival %B New Models for Managing Longevity Risk: Public-Private Partnerships %I Oxford University Press %@ 978–0–19–285980–8 %G eng %& 2 %R 10.1093/oso/9780192859808.001.0001 %0 Journal Article %J The Journals of Gerontology: Series B %D 2022 %T Racial/Ethnic and Educational Disparities in the Impact of Diabetes on Population Health Among the U.S.-Born Population %A Zang, Emma %A Scott M Lynch %A Liu, Chen %A Lu, Nancy %A Banas, Julia %K Diabetes %K Education %K Health Disparities %K Life Expectancy %K Race/ethnicity %X

OBJECTIVES: This study examines total life expectancies (TLE) for both healthy and diabetic US-born populations and two measures capturing quality of life: 1) the proportion of remaining life to be spent without either other chronic conditions or ADL disabilities (ADLs), and 2) the proportion of remaining life to be spent with ADLs for US-born diabetic populations by race/ethnicity and educational attainment.

METHODS: Using the 1998-2014 waves of the Health and Retirement Study (n=16,983), we apply a Bayesian multistate life table method to calculate these quantities from the constructed life tables.

RESULTS: TLE at age 50 is shorter for diabetic individuals than healthy individuals, for non-Hispanic Blacks than members of other racial/ethnic groups, and for less-educated individuals. Gaps in TLE at age 50 between healthy and diabetic populations range from 6.3 to 8.8 years across sex-race combinations, and 5.6 to 9.2 years across sex-education combinations. Among the diabetic population, those with at least a college degree on average have a higher proportion of remaining life to be spent without either other chronic conditions or ADLs. Hispanics and those without a college degree have a particularly high proportion of remaining life to be spent with ADLs. Although diabetic women on average live longer than men, their quality of life tends to be lower.

DISCUSSION: The impact of diabetes on population health varies across racial/ethnic and educational groups. The findings support targeted interventions for vulnerable groups, such as people of color, women, and less-educated individuals.

%B The Journals of Gerontology: Series B %V 77 %P 1519-1528 %G eng %N 8 %R 10.1093/geronb/gbab149 %0 Journal Article %J Innovation in Aging %D 2022 %T REACHING THE LIMIT: CENTENARIANS IN THE HEALTH AND RETIREMENT STUDY %A Martin, Peter %A Jennifer A Ailshire %K centenarian survivors %K Life Expectancy %X Although life expectancy has increased significantly over the last century, it is still unlikely that individuals reach the century mark of their lives. As a result, it is difficult to study a large enough sample of centenarian survivors; it is even more difficult to follow developmental trajectories of those who survive into very late life. The AHEAD sample of the Health and Retirement Study (HRS) contains longitudinal data of older adults who first participated in 1993. More than 500 HRS participants survived to at least 98 years of age. In this symposium, we present three uses of the data: first, we compare centenarians to older adults who did not survive into their nineties. Second, we compare different cohorts of centenarians with regard to health and psychosocial behavior. Third, we follow participants from their eighties to 100 years of age. The first presentation provides an overview of the HRS subsample. The second presentation highlights the personality profiles of centenarians. The third presentation traces health and psychological well-being among centenarians in the HRS. Finally, we discuss trajectories of cognition and functional limitations for three cohorts of centenarians. The results provide important information for policies and practical implications for families and service providers to older adults, highlighting available resources and health and well-being changes in very late life. %B Innovation in Aging %V 6 %P 304 %G eng %N Suppl 1 %R 10.1093/geroni/igac059.1202 %0 Web Page %D 2022 %T Underestimating Longevity Risk %A McCarthy, Ed %K Life Expectancy %K longevity risk %K Retirement %I planadviser %G eng %U https://www.planadviser.com/exclusives/decumulation-is-personal/ %0 Web Page %D 2022 %T When saving for retirement, seniors overestimate market volatility and underestimate life expectancy %A Paul, Trina %K Life Expectancy %K Retirement %K Saving %I CNBC %G eng %U https://www.cnbc.com/select/seniors-overestimate-market-volatility-when-saving-for-retirement/ %0 Report %D 2021 %T The Consequences of Current Benefit Adjustments for Early and Delayed Claiming %A Andrew G. Biggs %A Anqi Chen %A Alicia H. Munnell %K interest rates %K Life Expectancy %K Social Security claiming %X Workers have the option of claiming Social Security retirement benefits at any age between 62 and 70, with later claiming resulting in higher monthly benefits. These higher monthly benefits reflect an actuarial adjustment designed to keep lifetime benefits equal, for an individual with average life expectancy, regardless of when benefits are claimed. The actuarial adjustments, however, are decades old. Since then, interest rates have declined; life expectancy has increased; and longevity improvements have been much greater for high earners than low earners. This paper explores how changes in longevity and interest rates have affected the fairness of the actuarial adjustment over time and how the disparity in life expectancy affects the equity across the income distribution. It also looks at the impact of these developments on the costs of the program and the progressivity of benefits. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston, MA %G eng %U https://crr.bc.edu/working-papers/the-consequences-of-current-benefit-adjustments-for-early-and-delayed-claiming/ %0 Journal Article %J The Journals of Gerontology: Series B %D 2021 %T Demographic and Socioeconomic Disparities in Life Expectancy with Hearing Impairment in the U.S. %A Jessica S West %A Scott M Lynch %K Aging %K Bayesian multistate life table methods %K Hearing impairment %K Life Expectancy %X Hearing impairment is one of the most common disabilities among older people, and its prevalence will increase as the U.S. population ages. However, little is known about social disparities in onset or transitions into and out of hearing impairment, nor how these transitions impact years of life to be spent impaired. We investigate the number of years an “average” person can expect to live with and without hearing impairment after age 50; sex, race, educational, and regional differences in these expectancies; and the implication of hearing impairment for remaining life expectancy. Bayesian multistate life table methods are applied to 9 waves of data from the Health and Retirement Study (1998-2014) to investigate social disparities in life expectancy with hearing impairment (n=20,200) for the general population, people hearing impaired at age 50, and people hearing unimpaired at age 50. Men, Hispanics, persons with less educational attainment, and those born in the south can expect to live a larger proportion of their remaining lives hearing impaired. Although transitions from hearing impaired to unimpaired occur, those with some hearing impairment at age 50 can expect to live more years with hearing impairment, and hearing impairment does not shorten remaining life expectancy. Significant sociodemographic disparities in hearing impaired life expectancy exist. In contrast to past research, we find that hearing impairment does not affect total life expectancy. Future research should consider the consequences of hearing impairment for years to be lived with other age-related and potentially downstream health outcomes. %B The Journals of Gerontology: Series B %V 76 %P 944-955 %@ 1079-5014 %G eng %N 5 %R 10.1093/geronb/gbaa166 %0 Journal Article %J Journal of Aging and Health %D 2021 %T Disability in Childhood, Special Education Histories, and Lifetime Health Outcomes in the United States %A Laditka, Sarah B. %A Laditka, James N. %A Hoyle, Jessica N. %K dependency %K developmental delay %K developmental disability %K Life Expectancy %K Mortality %X Objectives: We evaluated special education as an indicator of childhood disability and used that indicator to estimate lifetime dependency and life expectancy. Methods: Data: Panel Study of Income Dynamics and Health and Retirement Study (n = 20,563). Dependency: Nursing home care or equivalent. Analysis: We first analyzed special education as an indicator of childhood disability; multinomial logistic Markov models and microsimulation then compared populations with and without childhood disability. Results: Special education history was a valid indicator of childhood disability. For example, with parents who did not complete high school, 3.8% with no special education history were dependent at least 5 years of adult life; that result with special education was 15.2%. Life expectancy from age 20 was 58.3 years without special education, 46.0 years with special education (both p < .05). Discussion: Special education history can indicate childhood disability. People with that history had significantly a more dependency than others and significantly shorter lives. %B Journal of Aging and Health %V 33 %P 919-930 %@ 0898-2643 %G eng %N 10 %R 10.1177/08982643211018918 %0 Journal Article %J The Gerontologist %D 2021 %T Educational Benefits and Cognitive Health Life Expectancies: Racial/Ethnic, Nativity, and Gender Disparities %A Marc Garcia %A Brian Downer %A Chi-Tsun Chiu %A Joseph L Saenz %A Ortiz, Kasim %A Rebeca Wong %K cognitive impairment %K Dementia %K Life Expectancy %K nativity %K Race/ethnicity %X To examine racial/ethnic, nativity, and gender differences in the benefits of educational attainment on cognitive life expectancies among older adults in the United States.We used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively healthy, cognitively impaired/no dementia (CIND), and dementia life expectancies by gender for older White, Black, U.S.-born and foreign-born Hispanic adults with less than high school, high school, and some college or more.White respondents lived a greater percentage of their remaining lives cognitive healthy than their minority Black or Hispanic counterparts, regardless of level of education. Among respondents with some college or more, versus less than high school, Black and U.S.-born Hispanic women exhibited the greatest increase (both 37 percentage points higher) in the proportion of total life expectancy spent cognitively healthy; whereas White women had the smallest increase (17 percentage points higher). For men, the difference between respondents with some college or more, versus less than high school, was greatest for Black men (35 percentage points higher) and was lowest for U.S.-born Hispanic men (21 percentage points higher).Our results provide evidence that the benefits of education on cognitive life expectancies are largest for Black men and women, and U.S.-born Hispanic women. The combination of extended longevity and rising prevalence of Alzheimer’s disease point to the need for understanding why certain individuals spend an extended period of their lives with poor cognitive health. %B The Gerontologist %V 61 %P 330-340 %@ 0016-9013 %G eng %N 3 %R 10.1093/geront/gnaa112 %0 Thesis %B Sociology %D 2021 %T Educational Disparities in Chronic Pain and Life Expectancy: Gaps and Pathways %A Luo, Wei %K Chronic pain %K educational disparities %K Life Expectancy %X Chronic pain is a debilitating and costly health condition that affects a large number of people in the United States. The distribution of chronic pain is not universal in the population, with less educated individuals disproportionately suffering from chronic pain and bearing related adverse health consequences. This dissertation aims to provide evidence on the full causal chain between education, chronic pain, and mortality. In the second chapter, the association between education and different types of chronic pain is investigated. Moreover, mediation analyses are performed to unveil the factors that underlie the association. In the third chapter, the influence of chronic pain on certain health-compromising behaviors that are known to have an enormous impact on life expectancy is explored. Using a matching technique, this chapter distinguishes itself from prior studies by arguing for a causal relationship between chronic pain and changes in health behaviors. While the aforementioned causal chain may be indirectly inferred from the above two chapters, the fourth chapter directly tests the relationship using survival analyses and, through a multivariable mediation analysis method, quantifies the unique contribution of chronic pain to educational gradients in life expectancy. The datasets used in this dissertation come from the National Health Interview Survey (NHIS) (for chapter two) and the Health and Retirement Study (HRS) (for chapter three and four). %B Sociology %I State University of New York at Buffalo %V Ph.D. %G eng %U https://www.proquest.com/docview/2634625856/fulltextPDF/AEAB435E0BFF4E30PQ/1?accountid=14667 %0 Report %D 2021 %T Functional disability with systematic trends and uncertainty: A comparison between China and the U.S. %A Fu, Yu %A Sherris, Michael %A Xu, Mengyi %K functional disability %K Life Expectancy %K multi-state latent factor intensity model %K systematic trend and uncertainty %X China and the U.S. are two contrasting countries in terms of functional disability and long-term care. China is experiencing declining family support for long-term care and developing private long-term care insurance. The U.S. has more developed public aged care and private long-term care insurance than in China. Changes in the demand for longterm care are closely related to levels of and trends in mortality and functional disability. To understand future potential demand for long-term care, we compare mortality and functional disability experiences in both China and the U.S. using a multi-state latent factor intensity model to estimate time trends and systematic uncertainty in transition rates. The estimation results show that if trends continue, both countries will experience longevity improvement with morbidity compression and a declining proportion of the older population with a functional disability. Although the elderly Chinese have an estimated shorter life expectancy, they are expected to spend a smaller proportion of that future lifetime functionally disabled in contrast to the U.S. Systematic uncertainty is shown to be significant in future trends in disability rates and our model estimates higher uncertainty in trends for the Chinese elderly, especially for urban residents. %B CEPAR Working Paper %I ARC Centre of Excellence in Population Ageing Research %G eng %U https://www.cepar.edu.au/sites/default/files/WP2021_21_Functional_disability.pdf %0 Journal Article %J SSM - Population Health %D 2021 %T Socioeconomic status across the life course and dementia-status life expectancy among older Americans %A Hyungmin Cha %A Mateo P Farina %A Mark D Hayward %K Dementia %K Life Expectancy %K Mortality %K socioeconomic status %X This study examines how socioeconomic status (SES) across the life course is associated with individuals’ lifetime dementia experience – the years of life persons can expect to live and without with dementia. Conceptually, dementia-free life expectancy reflects the ability to postpone dementia onset while dementia life expectancy reflects the average lifetime period with the condition. How SES across the life course contributes to dementia-status life expectancy is the focus of this study. We assess whether persons who are advantaged in their lifetime SES live the most years without dementia and the fewest years with dementia compared to less advantaged persons. Using the Health and Retirement Study (2000–2016), we examine these questions for U.S. adults aged 65 and older using multistate life tables and a microsimulation approach. The results show that higher SES persons can expect to live significantly more years of life without dementia and that the period of life with dementia is compressed compared to less advantaged persons. The results also underscore that importance of cumulative exposure, showing that adults from disadvantaged childhoods who achieve high education levels often have dementia experiences that are similar to or better than those of adults from advantaged childhoods who achieved low education levels. %B SSM - Population Health %V 15 %P 100921 %G eng %R 10.1016/j.ssmph.2021.100921 %0 Journal Article %J Innovation in Aging %D 2020 %T Age of Migration and Cognitive Life Expectancies Among Older Latinos: Evidence From the Health and Retirement Study %A Marc Garcia %K Cognition %K Latinos/Hispanics %K Life Expectancy %X This study used data from the Health and Retirement Study (1998-2014) to estimate Sullivan-based life tables of cognitively intact, cognitively impaired/no dementia (CIND), and dementia life expectancies by nativity, age of migration, and sex for older Latinos residing in the United States. Results show foreign-born Latinos, regardless of age of migration or sex, spend a greater number of years after age 50 with CIND compared to U.S.-born Latinos. Furthermore, we document an advantage in total life expectancy and cognitively intact life expectancy among mid-life immigrant men relative to their U.S.-born counterparts. The robust relationship between nativity, age of migration, and cognitive health suggests that the foreign-born may place particularly serious burdens on families and the government. This issue merits special attention in the development of community-based long-term care programs to appropriately target the specific needs of different subgroups of older Latinos who are entering into their last decades of life. %B Innovation in Aging %V 4 %P 574 %@ 2399-5300 %G eng %N Suppl 1 %R 10.1093/geroni/igaa057.1904 %0 Journal Article %J International Journal of Behavioral Development %D 2019 %T The effects of subjective life expectancy on volunteerism in older adults %A Kyuho Lee %A Dahee Kim %A Megan Gilligan %A Peter Martin %K Life Expectancy %K Volunteering %X Previous studies used chronological age to examine the relationship between aging and volunteerism. In the current study, we examined the influence of subjective life expectancy (SLE) on volunteering based on the socioemotional selectivity theory emphasizing that older adults focus on very close relationships. Data of 11,203 older adults, 55 to 74 years old (M = 65.0, SD = 5.6), from five waves (2006–2014) of the Health and Retirement Study were included. Growth curve modeling results showed that older adults with higher SLE scores at baseline not only spent more time volunteering but also showed a slower decrease in volunteering over time. Furthermore, changes in older adults’ SLE were associated with a change in volunteering. The findings may show the relative importance of close relationships and social activities for older adults and contribute to demystifying the differences shown in the volunteer participation among older adults. %B International Journal of Behavioral Development %V 43 %P 342-350 %G eng %U https://doi.org/10.1177/0165025419830238 %R 10.1177/0165025419830238 %0 Thesis %B Economics %D 2019 %T The Impact of Medicare Part D on Mortality and Financial Stability %A Toran, Katherine %K Economics %K Health Economics %K Health Insurance %K Life Expectancy %K Medicare Part D %K Public Economics %K Racial Disparities %X Using the Health and Retirement Study Panel core files from 1996 to 2014, I analyze how Medicare Part D impacted access to prescription drug coverage by various demographic factors such as race, gender, and income. In Chapter 1, I find the highest take-up rates for those who were white, female, and with higher incomes. However, increases in coverage were high across the board, such that Medicare Part D also improved drug insurance coverage for those who were black, male, and with lower income. Thus, although Medicare Part D did increase prescription drug insurance coverage for seniors across the board, I also find potential for improvement in enrollment for difficult-to-reach groups. Next, Chapter 2 examines the impact of Medicare Part D on mortality. Although I do not find an impact on the life expectancy of respondents as a whole, I do find a significant positive effect for black respondents, indicating that Medicare Part D may have mattered more for disadvantaged groups. The largest impact is for black men, who have an additional 9 percentage point chance of living to age 73 for an additional 8 years of coverage (significant at the 5% level). When looking only at cardiovascular mortality, which is more likely to be influenced by drug coverage, I find improvements in life expectancy for the total population, with stronger effects for minorities and men. Overall, my findings suggest that Medicare Part D did move the needle on its goal: to improve the health of those who, without government intervention, had the most difficulty paying for prescription drugs. Chapter 3 looks at the impact of Medicare Part D prescription drug coverage on cost-related medication adherence, food insecurity, and finances among seniors. It would be reasonable to assume that Medicare Part D, which led to near-universal drug coverage among senior citizens, could allow seniors to shift money previously spent on drug expenditures to other areas. The strongest effect of Medicare Part D is on cost-related medication nonadherence, leading to a 21% decrease for an additional 8 years of Medicare Part D coverage. The impact is even stronger for the black male population (30%). I fail to reject the null hypothesis that Medicare Part D did not reduce food insecurity or household debt. Overall, Medicare Part D appears to have improved the financial stability of seniors. %B Economics %I University of Kentucky %C Lexington, United States %V Doctor of Philosophy %P 168 %8 2019 %G eng %U https://uknowledge.uky.edu/economics_etds/45/ %R https://doi.org/10.13023/etd.2019.325 %0 Newspaper Article %B Prince George Citizen %D 2019 %T Poverty report links wealth to life expectancy %K americans %K Bernard %K compounded %K divide %K General Interest Periodicals–United States %K Home ownership %K Households %K Income distribution %K Life Expectancy %K Mongolia %K Sanders %K stark %K survive %K United States–US %K Virginia %K West Virginia %X Poorer Americans are much less likely to survive into their 70s and 80s than rich Americans, a stark lifeexpectancy divide compounded by the nation's growing disparities in wealth, according to a U.S. report. Over three-quarters of the richest 50-somethings in 1991 were still alive 23 years later, in 2014, the report found. But among the poorest 20 per cent of that cohort, the survival rate was less than 50 per cent, according to the analysis by the Government Accountability Office, a nonpartisan congressional research agency. The report finds that while average life expectancy increased over that period, it "has not increased uniformly across all income groups, and people who have lower incomes tend to have shorter lives than those with higher incomes." %B Prince George Citizen %C British Columbia %G eng %U https://proxy.lib.umich.edu/login?url=https://search.proquest.com/docview/2292028778?accountid=14667 %0 Report %D 2018 %T Life Expectancy and Life-Cycle Wages: Evidence from the Cardiovascular Revolution in U.S. States %A Rainer Kotschy %K Cardiovascular health %K life cycle %K Life Expectancy %K wages %X This paper exploits quasi-experimental variation in mortality from cardiovascular diseases across U.S. states to establish a positive causal link between adult life expectancy and average wages per worker. A cohort-specific analysis reveals that wage gains accrue to prime-age workers between 25 and 54 as well as old-age workers above 65. This pattern is consistent with a shift in life-cycle earnings toward a profile that increases more steeply for young ages and that flattens out more slowly at advanced ages. Health improvements, higher educational attainment, and changes in individual behavior constitute potential channels for this shift. %I PROGRAM ON THE GLOBAL DEMOGRAPHY OF AGING AT HARVARD UNIVERSITY %8 04/2018 %G eng %U https://www.hsph.harvard.edu/pgda/working/ %0 Web Page %D 2018 %T Loss of life savings is a killer, say researchers: Health Study [Europe Region] %A Cookson, Clive %K Cardiovascular disease %K Life Expectancy %K Mortality %K Savings %I Financial Times %C London, UK %V 2018 %G eng %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2018 %T The Potential Effects of Obesity on Social Security Claiming Behavior and Retirement Benefits. %A Michael D Hurd %A James P Smith %A Julie M Zissimopoulos %K Aged %K Female %K Humans %K Life Expectancy %K Male %K Obesity %K Pensions %K Poverty %K Social Class %K Social Security %K United States %X

OBJECTIVES: Obesity prevalence among Americans has increased for nearly three decades. We explore the relationship between the rise in obesity and Social Security retirement benefit claiming, a decision impacting nearly all aging Americans. Specifically, we investigate whether obesity can affect individuals' decision to claim benefits early, a choice that has important implications for financial security in retirement, particularly for those with lower socioeconomic status (SES).

METHOD: We use a microsimulation model called MINT6 (Modeling Income in the Near Term, version 6) to demonstrate the potential effects of obesity on subjective life expectancy and claiming behavior. We impute obesity status using data from the National Health and Nutrition Examination Survey (NHANES), which describes the distribution of obesity prevalence within the United States by gender, poverty status, and race/ethnicity.

RESULTS: We find that the rise in obesity and the consequent incidence of obesity-related diseases may lead some individuals to make claiming decisions that lead to lower monthly and lifetime Social Security retirement benefits. Further, we find that the potential economic impact of this decision is larger for those with lower SES.

DISCUSSION: We present a behavioral perspective by addressing the potential effects that obesity can have on individuals' retirement decisions and their resulting Social Security retirement benefits.

%B J Gerontol B Psychol Sci Soc Sci %I 19 %V 73 %P 723-732 %8 2018 Apr 16 %G eng %N 4 %L pubs_2004_Hurd_etal_JAE.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/27044665?dopt=Abstract %4 Social Security benefit claiming/Subjective Probabilities of Survival %$ 13622 %R 10.1093/geronb/gbw016 %0 Journal Article %J PLOS ONE %D 2018 %T Poverty dynamics, poverty thresholds and mortality: An age-stage Markovian model %A Bernstein, Shayna Fae %A David Rehkopf %A Tuljapurkar, Shripad %A Horvitz, Carol C. %E Komarova, Natalia L. %K Life Expectancy %K Mortality %K Poverty %K Socioeconomic factors %X Recent studies have examined the risk of poverty throughout the life course, but few have considered how transitioning in and out of poverty shape the dynamic heterogeneity and mortality disparities of a cohort at each age. Here we use state-by-age modeling to capture individual heterogeneity in crossing one of three different poverty thresholds (defined as 1×, 2× or 3× the “official” poverty threshold) at each age. We examine age-specific state structure, the remaining life expectancy, its variance, and cohort simulations for those above and below each threshold. Survival and transitioning probabilities are statistically estimated by regression analyses of data from the Health and Retirement Survey RAND data-set, and the National Longitudinal Survey of Youth. Using the results of these regression analyses, we parameterize discrete state, discrete age matrix models. We found that individuals above all three thresholds have higher annual survival than those in poverty, especially for mid-ages to about age 80. The advantage is greatest when we classify individuals based on 1× the “official” poverty threshold. The greatest discrepancy in average remaining life expectancy and its variance between those above and in poverty occurs at mid-ages for all three thresholds. And fewer individuals are in poverty between ages 40-60 for all three thresholds. Our findings are consistent with results based on other data sets, but also suggest that dynamic heterogeneity in poverty and the transience of the poverty state is associated with income-related mortality disparities (less transience, especially of those above poverty, more disparities). This paper applies the approach of age-by-stage matrix models to human demography and individual poverty dynamics. In so doing we extend the literature on individual poverty dynamics across the life course. %B PLOS ONE %V 13 %P e0195734 %8 Apr-05-2019 %G eng %U http://dx.doi.org/10.1371/journal.pone.0195734 %N 5 %! PLoS ONE %R 10.1371/journal.pone.0195734 %0 Journal Article %J Advances in Life Course Research %D 2018 %T Smoking, education and the ability to predict own survival probabilities %A Bruno Arpino %A Valeria Bordone %A Sergei Scherbov %K Education %K Life Expectancy %K Smoking %X Abstract Subjective survival probabilities (SSPs) are a good predictor of mortality, go beyond the aggregate description of survival defined by life tables, and are important for individuals’ decision-making in later life. However, despite the well-known mortality differentials by education as well as by characteristics such as smoking, little investigation has focused on SSPs by population sub-groups defined as a combination of these two characteristics. We use data on individuals aged 50–89 from the Health and Retirement Study (HRS) carried out in the USA between 2000 and 2012 (N = 23,895). Respondents were asked to assess the probability to survive to a given target age according to their age at the time of the survey. We assess how individuals’ SSPs and estimated objective survival probabilities (OSPs) vary by education and smoking and calculate, for each respondent, the gap between them. Consistently with real mortality patterns, smokers report the lowest SSPs in each of the three considered education groups. When comparing SSPs and OSPs we find that all groups tend to underestimate survival. Within each education group, past smokers better predict their survival probability. Current smokers with low education show the highest probability to overestimate their survival. Smokers are aware of their lower life expectancy. Still, a considerable proportion of them overestimate their survival probabilities, independently of their level of education. %B Advances in Life Course Research %V 37 %P 23-30 %G eng %R 10.1016/J.ALCR.2018.06.001 %0 Journal Article %J The B.E. Journal of Economic Analysis & Policy %D 2018 %T Widowhood and Retirement Timing: Evidence from the Health and Retirement Study %A Schreiber, Philipp %K Life Expectancy %K Retirement Age %K Social Security %K Widowhood %X The combination of an increasing life expectancy, low fertility rates, and an early effective retirement age creates a pressure to act for governments and organizations. The pay-as-you-go social security systems of many countries are troubled by the increasing ratio of retirees to working people. In addition, many organizations face difficulties caused by a shrinking workforce and the accompanied shortage of skilled workers. To counteract, it is essential to create an environment in which older workers are encouraged to stay in the workforce. Therefore, it is important to understand which factors influence the retirement timing decision of workers. This study analyzes how widowhood and changes in demographic, health-related, and financial factors lead to changes in retirement plans of Health and Retirement Study (HRS) respondents. I compare respondents’ actual retirement age with their retirement plans elicited in the HRS wave prior to retirement. The strongest change in retirement timing is caused by widowhood. Respondents who become widowed retire on average 1.7 years earlier than previously planned. The estimated effect of widowhood goes beyond the deterioration of physical health and mental health. My findings suggest that an intervention in an early stage after widowhood by the employer or by health and social care services can help the widowed employee to overcome the temporary adverse effects of widowhood and to prevent a precipitous retirement decision. %B The B.E. Journal of Economic Analysis & Policy %V 18 %8 Sep-06-2019 %G eng %U https://search.proquest.com/docview/2091249748/ED9FE239DE41490BPQ?accountid=14667 %N 3 %R 10.1515/bejeap-2017-0178 %0 Journal Article %J The Geneva Papers on Risk and Insurance - Issues and Practice %D 2017 %T How the growing gap in life expectancy may affect retirement benefits and reforms %A Auerbach, Alan %A Kerwin K. Charles %A Courtney Coile %A William G. Gale %A Dana P Goldman %A Lee, Ronald %A Lucas, Charles %A Orszag, Peter R. %A Sheiner, Louise %A Tysinger, Bryan %A Weil, David %A Wolfers, Justin %A Rebeca Wong %K Life Expectancy %K Mortality %K Retirement Planning and Satisfaction %K Social Security %B The Geneva Papers on Risk and Insurance - Issues and Practice %V 42 %P 475-499 %8 Jan-07-2017 %G eng %U http://link.springer.com/10.1057/s41288-017-0057-0http://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdfhttp://link.springer.com/article/10.1057/s41288-017-0057-0/fulltext.htmlhttp://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdf %N 3 %! Geneva Pap Risk Insur Issues Pract %R 10.1057/s41288-017-0057-0 %0 Journal Article %J Health Affairs %D 2017 %T The population health benefits of a healthy lifestyle: Life expectancy increased and onset of disability delayed. %A Neil K Mehta %A Mikko Myrskylä %K Disabilities %K Life Expectancy %K Mortality %K Population Health %X A key determinant of population health is the behavioral profile of a population. Nearly 80 percent of Americans reach their fifties having smoked cigarettes, been obese, or both. It is unknown to what extent risky behaviors (for example, smoking, having a poor diet, being physically inactive, and consuming an excessive amount of alcohol) collectively are reducing the health and life expectancy of the US population, or what improvements might be achievable in their absence. Using data from the Health and Retirement Study, we studied people ages fifty and older who had never smoked, who were not obese, and who consumed alcohol moderately. Compared to the whole US population, those with such a favorable behavioral profile had a life expectancy at age fifty that was seven years longer, and they experienced a delay in the onset of disability of up to six years. These results provide a benchmark for evaluating the massively damaging effects that behavioral risks have on health at older ages and the importance of prioritizing policies to implement behavioral-based interventions. %B Health Affairs %V 36 %P 1495-1502 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/28724530?dopt=Abstract %R 10.1377/hlthaff.2016.1569 %0 Report %D 2017 %T Smoking, Education and the Ability to Predict Own Survival Probabilities: An Observational Study on US Data %A Bruno Arpino %A Valeria Bordone %A Sergei Scherbov %K Education %K Life Expectancy %K Smoking %X Background: Subjective survival probabilities (SSPs) are a good predictor of mortality, go beyond the aggregate description of survival defined by life tables, and are important for individuals’ decision-making in later life. Despite the well-known mortality differentials by education as well as by characteristics such as smoking, little investigation has focused on SSPs by population sub-groups. Methods: We use data on individuals aged 50-89 from the Health and Retirement Study(HRS) carried out in the USA between 2000 and 2012 (N=23,895). Each respondent was asked to assess the probability to survive to a given target age according to their age at the time of the survey. We assess how individuals’ SSPs and estimated objective survival probabilities (OSPs) vary by education and smoking and calculate, for each respondent, the gap between them. Results: Consistently with real mortality patterns, smokers report the lowest SSPs, both among lower and higher educated people. When comparing SSPs and OSPs we find that, irrespectively of the smoking status, higher educated people are more likely to correctly predict their survival probabilities than their lower educated counterparts. Within both education groups, past smokers better predict their survival probability. Current smokers with low education show the highest probability to overestimate their survival probability. Conclusions: Lower educated people and smokers are aware of their lower life expectancy. Still, they overestimate their survival probabilities more than the higher educated and non-smokers. Our findings emphasize the need for policy makers to disseminate information about the risks of smoking, targeting people with lower education. %B IIASA Working Paper %I International Institute for Applied Systems Analysis %C Laxenburg, Austria %G eng %U http://pure.iiasa.ac.at/id/eprint/14692/ %0 Journal Article %J J Epidemiol Community Health %D 2016 %T Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA. %A Wu, Chenkai %A Michelle C Odden %A Gwenith G Fisher %A Stawski, Robert S %K Adult %K Aged %K Female %K Health Status %K Humans %K Life Expectancy %K Life Style %K Longitudinal Studies %K Male %K Middle Aged %K Mortality, Premature %K Retirement %K Risk Factors %K United States %X

BACKGROUND: Retirement is an important transitional process in later life. Despite a large body of research examining the impacts of health on retirement, questions still remain regarding the association of retirement age with survival. We aimed to examine the association between retirement age and mortality among healthy and unhealthy retirees and to investigate whether sociodemographic factors modified this association.

METHODS: On the basis of the Health and Retirement Study, 2956 participants who were working at baseline (1992) and completely retired during the follow-up period from 1992 to 2010 were included. Healthy retirees (n=1934) were defined as individuals who self-reported health was not an important reason to retire. The association of retirement age with all-cause mortality was analysed using the Cox model. Sociodemographic effect modifiers of the relation were examined.

RESULTS: Over the study period, 234 healthy and 262 unhealthy retirees died. Among healthy retirees, a 1-year older age at retirement was associated with an 11% lower risk of all-cause mortality (95% CI 8% to 15%), independent of a wide range of sociodemographic, lifestyle and health confounders. Similarly, unhealthy retirees (n=1022) had a lower all-cause mortality risk when retiring later (HR 0.91, 95% CI 0.88 to 0.94). None of the sociodemographic factors were found to modify the association of retirement age with all-cause mortality.

CONCLUSIONS: Early retirement may be a risk factor for mortality and prolonged working life may provide survival benefits among US adults.

%B J Epidemiol Community Health %V 70 %P 917-23 %8 2016 Sep %G eng %U http://jech.bmj.com/content/early/2016/03/21/jech-2015-207097.abstract %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/27001669?dopt=Abstract %$ 999999 %R 10.1136/jech-2015-207097 %0 Journal Article %J J Aging Health %D 2016 %T A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States. %A Chi-Tsun Chiu %A Mark D Hayward %A Saito, Yasuhiko %K Activities of Daily Living %K Age Distribution %K Aged %K Cause of Death %K Cross-Cultural Comparison %K Educational Status %K Employment %K Family Characteristics %K Female %K Health Status %K Health Surveys %K Healthy Lifestyle %K Humans %K Japan %K Life Expectancy %K Life Tables %K Longitudinal Studies %K Male %K Middle Aged %K Regression Analysis %K Retirement %K Sex Distribution %K United States %X

OBJECTIVE: This study examined the educational gradient of health and mortality between two long-lived populations: Japan and the United States.

METHOD: This analysis is based on the Nihon University Japanese Longitudinal Study of Aging and the Health and Retirement Study to compare educational gradients in multiple aspects of population health-life expectancy with/without disability, functional limitations, or chronic diseases, using prevalence-based Sullivan life tables.

RESULTS: Our results show that education coefficients from physical health and mortality models are similar for both Japan and American populations, and older Japanese have better mortality and health profiles.

DISCUSSION: Japan's compulsory national health service system since April 1961 and living arrangements with adult children may play an important role for its superior health profile compared with that of the United States.

%B J Aging Health %V 28 %P 1256-78 %8 2016 10 %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/27590801?dopt=Abstract %R 10.1177/0898264316656505 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2016 %T Life Expectancy With and Without Pain in the U.S. Elderly Population. %A Zachary Zimmer %A Rubin, Sara %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Disabled Persons %K Female %K Health Status Indicators %K Humans %K Incidence %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K pain %K Quality of Life %K Risk Factors %K Surveys and Questionnaires %K United States %X

BACKGROUND: This study contributes to dialogue on quality versus quantity of life by examining years older persons can expect to live in various states of pain.

METHODS: Data from seven waves of the Health and Retirement Study; N = 26,896; age 55+. Estimations using the Interpolative Markov Chain approach apply probability transitions to multistate life table functions. Two estimates are interpreted: (i) population-based, which provide population averages aggregated across baseline states and (ii) status-based, which provide independent estimates by baseline state. Age- and sex-specific years with no pain, milder nonlimiting, and severe or limiting pain are reported as is percent of life in states of pain.

RESULTS: Females have higher life expectancy than males but similar expectations of pain-free life. Total life expectancy varies only slightly by baseline pain states but pain-free life expectancy varies greatly. For example, an 85-year-old female pain-free at baseline expects 7.04 more years, 5.28 being pain-free. An 85-year-old female with severe pain at baseline expects 6.42 years with only 2.66 pain-free. Percent of life with pain decreases by age for those pain-free at baseline and increases for those with pain at baseline.

CONCLUSION: Pain is moderately associated with quantity of or total life but substantially and importantly associated with quality of or pain-free life.

%B J Gerontol A Biol Sci Med Sci %V 71 %P 1171-6 %8 2016 Sep %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2016/03/17/gerona.glw028.abstract %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/26988661?dopt=Abstract %4 Aging/Longevity/Demography/Health and Retirement Survey/Multistate life tables/Interpolative Markov Chains/Quality of life %$ 999999 %R 10.1093/gerona/glw028 %0 Newspaper Article %B The New York Times %D 2016 %T Life Spans of the Rich Leave the Poor Behind %A Tavernise, Sabrina %K Income %K Life Expectancy %K Older Adults %K Wage gap %B The New York Times %7 February 13, 2016 %G eng %U http://www.nytimes.com/2016/02/13/health/disparity-in-life-spans-of-the-rich-and-the-poor-is-growing.html %! Disparity in Life Spans of the Rich and the Poor Is Growing %& A %0 Journal Article %J PLoS One %D 2016 %T The Long-Term Benefits of Increased Aspirin Use by At-Risk Americans Aged 50 and Older. %A David B. Agus %A Gaudette, Étienne %A Dana P Goldman %A Messali, Andrew %E Song, Qing %K Aged %K Aged, 80 and over %K Anti-Inflammatory Agents, Non-Steroidal %K Aspirin %K Cardiovascular Diseases %K Female %K Humans %K Incidence %K Life Expectancy %K Male %K Middle Aged %K Nutrition Surveys %K Primary Prevention %K Quality-Adjusted Life Years %K Risk Assessment %K United States %X

BACKGROUND: The usefulness of aspirin to defend against cardiovascular disease in both primary and secondary settings is well recognized by the medical profession. Multiple studies also have found that daily aspirin significantly reduces cancer incidence and mortality. Despite these proven health benefits, aspirin use remains low among populations targeted by cardiovascular prevention guidelines. This article seeks to determine the long-term economic and population-health impact of broader use of aspirin by older Americans at higher risk for cardiovascular disease.

METHODS AND FINDINGS: We employ the Future Elderly Model, a dynamic microsimulation that follows Americans aged 50 and older, to project their lifetime health and spending under the status quo and in various scenarios of expanded aspirin use. The model is based primarily on data from the Health and Retirement Study, a large, representative, national survey that has been ongoing for more than two decades. Outcomes are chosen to provide a broad perspective of the individual and societal impacts of the interventions and include: heart disease, stroke, cancer, life expectancy, quality-adjusted life expectancy, disability-free life expectancy, and medical costs. Eligibility for increased aspirin use in simulations is based on the 2011-2012 questionnaire on preventive aspirin use of the National Health and Nutrition Examination Survey. These data reveal a large unmet need for daily aspirin, with over 40% of men and 10% of women aged 50 to 79 presenting high cardiovascular risk but not taking aspirin. We estimate that increased use by high-risk older Americans would improve national life expectancy at age 50 by 0.28 years (95% CI 0.08-0.50) and would add 900,000 people (95% CI 300,000-1,400,000) to the American population by 2036. After valuing the quality-adjusted life-years appropriately, Americans could expect $692 billion (95% CI 345-975) in net health benefits over that period.

CONCLUSIONS: Expanded use of aspirin by older Americans with elevated risk of cardiovascular disease could generate substantial population health benefits over the next twenty years and do so very cost-effectively.

%B PLoS One %V 11 %P e0166103 %8 2016 %G eng %U http://dx.plos.org/10.1371/journal.pone.0166103 %N 11 %1 http://www.ncbi.nlm.nih.gov/pubmed/27902693?dopt=Abstract %! PLoS ONE %R 10.1371/journal.pone.0166103 %0 Journal Article %J The Journals of Gerontology: Series B %D 2016 %T Methodological Aspects of Subjective Life Expectancy: Effects of Culture-Specific Reporting Heterogeneity Among Older Adults in the United States. %A Lee, Sunghee %A Jacqui Smith %K Aged %K Aged, 80 and over %K Bias %K Cross-Cultural Comparison %K Cross-Sectional Studies %K Diagnostic Self Evaluation %K Ethnic Groups %K Female %K Frail Elderly %K Humans %K Language %K Life Expectancy %K Longitudinal Studies %K Male %K Middle Aged %K Self Report %K United States %X

OBJECTIVES: Subjective life expectancy (SLE) has been suggested as a predictor of mortality and mortality-related behaviors. Although critical for culturally diverse societies, these findings do not consider cross-cultural methodological comparability. Culture-specific reporting heterogeneity is a well-known phenomenon introducing biases, and research on this issue with SLE is not established.

METHOD: Using data from the Health and Retirement Study, we examined reporting heterogeneity in SLE focusing on item nonresponse, focal points, and reports over time for five ethnic-cultural groups: non-Hispanic Whites, non-Hispanic Blacks, non-Hispanic other races, English-interviewed Hispanics, and Spanish-interviewed Hispanics.

RESULTS: On item nonresponse, Spanish-interviewed Hispanics said, "I don't know," to SLE significantly more than any other groups. Nearly half of the respondents chose 0, 50, or 100, making them focal points. However, the focal points differed: 50 for Whites, 100 for Blacks, and 0 for Spanish-interviewed Hispanics. The relationship of SLE measured at two time points was higher for Whites than minorities. Moreover, those who said "I don't know" to SLE showed higher subsequent mortality than those who gave an answer. SLE was not a significant mortality predictor for Hispanics.

DISCUSSION: Overall, SLE is not free from culture-specific reporting heterogeneity. This warrants further research about its culture-relevant measurement mechanisms.

%B The Journals of Gerontology: Series B %I 71 %V 71 %P 558-568 %G eng %N 3 %4 Mortality predictions/Nonresponse/Racial and ethnic minorities/Reporting heterogeneity/Subjective life expectancy %$ 999999 %R 10.1093/geronb/gbv048 %0 Report %D 2016 %T Mortality Inequality: The Good News from a County-Level Approach %A Currie, Janet %A Schwandt, Hannes %K Childhood adversity %K Life Expectancy %K Mortality %K Socioeconomic factors %X Analysts who have concluded that inequality in life expectancy is increasing have generally focused on life expectancy at age 40 to 50. However, we show that among infants, children, and young adults, mortality has been falling more quickly in poorer areas with the result that inequality in mortality has fallen substantially over time. This is an important result given the growing literature showing that good health in childhood predicts better health in adulthood and suggests that today’s children are likely to face considerably less inequality in mortality as they age than current adults. We also show that there have been stunning declines in mortality rates for African-Americans between 1990 and 2010, especially for black men. The fact that inequality in mortality has been moving in opposite directions for the young and the old, as well as for some segments of the African-American and non-African-American populations argues against a single driver of trends in mortality inequality, such as rising income inequality. Rather, there are likely to be multiple specific causes affecting different segments of the population. %I National Bureau of Economic Research %C Cambridge, MA %P 1-54 %8 04/2016 %G eng %U http://www.nber.org/papers/w22199.pdf %R 10.3386/w22199 %0 Report %D 2016 %T The Rise in Life Expectancy, Health Trends among the Elderly, and the Demand for Care - A Selected Literature Review %A Lindgren, Bjorn %K Caregiving %K Health Trajectories %K Life Expectancy %K Literature Review %K Meta-analyses %K Older Adults %X The objective is to review the evidence on (a) ageing and health and (b) the demand for health- and social services among the elderly. Issues are: does health status of the elderly improve over time, and how do the trends in health status of the elderly affect the demand for health- and elderly care? It is not a complete review, but it covers most of recent empirical studies. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %P 1-31 %8 08/2016 %G eng %U http://www.nber.org/papers/w22521.pdf %R 10.3386/w22521 %0 Journal Article %J J Am Geriatr Soc %D 2016 %T Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions? %A Linos, Eleni %A Chren, Mary-Margaret %A Irena Cenzer %A Kenneth E Covinsky %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Carcinoma, Basal Cell %K Carcinoma, Squamous Cell %K Comorbidity %K Cost-Benefit Analysis %K Cross-Sectional Studies %K Curettage %K Decision Support Techniques %K Disability Evaluation %K Electrosurgery %K Female %K Humans %K Keratinocytes %K Life Expectancy %K Male %K Mohs Surgery %K Prognosis %K Skin Neoplasms %X

OBJECTIVES: To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare.

DESIGN: Nationally representative cross-sectional study.

SETTING: Nationally representative Health and Retirement Study linked to Medicare claims.

PARTICIPANTS: Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included.

MEASUREMENTS: Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED&C) (least intensive, lowest cost)), according to procedure code.

RESULTS: Most KCs (61%) were treated surgically. Rates of MMS (19%), excision (42%), and ED&C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in ADLs, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer.

CONCLUSION: A one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.

%B J Am Geriatr Soc %V 64 %P 1610-5 %8 2016 08 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27303932 %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/27303932?dopt=Abstract %R 10.1111/jgs.14202 %0 Thesis %B Economics %D 2016 %T Three essays in life-cycle labor supply and human capital formation %A Han, Joseph %K Annuitization %K Employment and Labor Force %K Life Expectancy %K Older Adults %K Retirement Planning and Satisfaction %X This dissertation consists of three independent essays on earnings dynamics, educational production function, and retirement. Each chapter explains labor supply and human capital formation from a life-cycle perspective. In the first chapter, I investigate how two different kinds of uncertainty jointly affect young workers' decisions. This paper introduces the possibility of multidimensional learning about worker ability and job match quality into a model of work decisions. This mechanism has a unique prediction, negative sorting into job mobility that fades away over time, which is verified in the NLSY79 data if the AFQT score carries over some information unused by workers and employers. I estimate the structural model, which also has flexible skill accumulation, by indirect inference. From simulation results on earnings dynamics, I find that the contribution of job shopping to average earnings growth is higher than previous estimates; also, individual heterogeneity in earnings growth is mostly explained by the process of resolving uncertainties. In the second chapter, which is joint work with Keunkwan Ryu, we estimate the effects of high school class size on college entrance exam scores, using Korean administrative data. For the identification, we exploit quasi-experimental variation in class size arising from distinct institutional settings in Korea: especially, students are separately educated by major from grade 11 with different class sizes between majors. By using multi-level differencing and instrumental variable techniques, we find the effects of high school class size reduction on the test scores are positive but small. In the third chapter, I examine the effects of life expectancy on retirement and related decisions. I construct a structural model which has a realistic description of complicated dynamic incentives facing the elderly, including Social Security. Furthermore, individual heterogeneity in survival beliefs are flexibly modeled, directly using subjective survival probabilities in the Health and Retirement Study (HRS) data. The estimated model suggests that many people in the data believed their wealth was over-annuitized; they would have chosen to work and save less if their average life expectancy had increased. This result partially explains the early retirement puzzle in the last century. %B Economics %I The University of Wisconsin - Madison %C Madison %V Ph.D. %P 137 %@ 9781339835891 %G eng %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1796375588?accountid=14667 %9 Dissertation %0 Newspaper Article %B The Washington Post %D 2016 %T U.S. life expectancy declines for the first time since 1993 %A Lenny Bernstein %K Life Expectancy %K Meta-analyses %K Older Adults %B The Washington Post %C Washington, D.C. %8 12/08/2016 %G eng %U https://www.washingtonpost.com/national/health-science/us-life-expectancy-declines-for-the-first-time-since-1993/2016/12/07/7dcdc7b4-bc93-11e6-91ee-1adddfe36cbe_story.html %0 Journal Article %J The Lancet %D 2016 %T The World report on ageing and health: a policy framework for healthy ageing %A Beard, John R %A Officer, Alana %A de Carvalho, Islene Araujo %A Sadana, Ritu %A Pot, Anne Margriet %A Michel, Jean-Pierre %A Lloyd-Sherlock, Peter %A Epping-Jordan, JoAnne E %A G. M. E. E. Peeters %A Mahanani, Wahyu Retno %A Thiyagarajan, Jotheeswaran Amuthavalli %A Chatterji, Somnath %K Aging %K Life Expectancy %K Mortality %K Older Adults %X Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report. %B The Lancet %V 387 %P 2145 - 2154 %8 Jan-05-2016 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0140673615005164http://api.elsevier.com/content/article/PII:S0140673615005164?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0140673615005164?httpAccept=text/plain %N 10033 %! The Lancet %R 10.1016/S0140-6736(15)00516-4 %0 Journal Article %J Pharmacoeconomics %D 2015 %T Do Statins Reduce the Health and Health Care Costs of Obesity? %A Gaudette, Étienne %A Dana P Goldman %A Messali, Andrew %A Sood, Neeraj %K Aged %K Computer Simulation %K Cost-Benefit Analysis %K Health Care Costs %K Humans %K Hydroxymethylglutaryl-CoA Reductase Inhibitors %K Life Expectancy %K Markov chains %K Models, Economic %K Obesity %K Quality-Adjusted Life Years %X

CONTEXT: Obesity impacts both individual health and, given its high prevalence, total health care spending. However, as medical technology evolves, health outcomes for a number of obesity-related illnesses improve. This article examines whether medical innovation can mitigate the adverse health and spending associated with obesity, using statins as a case study. Because of the relationship between obesity and hypercholesterolaemia, statins play an important role in the medical management of obese individuals and the prevention of costly obesity-related sequelae.

METHODS: Using well-recognized estimates of the health impact of statins and the Future Elderly Model (FEM)-an established dynamic microsimulation model of the health of Americans aged over 50 years-we estimate the changes in life expectancy, functional status and health care costs of obesity due to the introduction and widespread use of statins.

RESULTS: Life expectancy gains of statins are estimated to be 5-6 % greater for obese individuals than for healthy-weight individuals, but most of these additional gains are associated with some level of disability. Considering both medical spending and the value of quality-adjusted life-years, statins do not significantly alter the costs of class 1 and 2 obesity (body mass index [BMI] ≥30 and ≥35 kg/m(2), respectively) and they increase the costs of class 3 obesity (BMI ≥40 kg/m(2)) by 1.2 %.

CONCLUSIONS: Although statins are very effective medications for lowering the risk of obesity-associated illnesses, they do not significantly reduce the costs of obesity.

%B Pharmacoeconomics %V 33 %P 723-34 %8 2015 Jul %G eng %N 7 %1 http://www.ncbi.nlm.nih.gov/pubmed/25576147?dopt=Abstract %R 10.1007/s40273-014-0234-y %0 Journal Article %J Gerontologist %D 2015 %T Lifespan and Healthspan: Past, Present, and Promise. %A Eileen M. Crimmins %K Aged %K Aged, 80 and over %K Aging %K Disabled Persons %K Humans %K Life Expectancy %K Socioeconomic factors %K United States %X

The past century was a period of increasing life expectancy throughout the age range. This resulted in more people living to old age and to spending more years at the older ages. It is likely that increases in life expectancy at older ages will continue, but life expectancy at birth is unlikely to reach levels above 95 unless there is a fundamental change in our ability to delay the aging process. We have yet to experience much compression of morbidity as the age of onset of most health problems has not increased markedly. In recent decades, there have been some reductions in the prevalence of physical disability and dementia. At the same time, the prevalence of disease has increased markedly, in large part due to treatment which extends life for those with disease. Compressing morbidity or increasing the relative healthspan will require "delaying aging" or delaying the physiological change that results in disease and disability. While moving to life expectancies above age 95 and compressing morbidity substantially may require significant scientific breakthroughs; significant improvement in health and increases in life expectancy in the United States could be achieved with behavioral, life style, and policy changes that reduce socioeconomic disparities and allow us to reach the levels of health and life expectancy achieved in peer societies.

%B Gerontologist %V 55 %P 901-11 %8 2015 Dec %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/26561272?dopt=Abstract %R 10.1093/geront/gnv130 %0 Journal Article %J Journal of Economic Behavior & Organization %D 2015 %T Subjective life horizon and portfolio choice %A Spaenjers, Christophe %A Spira, Sven Michael %K Bequests %K Investment horizon %K Life Expectancy %K Portfolio choice %K Subjective Expectations %X Using data from a U.S. household survey, we examine the empirical relation between subjective life horizon (i.e., the self-reported expectation of remaining life span) and portfolio choice. We find that equity portfolio shares are higher for investors with longer horizons, controlling for gender-specific age effects, socio-economic characteristics, health, and optimism. Our result is robust to accounting for the endogeneity of equity market participation or instrumenting subjective life horizon with parental survival. Finally, we show that the effect of a shortening horizon on portfolio allocation is stronger for households without bequest motives. %B Journal of Economic Behavior & Organization %V 116 %P 94-106 %@ 0167-2681 %G eng %R https://doi.org/10.1016/j.jebo.2015.04.006 %0 Journal Article %J PLoS One %D 2014 %T Individualizing life expectancy estimates for older adults using the Gompertz Law of Human Mortality. %A Sei J. Lee %A W John Boscardin %A Katharine A Kirby %A Kenneth E Covinsky %K Age Factors %K Aged %K Aged, 80 and over %K Aging %K Female %K Humans %K Life Expectancy %K Longevity %K Longitudinal Studies %K Male %K Middle Aged %K Mortality %K Proportional Hazards Models %K Risk Factors %X

BACKGROUND: Guidelines recommend incorporating life expectancy (LE) into clinical decision-making for preventive interventions such as cancer screening. Previous research focused on mortality risk (e.g. 28% at 4 years) which is more difficult to interpret than LE (e.g. 7.3 years) for both patients and clinicians. Our objective was to utilize the Gompertz Law of Human Mortality which states that mortality risk doubles in a fixed time interval to transform the Lee mortality index into a LE calculator.

METHODS: We examined community-dwelling older adults age 50 and over enrolled in the nationally representative 1998 wave of the Health and Retirement Study or HRS (response rate 81%), dividing study respondents into development (n = 11701) and validation (n = 8009) cohorts. In the development cohort, we fit proportional hazards Gompertz survival functions for each of the risk groups defined by the Lee mortality index. We validated our LE estimates by comparing our predicted LE with observed survival in the HRS validation cohort and an external validation cohort from the 2004 wave of the English Longitudinal Study on Ageing or ELSA (n = 7042).

RESULTS: The ELSA cohort had a lower 8-year mortality risk (14%) compared to our HRS development (23%) and validation cohorts (25%). Our model had good discrimination in the validation cohorts (Harrell's c 0.78 in HRS and 0.80 in the ELSA). Our predicted LE's were similar to observed survival in the HRS validation cohort without evidence of miscalibration (Hosmer-Lemeshow, p = 0.2 at 8 years). However, our predicted LE's were longer than observed survival in the ELSA cohort with evidence of miscalibration (Hosmer-Lemeshow, p<0.001 at 8 years) reflecting the lower mortality rate in ELSA.

CONCLUSION: We transformed a previously validated mortality index into a LE calculator that incorporated patient-level risk factors. Our LE calculator may help clinicians determine which preventive interventions are most appropriate for older US adults.

%B PLoS One %I 9 %V 9 %P e108540 %8 2014 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/25265291?dopt=Abstract %2 PMC4180452 %4 clinical decision-making/interventions/life Expectancy/cancer screening/mortality risk/mortality risk/survival Analysis/ELSA_/cross-national comparison/preventive health care %$ 999999 %R 10.1371/journal.pone.0108540 %0 Journal Article %J JAMA %D 2013 %T Predicting 10-year mortality for older adults. %A Cruz, Marisa %A Kenneth E Covinsky %A Eric W Widera %A Stijacic-Cenzer, Irena %A Sei J. Lee %K Aged %K Aged, 80 and over %K Cohort Studies %K Female %K Forecasting %K Humans %K Kaplan-Meier Estimate %K Life Expectancy %K Male %K Middle Aged %K Mortality %K Risk Assessment %K United States %B JAMA %I 309 %V 309 %P 874-6 %8 2013 Mar 06 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/23462780?dopt=Abstract %2 PMC3760279 %4 mortality/cancer screening/Diabetes/glycemic control/glycemic control/preventive interventions %$ 69310 %R 10.1001/jama.2013.1184 %0 Journal Article %J Demography %D 2012 %T The significance of education for mortality compression in the United States. %A Dustin C. Brown %A Mark D Hayward %A Jennifer Karas Montez %A Robert A Hummer %A Chi-Tsun Chiu %A Mira M Hidajat %K Aged %K Aged, 80 and over %K Aging %K Educational Status %K Female %K Health Status Disparities %K Humans %K Life Expectancy %K Male %K Middle Aged %K Mortality %K Mortality, Premature %K Sex Distribution %K Socioeconomic factors %K United States %X

Recent studies of old-age mortality trends assess whether longevity improvements over time are linked to increasing compression of mortality at advanced ages. The historical backdrop of these studies is the long-term improvement in a population's socioeconomic resources that fueled longevity gains. We extend this line of inquiry by examining whether socioeconomic differences in longevity within a population are accompanied by old-age mortality compression. Specifically, we document educational differences in longevity and mortality compression for older men and women in the United States. Drawing on the fundamental cause of disease framework, we hypothesize that both longevity and compression increase with higher levels of education and that women with the highest levels of education will exhibit the greatest degree of longevity and compression. Results based on the Health and Retirement Study and the National Health Interview Survey Linked Mortality File confirm a strong educational gradient in both longevity and mortality compression. We also find that mortality is more compressed within educational groups among women than men. The results suggest that educational attainment in the United States maximizes life chances by delaying the biological aging process.

%B Demography %I 49 %V 49 %P 819-40 %8 2012 Aug %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2712630621andFmt=7andclientId=17822andRQT=309andVName=PQD %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22556045?dopt=Abstract %2 PMC3500099 %4 Studies/Socioeconomic factors/Mortality/Educational attainment/Gender differences %$ 69502 %R 10.1007/s13524-012-0104-1 %0 Journal Article %J Soc Sci Med %D 2011 %T Differences in health between Americans and Western Europeans: Effects on longevity and public finance. %A Pierre-Carl Michaud %A Dana P Goldman %A Darius Lakdawalla %A Adam Gailey %A Yuhui Zheng %K Activities of Daily Living %K Adult %K Aged %K Body Mass Index %K Cross-Cultural Comparison %K Disabled Persons %K Europe %K Female %K Health Expenditures %K health policy %K Health Status Disparities %K Health Surveys %K Humans %K Internationality %K Life Expectancy %K Male %K Middle Aged %K Models, Economic %K Models, Statistical %K Mortality %K Public Health %K United States %X

In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.

%B Soc Sci Med %I 73 %V 73 %P 254-63 %8 2011 Jul %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21719178?dopt=Abstract %2 PMC3383030 %4 disability/disability/mortality/international comparisons/Cross-national/microsimulation/Europe/SHARE/ELSA_/longevity %$ 69616 %R 10.1016/j.socscimed.2011.05.027 %0 Journal Article %J Eur J Epidemiol %D 2011 %T Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study. %A Mieke Reuser %A Frans J Willekens %A Luc G Bonneux %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Cognition Disorders %K Educational Status %K Female %K Health Surveys %K Humans %K Incidence %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Prevalence %K Proportional Hazards Models %K Retirement %K Sex Factors %K Smoking %K Time Factors %K United States %X

Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992-2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.

%B Eur J Epidemiol %I 26 %V 26 %P 395-403 %8 2011 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21337033?dopt=Abstract %2 PMC3109265 %4 Cognitive ability/Life tables/Body mass index/Smoking/Educational attainment/Minority groups/ethnic Groups %$ 69390 %R 10.1007/s10654-011-9553-x %0 Journal Article %J Soc Sci Med %D 2011 %T Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA. %A Rasmus Hoffmann %K Aged %K Aged, 80 and over %K Analysis of Variance %K Cross-Cultural Comparison %K Denmark %K Educational Status %K Female %K Health Expenditures %K Humans %K Income %K Life Expectancy %K Male %K Middle Aged %K Mortality %K Political Systems %K Social Class %K Social Welfare %K United States %X

Previous studies have reported important variations in the magnitude of health inequalities between countries that belong to different welfare systems. This suggests that there is scope for reducing health inequalities by means of country-level interventions. The present study adds to this literature by exploring whether the magnitude of socioeconomic inequalities in mortality is associated with social inequality levels. Denmark and the USA belong to fundamentally different welfare systems (social democratic and liberal) and our study thereby contributes to the ongoing debate on whether welfare systems are linked to health inequalities. We analyze Denmark and the USA in terms of socioeconomic differences in mortality above age 58. The data sources were Danish register data from 1980 to 2002 (n = 2,029,324), and survey data from the US Health and Retirement Study (HRS) from 1992 to 2006 (n = 9374). Survival analysis was used to study the impact of socioeconomic status on mortality and the magnitude of mortality differences between the two countries was compared. The results showed surprisingly that mortality differentials were larger in Denmark than in the USA even after controlling for a number of covariates: The poorest 10 percent of the Danish elderly population have a mortality rate ratio of 3.32 (men) and 3.70 (women) compared to the richest 25 percent. In the USA the corresponding rate ratios are 1.67 and 1.56. Low income seems to be a more powerful risk factor for mortality than low education. A number of possible explanations for higher mortality differences in Denmark are discussed: unintended positive correlation between generous health services and health inequality, early life influences, mortality selection, and relative deprivation.

%B Soc Sci Med %I 72 %V 72 %P 1986-92 %8 2011 Jun %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/21636194?dopt=Abstract %3 21636194 %4 Socioeconomic factors/Inequality/Mortality/Older people/Cross Cultural Comparison %$ 69360 %R 10.1016/j.socscimed.2011.04.019 %0 Journal Article %J J Econ Perspect %D 2011 %T Who pays for obesity? %A Bhattacharya, Jay %A Sood, Neeraj %K Adult %K Cost of Illness %K Financing, Personal %K Health Benefit Plans, Employee %K Health Care Costs %K health policy %K Humans %K Income %K Insurance Coverage %K Insurance Pools %K Insurance, Health %K Life Expectancy %K Models, Econometric %K Obesity %K Prevalence %K Private Sector %K Public Sector %K Risk Adjustment %K Social Control Policies %K United States %X

Adult obesity is a growing problem. From 1962 to 2006, obesity prevalence nearly tripled to 35.1 percent of adults. The rising prevalence of obesity is not limited to a particular socioeconomic group and is not unique to the United States. Should this widespread obesity epidemic be a cause for alarm? From a personal health perspective, the answer is an emphatic "yes." But when it comes to justifications of public policy for reducing obesity, the analysis becomes more complex. A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population—a statement which is then taken to justify public policy interventions. But the question of who pays for obesity is an empirical one, and it involves analysis of how obese people fare in labor markets and health insurance markets. We will argue that the existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. We begin by estimating the lifetime costs of obesity. We then discuss the extent to which private health insurance pools together obese and thin, whether health insurance causes obesity, and whether being fat might actually cause positive externalities for those who are not obese. If public policy to reduce obesity is not justified on the grounds of external costs imposed on others, then the remaining potential justification would need to be on the basis of helping people to address problems of ignorance or self-control that lead to obesity. In the conclusion, we offer a few thoughts about some complexities of such a justification.

%B J Econ Perspect %I 25 %V 25 %P 139-58 %8 2011 Winter %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21598459?dopt=Abstract %3 21598459 %4 Future Elderly Model/obesity/labor force participation/health insurance/public policy/Moral hazard/Public Policy %$ 69614 %R 10.1257/jep.25.1.139 %0 Report %D 2010 %T Adjusting Social Security for Increasing Life Expectancy: Effects on Progressivity %A Natalia A. Zhivan %A Courtney Monk %A John A. Turner %K Life Expectancy %K Social Security %K Social Security Eligibility %X Achieving long-run Social Security solvency requires addressing rising life expectancy. Increasing the Full Retirement Age (FRA), while holding the Early Entitlement Age (EEA) fixed, could be effective but eventually will result in replacement rates that are viewed by many as too low. A possible policy to prop up replacement rates is to raise the EEA, which has been age 62 for more than 40 years. However, an increase in the EEA introduces unfairness because the variation in life expectancy across socioeconomic groups is positively correlated with lifetime income. Using data from the Health and Retirement Study to investigate how earnings relate to mortality risk and health limitations, this project explores the possibility of constructing a flexible FRA that could preserve or even enhance the progressivity of Social Security benefits. If life expectancy were correlated with lifetime income, Social Security policy could use the AIME (Average Indexed Monthly Earnings) to target policies that are more equitable for people with both lower lifetime income and lower life expectancy. %B Center for Retirement Research at Boston College Working Papers %I Center for Retirement Research at Boston College %C Boston, MA %G eng %U https://crr.bc.edu/working-papers/adjusting-social-security-for-increasing-life-expectancy-effects-on-progressivity/ %0 Journal Article %J Obesity (Silver Spring) %D 2009 %T Smoking kills, obesity disables: a multistate approach of the US Health and Retirement Survey. %A Mieke Reuser %A Luc G Bonneux %A Frans J Willekens %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Body Mass Index %K Disability Evaluation %K Educational Status %K Female %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Obesity %K Proportional Hazards Models %K Prospective Studies %K Smoking %K United States %K White People %X

Increasing BMI causes concerns about the consequences for health care. Decreasing cardiovascular mortality has lowered obesity-related mortality, extending duration of disability. We hypothesized increased duration of disability among overweight and obese individuals. We estimated age-, risk-, and state-dependent probabilities of activities of daily living (ADL) disability and death and calculated multistate life tables, resulting in the comprehensive measure of life years with and without ADL disability. We used prospective data of 16,176 white adults of the Health and Retirement Survey (HRS). Exposures were self-reported BMI and for comparison smoking status and levels of education. Outcomes were years to live with and without ADL disability at age 55. The reference categories were high normal weight (BMI: 23-24.9), nonsmoking and high education. Mild obesity (BMI: 30-34.9) did not change total life expectancy (LE) but exchanged disabled for disability-free years. Mild obesity decreased disability-free LE with 2.7 (95% confidence limits 1.2; 3.2) year but increased LE with disability with 2.0 (0.6; 3.4) years among men. Among women, BMI of 30 to 34.9 decreased disability-free LE with 3.6 (2.1; 5.1) year but increased LE with disability with 3.2 (1.6;4.8) years. Overweight (BMI: 25-29.9) increases LE with disability for women only, by 2.1 (0.8; 3.3) years). Smoking compressed disability by high mortality. Smoking decreased LE with 7.2 years, and LE with disability with 1.3 (0.5; 2.5) years (men) and 1.4 (0.3; 2.6) years (women). A lower education decreased disability-free life, but not duration of ADL disability. In the aging baby boom, higher BMI will further increase care dependence.

%B Obesity (Silver Spring) %I 17 %V 17 %P 783-9 %8 2009 Apr %G eng %N 4 %L newpubs20100129 %1 http://www.ncbi.nlm.nih.gov/pubmed/19165165?dopt=Abstract %3 19165165 %4 Obesity/Smoking/Body Mass Index/DISABILITY/DISABILITY/Mortality %$ 21690 %R 10.1038/oby.2008.640 %0 Journal Article %J Eur J Epidemiol %D 2008 %T The burden of mortality of obesity at middle and old age is small. A life table analysis of the US Health and Retirement Survey. %A Mieke Reuser %A Luc G Bonneux %A Frans J Willekens %K Aged %K Aged, 80 and over %K Body Mass Index %K Educational Status %K Female %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Multivariate Analysis %K Obesity %K Proportional Hazards Models %K Smoking %K United States %K Weight Gain %K Weight Loss %X

The evidence of effect of overweight and obesity on mortality at middle and old age is conflicting. The increased relative risk of cardiovascular disease and diabetes for overweight and obese individuals compared to normal weight is well documented, but the absolute risk of cardiovascular death has decreased spectacularly since the 1980s. We estimate the burden of mortality of obesity among middle and old aged adults in the Health and Retirement Survey (HRS), a US prospective longitudinal study. We calculate univariate and multivariate age-specific probabilities and proportional hazard ratios of death in relation to self-reported body mass index (BMI), smoking and education. The life table translates age specific adjusted event rates in survival times, dependent on risk factor distributions (smoking, levels of education and self reported BMI). 95% confidence intervals are calculated by bootstrapping. The highest life expectancy at age 55 was found in overweight (BMI 25-29.9), highly educated non smokers: 30.7 (29.5-31.9) years (men) and 33.2 (32.1-34.3) (women), slightly higher than a BMI 23-24.9 in both sexes. Smoking decreased the population life expectancy with 3.5 (2.7-4.4) years (men) and 1.8 (1.0-2.5) years (women). Less than optimal education cost men and women respectively 2.8 (2.1-3.6) and 2.6 (1.6-3.6) years. Obesity and low normal weight decreased population life expectancy respectively by 0.8 (0.2-1.3) and 0.8 (0.0-1.5) years for men and women in a contemporary, US population. The burden of mortality of obesity is limited, compared to smoking and low education.

%B Eur J Epidemiol %I 23 %V 23 %P 601-7 %8 2008 %G eng %N 9 %L newpubs20081014_Reuser_EJEP_2008.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18584293?dopt=Abstract %3 18584293 %4 Mortality/Obesity/Education/Smoking/Life Expectancy %$ 19400 %R 10.1007/s10654-008-9269-8 %0 Journal Article %J J Aging Health %D 2008 %T Educational differentials in life expectancy with cognitive impairment among the elderly in the United States. %A Agnès Lièvre %A Dawn E Alley %A Eileen M. Crimmins %K Aged %K Aged, 80 and over %K Cognition Disorders %K Educational Status %K Female %K Humans %K Life Expectancy %K Male %K United States %X

OBJECTIVE: This article provides estimates of education differentials in life expectancy with and without cognitive impairment for the noninstitutionalized population aged 70 years and older in the United States.

METHOD: Life expectancy with cognitive impairment was calculated using multistate models, allowing transitions between cognitively intact and cognitively impaired states and from each of these states to death and allowing transition rates to vary across age and education. Four waves of the Assets and Health Dynamics of the Oldest Old survey were used.

RESULTS: Those with low levels of education are more likely to become cognitively impaired and do so at an earlier age. After age 70, persons with low educational levels can expect to live 11.6 years, and persons with high education 14.1 years, without cognitive impairment. Length of life with cognitive impairment differs by education (1.6 years and 1.0 years at age 70, respectively) but differs little by age.

DISCUSSION: Although those with higher education have lower rates of both cognitive impairment and mortality, those who do become cognitively impaired appear to be in poorer health, leading to a reduced probability of improved cognition and increased probability of mortality relative to those with lower educational levels.

%B J Aging Health %I 20 %V 20 %P 456-77 %8 2008 Jun %G eng %N 4 %L newpubs20101112_Lievre %1 http://www.ncbi.nlm.nih.gov/pubmed/18448687?dopt=Abstract %2 PMC2966893 %4 cognition Disorders/cognitive Impairment/educational Status/life Expectancy/education/MORTALITY %$ 23790 %R 10.1177/0898264308315857 %0 Journal Article %J Med Decis Making %D 2008 %T End-of-life medical treatment choices: do survival chances and out-of-pocket costs matter? %A Chao, Li-Wei %A José A Pagán %A Beth J Soldo %K Aged %K Choice Behavior %K Female %K Financing, Personal %K Health Care Costs %K Humans %K Life Expectancy %K Male %K Medicare %K Neoplasms %K Socioeconomic factors %K Terminal Care %K United States %X

BACKGROUND: Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion.

OBJECTIVES: To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs.

METHODS: Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s.

RESULTS: Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects.

CONCLUSIONS: Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.

%B Med Decis Making %I 28 %V 28 %P 511-23 %8 2008 Jul-Aug %G eng %N 4 %L newpubs20090302_Chao_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18441252?dopt=Abstract %2 PMC2587497 %4 Economics of the Elderly/Medical Expenditures/Survival/Survivors/Saving %$ 19770 %R 10.1177/0272989X07312713 %0 Journal Article %J J Health Econ %D 2008 %T Health status and health dynamics in an empirical model of expected longevity. %A Hugo Benítez-Silva %A Ni, Huan %K Chronic disease %K Delivery of Health Care %K Empirical Research %K Female %K Health Expenditures %K Health Status %K Humans %K Life Expectancy %K Longevity %K Male %K Models, Econometric %X

Expected longevity is an important factor influencing older individuals' decisions such as consumption, savings, purchase of life insurance and annuities, claiming of Social Security benefits, and labor supply. It has also been shown to be a good predictor of actual longevity, which in turn is highly correlated with health status. A relatively new literature on health investments under uncertainty, which builds upon the seminal work by Grossman [Grossman, M., 1972. On the concept of health capital and demand for health. Journal of Political Economy 80, 223-255] has directly linked longevity with characteristics, behaviors, and decisions by utility maximizing agents. Our empirical model can be understood within that theoretical framework as estimating a production function of longevity. Using longitudinal data from the Health and Retirement Study, we directly incorporate health dynamics in explaining the variation in expected longevities, and compare two alternative measures of health dynamics: the self-reported health change, and the computed health change based on self-reports of health status. In 38% of the reports in our sample, computed health changes are inconsistent with the direct report on health changes over time. And another 15% of the sample can suffer from information losses if computed changes are used to assess changes in actual health. These potentially serious problems raise doubts regarding the use and interpretation of the computed health changes and even the lagged measures of self-reported health as controls for health dynamics in a variety of empirical settings. Our empirical results, controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, suggest that self-reported health changes are a preferred measure of health dynamics.

%B J Health Econ %I 27 %V 27 %P 564-84 %8 2008 May %G eng %N 3 %L newpubs20080822_JnlHealthEcon %1 http://www.ncbi.nlm.nih.gov/pubmed/18187217?dopt=Abstract %2 PMC2862058 %4 Longevity/PREDICTIVE MODEL/HEALTH %$ 19140 %R 10.1016/j.jhealeco.2007.09.008 %0 Journal Article %J J Women Aging %D 2008 %T Life with and without heart disease among women and men over 50. %A Eileen M. Crimmins %A Mark D Hayward %A Ueda, Hiroshi %A Saito, Yasuhiko %A Jung K Kim %K Activities of Daily Living %K Aged %K Female %K Health Status %K Heart Diseases %K Humans %K Life Expectancy %K Male %K Middle Aged %K Myocardial Infarction %K Patient Education as Topic %K Prejudice %K Risk Factors %K United States %K Women's Health %K Women's Health Services %X

This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men.

%B J Women Aging %I 20 %V 20 %P 5-19 %8 2008 %G eng %N 1-2 %L newpubs20101112_Crimmins2.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18581697?dopt=Abstract %2 PMC2994551 %4 Activities of Daily Living/health Status/Heart disease/life Expectancy/EDUCATION/risk factors/WOMEN %$ 23780 %R 10.1300/j074v20n01_02 %0 Journal Article %J Demography %D 2008 %T Using subjective expectations to forecast longevity: do survey respondents know something we don't know? %A Maria Perozek %K Aged %K Aged, 80 and over %K Aging %K Data collection %K Demography %K Female %K health policy %K Humans %K Life Expectancy %K Life Tables %K Longevity %K Male %K Middle Aged %K Mortality %K Risk Factors %K Sex Factors %K United States %X

Old-age mortality is notoriously difficult to predict because it requires not only an understanding of the process of senescence-which is influenced by genetic, environmental, and behavioral factors-but also a prediction of how these factors will evolve. In this paper I argue that individuals are uniquely qualified to predict their own mortality based on their own genetic background, as well as environmental and behavioral risk factors that are often known only to the individual. Given this private information, individuals form expectations about survival probabilities that may provide additional information to demographers and policymakers in their challenge to predict mortality. From expectations data from the 1992 Health and Retirement Study (HRS), I construct subjective, cohort life tables that are shown to predict the unusual direction of revisions to U.S. life expectancy by gender between 1992 and 2004: that is, for these cohorts, the Social Security Actuary (SSA) raised male life expectancy in 2004 and at the same lowered female life expectancy, narrowing the gender gap in longevity by 25% over this period. Further, although the subjective life expectancies for men appear to be roughly in line with the 2004 life tables, the subjective expectations of women suggest that female life expectancies estimated by the SSA might still be on the high side.

%B Demography %I 45 %V 45 %P 95-113 %8 2008 Feb %G eng %N 1 %L newpubs20080229_Perozek.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18390293?dopt=Abstract %2 PMC2831383 %4 Life Expectancy/Subjective Probabilities of Survival/Mortality/Actuarial Analysis %$ 18710 %R 10.1353/dem.2008.0010 %0 Journal Article %J Gerontologist %D 2005 %T The impact of obesity on active life expectancy in older American men and women. %A Sandra L Reynolds %A Saito, Yasuhiko %A Eileen M. Crimmins %K Activities of Daily Living %K Aged %K Female %K Health Status %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Logistic Models %K Male %K Markov chains %K Obesity %K Risk Factors %K United States %X

PURPOSE: The purpose of this article is to estimate the effect of obesity on both the length of life and length of nondisabled life for older Americans.

DESIGN AND METHODS: Using data from the first 3 waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, this article develops estimates of total, active, and disabled life expectancy for obese and nonobese older men and women. We used the Interpolation of Markov Chains (IMaCh) method to estimate the average number of years obese and nonobese older persons can expect to live with and without activity of daily living (ADL) disability.

RESULTS: Our findings indicate that obesity has little effect on life expectancy in adults aged 70 years and older. However, the obese are more likely to become disabled. This means that obese older adults live both more years and a higher proportion of their remaining lives disabled.

IMPLICATIONS: The lack of significant differences in life expectancy by obesity status among the old suggests that obesity-related death is less of a concern than disability in this age range. Given steady increases in obesity among Americans at all ages, future disability rates may be higher than anticipated among older U.S. adults. In order to reduce disability among future cohorts of older adults, more research is needed on the causes and treatment of obesity and evaluations done on interventions to accomplish and maintain weight loss.

%B Gerontologist %I 45 %V 45 %P 438-44 %8 2005 Aug %G eng %N 4 %L pubs_2005_obesity_ale.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/16051906?dopt=Abstract %4 Disability/Disability/Obesity/Life Expectancy %$ 15170 %R 10.1093/geront/45.4.438 %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 %0 Journal Article %J J Gerontol B Psychol Sci Soc Sci %D 2003 %T Life expectancy with cognitive impairment in the older population of the United States. %A Suthers, Kristen %A Jung K Kim %A Eileen M. Crimmins %K Aged %K Aged, 80 and over %K Alzheimer disease %K Cross-Sectional Studies %K Female %K Humans %K Life Expectancy %K Male %K Neuropsychological tests %K Probability %K Psychometrics %K Sex Factors %K Survival Analysis %K United States %X

OBJECTIVES: This article provides estimates of the prevalence of cognitive impairment by age and sex for a nationally representative sample of the U.S. population aged 70 and over. From these estimates, years of life with and without cognitive impairment are calculated.

METHODS: Using data from the Assets and Health Dynamics of the Oldest Old (AHEAD) survey, the prevalence of cognitive impairment is estimated for a sample representing both the community-dwelling and institutionalized older American population. Sullivan's method is used to calculate the average number of years an elderly person can expect to live with and without cognitive impairment.

RESULTS: The prevalence of moderate to severe cognitive impairment in the total U.S. population aged 70 and over is 9.5%. At age 70, the average American can expect 1.5 years with cognitive impairment. Expected length of life with cognitive impairment is longer for women than men because of their longer life expectancy.

DISCUSSION: As total life expectancy continues to increase, the length of life with cognitive impairment for the American population will increase unless age-specific prevalence is reduced. There is great potential for improvement in future early treatment and diagnosis of this condition.

%B J Gerontol B Psychol Sci Soc Sci %I 58B %V 58 %P S179-86 %8 2003 May %G eng %N 3 %L pubs_2003_Suthers_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/12730319?dopt=Abstract %4 Cognitive Function/Life Expectancy %$ 9902 %R 10.1093/geronb/58.3.s179 %0 Journal Article %J Gerontology %D 2003 %T Self-rated life expectancy as a predictor of mortality: evidence from the HRS and AHEAD surveys. %A Michele J. Siegel %A Elizabeth H Bradley %A Stanislav V Kasl %K Aged %K Female %K Health Status %K Health Surveys %K Humans %K Life Expectancy %K Male %K Mortality %K Prognosis %K Proportional Hazards Models %K Self Concept %K Sex Distribution %K Survival Analysis %X

BACKGROUND: An extensive literature has demonstrated that self-ratings of health predict mortality, even after controlling for more objective measures of health, health habits and sociodemographic characteristics. We examine the role of a related concept, self-rated life expectancy, in predicting mortality.

OBJECTIVE: To assess whether self-rated life expectancy predicts mortality after controlling for measures of health, self-rated health, and sociodemographic characteristics.

METHODS: Using data from the 1992 Health and Retirement Survey (HRS), the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, and the second Tracker file (2.0), Cox proportional hazard models were estimated to assess whether self-rated life expectancy predicts mortality, after adjusting for self-rated health and several potential confounders that might otherwise explain this relationship. The AHEAD sample included 2,102 men and 3,160 women. During the 2 years of follow-up, 9% (n = 185) of the men died and 5% (n = 166) of the women died. The HRS sample was comprised of 4,090 men and 4,885 women. Four percent (n = 164) of the men died and 2% (n = 99) of the women died in the 3 years of follow-up.

RESULTS: In the older, AHEAD sample, both self-rated life expectancy (p < 0.01) and self-rated health (p < 0.05) predicted mortality for both men and women, even when the two measures were included in the model together. In the younger, HRS sample, self-rated life expectancy was not significantly associated with mortality when self-rated health was included in the model.

CONCLUSION: Our findings suggest that, although self-rated life expectancy and self-rated health may be conceptually related, they have independent empirical effects on mortality.

%B Gerontology %I 49 %V 49 %P 265-71 %8 2003 Jul-Aug %G eng %N 4 %1 http://www.ncbi.nlm.nih.gov/pubmed/12792164?dopt=Abstract %4 Subjective expectations/Mortality/Health %$ 11972 %R 10.1159/000070409 %0 Journal Article %J Am J Public Health %D 2002 %T Driving life expectancy of persons aged 70 years and older in the United States. %A Foley, Daniel J. %A Heimovitz, Harley K. %A Jack M. Guralnik %A Brock, Dwight B. %K Accidents, Traffic %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Automobile Driving %K Decision making %K Family Characteristics %K Female %K Frail Elderly %K Humans %K Interviews as Topic %K Licensure %K Life Expectancy %K Logistic Models %K Male %K Risk Factors %K Transportation %K United States %X

OBJECTIVES: We estimated total life expectancy and driving life expectancy of US drivers aged 70 years and older.

METHODS: Life table methods were applied to 4699 elderly persons who were driving in 1993 and reassessed in a 1995 survey.

RESULTS: Drivers aged 70 to 74 years had a driving life expectancy of approximately 11 years. A higher risk of mortality among men as a cause of driving cessation offset a higher risk of driving cessation not related to mortality among women that resulted in similar driving life expectancies.

CONCLUSIONS: Nationwide, many elderly drivers quit driving each year and must seek alternative sources of transportation. Because of differences in life expectancy, women require more years of support for transportation, on average, than men after age 70.

%B Am J Public Health %I 92 %V 92 %P 1284-9 %8 2002 Aug %G eng %N 8 %L newpubs20070125_Foley_etal_AJPH %1 http://www.ncbi.nlm.nih.gov/pubmed/12144985?dopt=Abstract %4 Driving Patterns/Life Expectancy/Public Policy %$ 16990 %R 10.2105/ajph.92.8.1284 %0 Journal Article %J Soc Sci Med %D 1999 %T The influence of personal care and assistive devices on the measurement of disability. %A Agree, E M %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disability Evaluation %K Female %K Humans %K Life Expectancy %K Logistic Models %K Long-term Care %K Male %K Self-Help Devices %X

The goal of all long-term care arrangements is to reduce the disabling effects of physical impairments and functional limitations. However, the means with which individuals cope with disability may not be equivalent and these differences may influence self-reports of disability in surveys. This paper examines assistive devices and personal care as factors in the measurement of disability among persons aged 70 and older in the community using the 1994 Survey of Asset and Health Dynamics of the Oldest Old (AHEAD) in the US. The use of assistive technology differs from personal care on a fundamental level. It does not require the ongoing cooperation or coordination of other people and therefore increases the sense of independence with which a disabled individual can meet their long-term care needs. Results indicate that older individuals can expect to spend most of their remaining years in good functional health, but up to two-thirds of disabled years will be spent with unmet ADL needs. Among those who are disabled, those who use only equipment and no personal care report less residual difficulty with mobility than those who use personal assistance (either alone or in combination with equipment) but the use of equipment alone is most effective for those with the least severe limitations.

%B Soc Sci Med %I 48 %V 48 %P 427-43 %8 1999 Feb %G eng %N 4 %L pubs_1999_Agree_ESocSciandMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10075170?dopt=Abstract %R 10.1016/s0277-9536(98)00369-4