Life Course Patterns of Work Disability among African American and White Women and Men Sarah B. Laditka, PhD and Jim Laditka, DA, PhD Gerontological Society of America, November 2016 Session: Disability Patterns and Trends
Background & Motivation • Work disabilities are physical or nervous conditions that limit a person’s type or amount of work • A period of work disability may damage current and lifetime opportunities for career advancement and increasing income • With importance of work disability for individuals, employers, and governments, it is useful to estimate the number of individuals who experience work disability, and number of years disabled • Evidence that African Americans have more disability than whites • No previous research has separately examined work disability among African American and white women and men
Study Objectives • Examined work disability, ages 20-65 in United States • Explored associations between work disability and common measures of functional status and chronic disease • Calculated summary measures of work disability throughout working life
Panel Study of Income Dynamics (PSID) - • World’s longest running panel survey, 1968-present • Original aim to study income and poverty • Over 70,000 participants • Our sample nationally representative of African American and White women and men (n=23,325) • 33 years monthly work status and earlier annual reports
Work disability measure Physical or nervous problems that limited type or amount of work (1968- 2013)
Analytical Strategy, Overview 1. Estimate monthly probabilities of work disability transition using multinomial logistic Markov chain analysis 2. Conduct microsimulations 3. Analyze simulated populations
Controls Controls • Education, <8 years, grade 8, 9-12 without diploma, high school, some college, college degree • Age • Gender • Separate results for African Americans and whites (to account for varying patterns of disability, as well as life expectancy)
Multinomial Logistic Markov model • 274,996 disability and death transitions • 375,192 person-years
Microsimulation • Used transition probabilities to create populations of simulated individuals, each with monthly history of work disability status from age 20 through death • Simulated populations of 1 million • Analyzed simulated populations for outcomes
Associations of Work Disability with Results Functional Limitations and Health Conditions • Work disability significantly associated with ADLs, IADLs, chronic conditions, with large effect sizes • For example , t he odds of reporting work disability were: – 350% greater with difficulty walking – 106% greater with arthritis – 253% greater with a report of fair or poor health – 271% greater with each additional IADL difficulty – 275% greater with each additional ADL difficulty (all p < 0.001)
Results, Women African White American Moderate Severe Moderate Severe Percent with any spell "AfricanAmerican" White Moderate Severe Moderate Severe 1 year 36.5 29.6 34.1 * 34.9 * Percent with any spell 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 * 24.3 * 2 years 25.8 22.6 24.8 * 24.3 * 3 years 17.3 16.8 17.3 16.6 3 years 17.3 16.8 17.3 16.6 4 years 11.1 12.3 11.7 * 11.1 * 5+ years 9.3 18.7 12.1 4 years 11.1 12.3 11.7 * 11.1 * * 13.2 * Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Total years (mean) 2.7 3.3 2.9 5+ years 9.3 18.7 12.1 * 13.2 * * 2.1 * Recovery transitions: Moderate to none, n 2.2 2.3 Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Severe to none, n 0.9 0.6 * Severe to moderate, n 1.3 Total years (mean) 2.7 3.3 2.9 * 2.1 * 0.8 * *p < 0.01 Recovery transitions: Moderate to none, n 2.2 2.3 Severe to none, n 0.9 0.6 * Severe to moderate, n 1.3 0.8 * *p < 0.01
Results, Women African White American Moderate Severe Moderate Severe "AfricanAmerican" White Percent with any spell Moderate Severe Moderate Severe Percent with any spell 1 year 36.5 29.6 34.1 * 34.9 * 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 * 24.3 * 2 years 25.8 22.6 24.8 * 24.3 * 3 years 17.3 16.8 17.3 16.6 3 years 17.3 16.8 17.3 16.6 4 years 11.1 12.3 11.7 * 11.1 * 5+ years 9.3 18.7 12.1 * 13.2 * 4 years 11.1 12.3 11.7 * 11.1 * Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Total years (mean) 2.7 3.3 2.9 5+ years 9.3 18.7 12.1 * 13.2 * * 2.1 * Recovery transitions: Moderate to none, n 2.2 2.3 Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Severe to none, n 0.9 0.6 * Severe to moderate, n 1.3 Total years (mean) 2.7 3.3 2.9 * 2.1 * 0.8 * *p < 0.01 Recovery transitions: Moderate to none, n 2.2 2.3 Severe to none, n 0.9 0.6 * Severe to moderate, n 1.3 0.8 * *p < 0.01
Results, Men African White American Moderate Severe Moderate Severe "AfricanAmerican" White Percent with any spell Moderate Severe Moderate Severe Percent with any spell 1 year 38.0 30.1 35.4 * 34.9 * 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 2 years 25.9 22.6 25.0 * 24.1 * * 24.3 * 3 years 17.3 16.8 17.3 16.6 4 years 11.1 12.3 11.7 3 years 16.9 16.6 17.0 16.4 * 11.1 * 5+ years 9.3 18.7 12.1 * 13.2 * Spells, n (mean) 3.5 2.4 3.2 4 years 10.6 12.1 11.2 * 11.1 * * 1.6 * Total years (mean) 2.7 3.3 2.9 * 2.1 * 5+ years 8.7 18.6 11.4 * 13.5 * Recovery transitions: Moderate to none, n 2.2 2.3 Spells, n (mean) 2.8 2.0 2.5 * 1.3 * Severe to none, n 0.9 0.6 * Severe to moderate, n 1.3 0.8 * Total years (mean) 2.3 3.0 2.5 * 1.9 * *p < 0.01 Recovery transitions: Moderate to none, n 1.8 1.8 Severe to none, n 0.8 0.5 * 0.6 * Severe to moderate, n 1.0 *p < 0.01
Results, Men African White American Moderate Severe Moderate Severe "AfricanAmerican" White Percent with any spell Moderate Severe Moderate Severe Percent with any spell 1 year 38.0 30.1 35.4 * 34.9 * 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 2 years 25.9 22.6 25.0 * 24.1 * * 24.3 * 3 years 17.3 16.8 17.3 16.6 4 years 11.1 12.3 11.7 3 years 16.9 16.6 17.0 16.4 * 11.1 * 5+ years 9.3 18.7 12.1 * 13.2 * 4 years Spells, n (mean) 3.5 10.6 2.4 12.1 3.2 11.2 * 11.1 * * 1.6 * Total years (mean) 2.7 3.3 2.9 * 2.1 * 5+ years 8.7 18.6 11.4 * 13.5 * Recovery transitions: Moderate to none, n 2.2 2.3 Spells, n (mean) 2.8 2.0 2.5 * 1.3 * Severe to none, n 0.9 0.6 * Severe to moderate, n 1.3 0.8 * Total years (mean) 2.3 3.0 2.5 * 1.9 * *p < 0.01 Recovery transitions: Moderate to none, n 1.8 1.8 Severe to none, n 0.8 0.5 * 0.6 * Severe to moderate, n 1.0 *p < 0.01
Discussion • Work disability is substantially correlated with common measures of functional status • Work disability increased with age • Only modest differences between African Americans and whites for moderate work disability • More African Americans have severe work disability than whites, for longer periods • People often recover, even from severe work disability
Limitations • Self-reports of work disability may be subject to error • Small differences in wording of work disability questions may lead to different estimates than those of other surveys, e.g., Current Population Survey, National Health Interview Survey, Survey of Income and Program Participation
Conclusions and Implications • Many adults work with disabilities over long periods of working life, particularly in later working ages • Results should be considered in proposals to address solvency of Social Security by raising retirement age • Managers and organization leaders need to recognize that many employees work with disabilities • Given notable probability of recovery, useful for rehabilitation professionals to emphasize positive expectations and encourage persistence when helping people to recover from work disabilities
For details about our methods . . . Laditka, S.B., and J.N. Laditka (2016). "Moxie Matters: Associations of Future Orientation with Active Life Expectancy." Aging and Mental Health, epub ahead of print, June 29, 2016. Laditka, J.N. and S.B. Laditka. (2016). "Associations of Educational Attainment with Disability and Life Expectancy by Race and Gender in the United States: A Longitudinal Analysis of the Panel Study of Income Dynamics." Journal of Aging and Health, 28(8), 1403-1425. Laditka, J.N., and S.B. Laditka (2016). "Unemployment, Disability and Life Expectancy in the United States: A Life Course Study." Disability and Health Journal, 9(1), 46-53 Laditka, J.N. and S.B. Laditka (2016). "Associations of Multiple Chronic Health Conditions in the United States with Active Life Expectancy." Disability and Rehabilitation, 38(4), 354-361. Laditka, S.B., and J.N. Laditka (2015). "Active Life Expectancy of Americans with Diabetes: Risks of Heart Disease, Obesity, and Inactivity." Diabetes Research and Clinical Practice, 107(1), 37-45. Laditka, J.N. and S.B. Laditka (2014). "Stroke, Disability, and Mortality in the United States: 1999-2009." Disability and Health Journal, 7(4), 472-477. Laditka, S.B., and J.N. Laditka (2014). "More Education May Limit Disability and Extend Life for People with Cognitive Impairment." American Journal of Alzheimer’s Disease and Other Dementias, 29(5), 436-447.
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