Expansion, Compression, Neither, Both? Divergent Patterns in Healthy, Disability-Free, and Morbidity-Free Life Expectancy Across U.S. Birth Cohorts, 1998-2016

Abstract

This article explores how patterns of health, morbidity, and disability have changed across successive generations of older adults in the United States. Using a novel method for comparing state-specific partial life expectancies-that is, total life expectancy (LE), and health expectancies (HEs) in different health states, bounded between two ages-I explore changes in healthy life expectancy across successive birth cohorts of the U.S. population. Results show that little compression of disability is occurring across cohorts, LE with chronic morbidities has expanded considerably, and self-rated health is improving across cohorts, but only at ages 70+. These findings suggest that successive cohorts in the U.S. population may be on divergent paths in terms of late-life health and well-being. Exploring heterogeneity in these patterns, I find that less educated individuals have substantially lower partial LE and disability-free LE than those with more schooling, and that disability-free life is declining among those with less than a high school diploma. Differences in HEs are pervasive across racial and ethnic groups, and both disabled LE and unhealthy LE are expanding in some disadvantaged subgroups. The continued increases in partial LE with morbidities across successive cohorts, and the broad stagnation of disability-free and healthy LE, present a broad view of a U.S. population in which successive generations are not living healthier lives.

Keywords: Compression of morbidity; Disability; Heathy life expectancy; Population health.