Disparities in Disability Life Expectancy in US Birth Cohorts: The Influence of Sex and Race

Abstract

Racial and sex disparities in chronic diseases and mortality are sources of health inequality and have been observed from infancy to adulthood. Disparities in health and mortality contribute to corresponding disparities in healthy life. I address two previously unanswered questions in the aging literature. First, does the racial and sex gap in healthy life narrow, persist, or expand over age and time, particularly considering severity of ill health, among the oldest old? Second, do some race-sex groups of birth cohorts live not just longer lives, but longer healthier lives, while others spend additional years in illness? To estimate the quantities, I employ a refined definition of physical disability and apply a new extension of Sullivan's method to true birth cohorts. The results suggest among the oldest old, few racial or sex disparities exist over age and time in mild disability. Yet, racial and sex disparities persist over age and time in severe disability.

Fig. 1

Total Life Expectancy and Disability Life Expectancy (DLE) by Severity Level. This graph shows the total life expectancy and disability life expectancy by level of severity for select ages and birth cohorts. Mild disability is defined as less than three ADL dysfunctions. Severe disability is defined as three or more ADL dysfunctions. Total life expectancy is represented as a horizontal line. The balanced 95 percent confidence interval of the bounds of mild (severe) DLE is shown as a(n) closed (open) box. Estimates derived from US period of life tables and Medicare Current Beneficiary Survey. Note: Data for the 1904 burn cohort at age 82 are not available because the Medicare Current Beneficiary Survey started in 1991.

Fig. 2

Proportion of Remaining Life in Mild and Severe Disability for White Men and Black Women. The shaded region represents the 95 percent confidence interval of the proportion of remaining life spent in mild and severe disability. Severity assessed by the number of ADL dysfunctions.

Fig. 3

Proportion of Remaining Life in Mild and Sever Disability for White Women and Black Men. The shaded region represents the 95 percent confidence interal of the proportion of remaining life spent in mild and severe disability. Severity assessed by the number of ADL dysfunctions.

Fig. 4

Proportion of Remaining Life Spent in Severe Disability for the 1904 and 1909 Birth Cohorts by Sex and Race. Each panel shows the proportion of remaining life spent in severe disability for two birth cohorts, 1904 and 1909. The shaded region represents the 95 percent confidence interval of the proportion of remaining life spent in this disability. Severity assessed by the use of personal or equipment assistance.