Life Course Patterns of Work Disability among African American and - - PowerPoint PPT Presentation

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
• pportunities 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
• f 1 million
• Analyzed simulated

populations for

• utcomes

Results

Associations of Work Disability with Functional Limitations and Health Conditions

• Work disability significantly associated with ADLs,

IADLs, chronic conditions, with large effect sizes

• For example, the 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

"AfricanAmerican" White Moderate Severe Moderate Severe Percent with any spell 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 * 24.3 * 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 * Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Total years (mean) 2.7 3.3 2.9 * 2.1 * 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

Moderate Severe Moderate Severe Percent with any spell 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 * 24.3 * 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 * Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Total years (mean) 2.7 3.3 2.9 * 2.1 * 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 African American White

Results, Women

"AfricanAmerican" White Moderate Severe Moderate Severe Percent with any spell 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 * 24.3 * 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 * Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Total years (mean) 2.7 3.3 2.9 * 2.1 * 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

Moderate Severe Moderate Severe Percent with any spell 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 * 24.3 * 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 * Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Total years (mean) 2.7 3.3 2.9 * 2.1 * 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 African American White

Results, Men

"AfricanAmerican" White Moderate Severe Moderate Severe Percent with any spell 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 * 24.3 * 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 * Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Total years (mean) 2.7 3.3 2.9 * 2.1 * 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

Moderate Severe Moderate Severe Percent with any spell 1 year 38.0 30.1 35.4 * 34.9 * 2 years 25.9 22.6 25.0 * 24.1 * 3 years 16.9 16.6 17.0 16.4 4 years 10.6 12.1 11.2 * 11.1 * 5+ years 8.7 18.6 11.4 * 13.5 * Spells, n (mean) 2.8 2.0 2.5 * 1.3 * Total years (mean) 2.3 3.0 2.5 * 1.9 * Recovery transitions: Moderate to none, n 1.8 1.8 Severe to none, n 0.8 0.5 * Severe to moderate, n 1.0 0.6 * *p < 0.01 African American White

Results, Men

"AfricanAmerican" White Moderate Severe Moderate Severe Percent with any spell 1 year 36.5 29.6 34.1 * 34.9 * 2 years 25.8 22.6 24.8 * 24.3 * 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 * Spells, n (mean) 3.5 2.4 3.2 * 1.6 * Total years (mean) 2.7 3.3 2.9 * 2.1 * 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

Moderate Severe Moderate Severe Percent with any spell 1 year 38.0 30.1 35.4 * 34.9 * 2 years 25.9 22.6 25.0 * 24.1 * 3 years 16.9 16.6 17.0 16.4 4 years 10.6 12.1 11.2 * 11.1 * 5+ years 8.7 18.6 11.4 * 13.5 * Spells, n (mean) 2.8 2.0 2.5 * 1.3 * Total years (mean) 2.3 3.0 2.5 * 1.9 * Recovery transitions: Moderate to none, n 1.8 1.8 Severe to none, n 0.8 0.5 * Severe to moderate, n 1.0 0.6 * *p < 0.01 African American White

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.

Thank You

For many of the photos we thank: Centers for Disease Control and Prevention, & Alzheimer’s Association. The Healthy Brain Initiative: a national public health road map to maintaining cognitive health. Chicago, IL: Alzheimer’s Association; 2007. Centers for Disease Control and Prevention. The CDC Healthy Brain Initiative: Progress 2006-2011. Atlanta, GA: CDC; 2011.