Mark D. Hayward

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.

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.

Racial inequality in active life among adult Americans.

Is a shorter life with more years lived in poor health a defining attribute of the life cycle of disadvantaged groups? Based on the J990 5% Public Use Microdata Survey, we develop life table models of healthy (or active) life for the major racial groups, by sex, in the United States. The analysis underscores the complexity of the relationship between morbidity and mortality in the population. For Asians, longer life is associated with fewer years lived in poor health. In contrast, Native Americans’ relatively longer lives are accompanied by extended periods of chronic health problems. of all racial groups, blacks live the fewest years, and they live a high proportion of those years with a chronic health problem. Hispanics also live substantially fewer years, yet the period of life they spend with a health problem is relatively compressed. Racial differences in the link between morbidity and mortality point to the importance of investigating how chronic diseases and disease prevention and treatment are related to active life across the population subgroups.

Age differences in allostatic load: an index of physiological dysregulation

This preliminary report examines variation in allostatic load by age for a large nationally representative population of the United States. It uses data on 13 indicators of physiologic dysregulation from a nationally representative sample of the US population 20 years of age and over. Allostatic load is remarkably constant in the older ages after increasing sharply in the years from 20 to 60. We hypothesize that this represents mortality selectivity of the population by physiological status.

Marriage Markets and Marital Choice

This article presents a search model of marital choice. We tested the hypothesis that demographic shortages of suitable marital partners not only lower the probability of marriage, but increase the likelihood that never-married women will either: (a) marry men with characteristics dissimilar to their own or (b) marry men with low socioeconomic status. This analysis was accomplished using data from the 1979-1986 waves of the National Longitudinal Survey of Youth, merged with various local-area sex ratios from the 1980 decennial U.S. Census. We found that a favorable marriage market, measured in terms of the relative number of men to women, increases the odds of marrying a high-status man compared with a low-status man (as measured in terms of education and occupation). It also increases the chance of forgoing marriage rather than marrying low-status men. At the same time, we found little evidence that mate surpluses or deficits in the local marriage market affect patterns of homogamy or assortative mating. The implication is that market conditions— good or bad—have little to do with womens willingness to marry heterogamously. Women are unwilling to “cast a wider net” in the face of market constraints.

Occupational influences on retirement, disability, and death

This research examines the alternative mechanisms by which occupations influence the nature and timing of older men’s labor force withdrawal. We specifically assess the extent to which occupational factors operate directly and indirectly on exiting events and whether occupations constrain traditional determinants of labor force participation. Based on a discrete-time hazard modeling approach, the results substantiate that the occupational task activities—substantive complexity and physical demands— are key elements of the work environment that are evaluated against nonwork alternatives. In the case of retirement, these aspects of occupational attractiveness function as a dominant and direct force in retirement decision making. With regard to disability, the occupational attribute of substantive complexity operates as an indirect advantage (through higher wages) by reducing the risk of disability. Indicators of career continuity also influence retirement among older workers. Finally, the results suggest that financial characteristics and health problems are central to the distribution of older workers across the alternative destination statuses of retirement, disability, and death.

Change in Disability-Free Life Expectancy for Americans 70 Years Old and Older

In this article, we examine changes in life expectancy free of disability using longitudinal data collected from 1984 through 2000 from two cohorts who composed the Longitudinal Studies of Aging I and II. Life expectancies with and without ADL and/or IADL disability are calculated using a Markov-based multistate life table approach. At age 70, disability-free life expectancy increased over a 10-year period by 0.6 of a year in the later cohort, which was the same as the increase in total life expectancy, both increases marginally statistically significant. The average length of expected life with IADL and ADL disability did not change. Changes in disability-free life expectancy resulted from decreases in disability incidence and increases in the incidence of recovery from disability across the two survey cohorts. Age-specific mortality among the ADL disabled declined significantly in the later cohort after age 80. Mortality for the IADL disabled and the nondisabled did not change significantly. Those with ADL disability at age 70 experienced substantial increases in both total life expectancy and disability-free life expectancy. These results indicate the importance of efforts both to prevent and delay disability and to promote recovery from disability for increasing life expectancy without disability. Results also indicate that while reductions in incidence and increases in recovery work to decrease population prevalence of disability, declining mortality among the disabled has been a force toward increasing disability prevalence.

Occupational Careers and Mortality of Elderly Men

This article presents findings from an analysis of occupational differentials in mortality among a cohort of males aged 55 years and older in the United States for the period 1966–1983. Using the National Longitudinal Survey of Mature Men, we construct event histories for 3,080 respondents who reach the exact age of 55. The dynamics that characterize socioeconomic differentials in mortality are analyzed by evaluating the differential effects of occupation over the career cycle. Maximum likelihood estimates of hazard-model parameters show that the mortality of current or last occupation differssubstantially from that of longest occupation, controlling for education, income, health status, and other sociodemographic factors. In particular, the rate of mortality is reduced by the substantive complexity of the longest occupation while social skills and physical and environmental demands of the latest occupation lower mortality.

Early-life origins of the race gap in men's mortality

Using a life course framework, we examine the early life origins of the race gap in mens all-cause mortality. Using the National Longitudinal Survey of Older Men (1966–1990), we evaluate major social pathways by which early life conditions differentiate the mortality experiences of blacks and whites. Our findings indicate that early life socioeconomic conditions, particularly parental occupation and family structure, explain part of the race gap in mortality. Black mens higher rates of death are associated with lower socioeconomic standing in early life and living in homes lacking both biological parents. However, these effects operate indirectly through adult socioeconomic achievement processes, as education, family income, wealth, and occupational complexity statistically account for the race gap in mens mortality. Our findings suggest that policy interventions to eliminate race disparities in mortality and health should address both childhood and adult socioeconomic conditions.