Eileen M. Crimmins

Trends in healthy life expectancy in the united states, 1970-1990 : gender, racial, and educational differences

This paper examines healthy life expectancy by gender and education for whites and African Americans in the United States at three dates: 1970, 1980 and 1990. There are large racial and educational differences in healthy life expectancy at each date and differences by education in healthy life expectancy are even larger than differences in total life expectancy. Large racial differences exist in healthy life expectancy at lower levels of education. Educational differences in healthy life expectancy have been increasing over time because of widening differentials in both mortality and morbidity. In the last decade, a compression of morbidity has begun among those of higher educational status; those of lower status are still experiencing expansion of morbidity.

The Significance of Socioeconomic Status in Explaining the Racial Gap in Chronic Health Conditions

Black Americans live fewer years than whites and live more years with chronic health problems. The origins of this racial gap are ambiguous. This study examines the pervasiveness of this gap across chronic medical and disabling conditions among middle-aged persons. Alternative hypotheses about how fundamental social conditions of disease differentiate the health of blacks and whites are also examined. Results show that the racial gap in health is spread across all domains of health, and that socioeconomic conditions, not health risk behaviors, are the primary origins of the racial stratification of health. No evidence was found in support of the idea that blacks and whites differ in their ability to transform socioeconomic resources into good health. The results point to the importance of continued research on how health and achievement processes are linked across childhood, adolescence, adulthood, and old age. Such studies are needed to enrich work on the inequality of health and life cycle achievement.

Does childhood health affect chronic morbidity in later life

Our analysis examines whether childhood health has long-term and enduring consequences for chronic morbidity. As a part of this analysis, we address two methodological issues of concern in the literature. Is adult height a surrogate for childhood health experiences in modeling chronic disease in later life? And, are the effects of adult socioeconomic status on chronic disease overestimated when childhood health is not accounted for? The analysis is based on a topical module to the third wave of the Health and Retirement Study, a representative survey of Americans aged 55-65 in 1996. Our results support the hypothesis that poor childhood health increases morbidity in later life. This association was found for cancer, lung disease, cardiovascular conditions, and arthritis/rheumatism. The associations were highly persistent in the face of statistical controls for both adult and childhood socioeconomic status. No support was found for using adult height as a proxy for the effects of childhood health experiences. Further, the effects of adult socioeconomic status were not overestimated when childhood health was excluded from the explanatory models. Our results point to the importance of an integrated health care policy based on the premise of maximizing health over the entire life cycle.

Mortality and morbidity trends: Is there compression of morbidity?

OBJECTIVE This paper reviews trends in mortality and morbidity to evaluate whether there has been a compression of morbidity. METHODS Review of recent research and analysis of recent data for the United States relating mortality change to the length of life without 1 of 4 major diseases or loss of mobility functioning. RESULTS Mortality declines have slowed down in the United States in recent years, especially for women. The prevalence of disease has increased. Age-specific prevalence of a number of risk factors representing physiological status has stayed relatively constant; where risks decline, increased usage of effective drugs is responsible. Mobility functioning has deteriorated. Length of life with disease and mobility functioning loss has increased between 1998 and 2008. DISCUSSION Empirical findings do not support recent compression of morbidity when morbidity is defined as major disease and mobility functioning loss.

Resolving inconsistencies in trends in old-age disability: Report from a technical working group

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

Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population

Mice and humans with growth hormone receptor/IGF-1 deficiencies display major reductions in age-related diseases. Because protein restriction reduces GHR-IGF-1 activity, we examined links between protein intake and mortality. Respondents aged 50-65 reporting high protein intake had a 75% increase in overall mortality and a 4-fold increase in cancer death risk during the following 18 years. These associations were either abolished or attenuated if the proteins were plant derived. Conversely, high protein intake was associated with reduced cancer and overall mortality in respondents over 65, but a 5-fold increase in diabetes mortality across all ages. Mouse studies confirmed the effect of high protein intake and GHR-IGF-1 signaling on the incidence and progression of breast and melanoma tumors, but also the detrimental effects of a low protein diet in the very old. These results suggest that low protein intake during middle age followed by moderate to high protein consumption in old adults may optimize healthspan and longevity.

The Fertility Revolution: A Supply-Demand Analysis

Easterlin and Crimmins present and test a supply-demand theory of fertility determination that integrates both economic and sociologic approaches. According to this theory a couples use of fertility control varies directly with the excess of their supply of children over demand (motivation for family planning) and inversely with the perceived costs (both objective and subjective) of regulating fertility. This model is tested with household data from Sri Lanka and Colombia aggregative population data from Taiwan and the Indian state of Karnataka and macro data from 10 Indian states. In all data sets examined motivation for fertility control was consistently and significantly related to use of control. Changes in the supply of and demand for children that increase motivation appear to be most important in generating family planning adoption whereas changes in regulation costs appear less significant. Interestingly supply is as important as demand and perhaps more so. This approach to the fertility transition asserts that with the onset of modernization the number of children that would result from unregulated fertility comes to exceed desired family size and incentives to limit family size develop. The growing excess of the potential supply of children over demand appears to be due to increases in parents potential supply in turn due both to declining infant and child mortality and increasing natural fertility. Once use of fertility control has spread to 50% of married women 35-44 years of age a fertility decline can be expected. By raising the supply of children and lowering demand socioeconomic modernization is both increasing motivation for fertility control and lowering the costs of fertility regulation. The data suggest that family planning programs should be formulated with careful attention to the populations state of motivation and perceived costs of regulation. Early in the modernization process before motivation for family planning has emerged socioeconomic development programs should be prioritized. The targeting of populations for a family planning effort should be based on their motivation not their actual fertility levels and methods that are perceived as entailing low regulation costs should be promoted.

Changing Mortality and Morbidity Rates and the Health Status and Life Expectancy of the Older Population

This paper demonstrates the consequences of changes in mortality and health transition rates for changes in both health status life expectancy and the prevalence of health problems in the older population. A five-state multistate life table for the mid-1980s provides the baseline for estimating the effect of differing mortality and morbidity schedules. Results show that improving mortality alone implies increases in both the years and the proportion of dependent life; improving morbidity alone reduces both the years and the proportion of dependent life. Improving mortality alone leads to a higher prevalence of dependent individuals in the life table population; improving morbidity alone leads to a lower percentage of individuals with problems in functioning.

Disability trends among older Americans: National Health and Nutrition Examination Surveys, 1988-1994 and 1999-2004.

OBJECTIVES We investigated trends in disability among older Americans from 1988 through 2004 to test the hypothesis that more recent cohorts show increased burdens of disability. METHODS We used data from 2 National Health and Nutrition Examination Surveys (1988-1994 and 1999-2004) to assess time trends in basic activities of daily living, instrumental activities, mobility, and functional limitations for adults aged 60 years and older. We assessed whether changes could be explained by sociodemographic, body weight, or behavioral factors. RESULTS With the exception of functional limitations, significant increases in each type of disability were seen over time among respondents aged 60 to 69 years, independent of sociodemographic characteristics, health status, relative weight, and health behaviors. Significantly greater increases occurred among non-Whites and persons who were obese or overweight (2 of the fastest-growing subgroups within this population). We detected no significant trends among respondents aged 70 to 79 years; in the oldest group (aged>or=80 years), time trends suggested lower prevalence of functional limitations among more recent cohorts. CONCLUSIONS Our results have significant and sobering implications: older Americans face increased disability, and society faces increased costs to meet the health care needs of these disabled Americans.

Social Environment Effects on Health and Aging

Abstract: This paper provides an overview of epidemiological and demographic research linking social characteristics of both individuals and communities to differences in both morbidity and mortality risks. Evidence is presented linking three broad aspects of the social environment to health—the network of personal social relationships within which most of us live our lives, individual socioeconomic status (SES), and community‐level social characteristics. Large and consistent bodies of literature from both epidemiology and demography provide clear evidence for the generally health‐promoting effects of personal social relationships and SES. The bulk of the evidence relates to mortality although both fields have begun to examine other health outcomes, including aspects of physical and cognitive functioning as well as disease outcomes. A smaller but growing body of community‐level data, reflecting both the socioeconomic/resource characteristics of these broader communities and, more specifically, social features of these environments, also point to health impacts from these more macro level social environment characteristics. Much remains to be elucidated, however, concerning the actual mechanisms through which something as complex and multifaceted as SES “gets under the skin.” This necessarily includes consideration of external characteristics of the environments (both physical and sociocultural) where people live and work, and individual characteristics, as well as possible interactions between these in producing the observed SES gradients in health and mortality. These questions concerning links between social environment conditions and health may be a particularly fruitful area of future collaboration, drawing on the shared interest of demographers and epidemiologists in understanding how different social conditions promote variation in distributions of better versus worse health outcomes within a population.