Differential Trends in Disability Among Rich and Poor Adults in the United States and England From 2002 to 2016

HwaJung Choi; Robert F Schoeni; Andrew Steptoe; Tsai-Chin Cho; Kenneth M Langa

doi:10.1093/geronb/gbac029

Differential Trends in Disability Among Rich and Poor Adults in the United States and England From 2002 to 2016

J Gerontol B Psychol Sci Soc Sci. 2022 May 27;77(Suppl_2):S189-S198. doi: 10.1093/geronb/gbac029.

Authors

HwaJung Choi^{1

2}, Robert F Schoeni^{3

4}, Andrew Steptoe⁵, Tsai-Chin Cho⁶, Kenneth M Langa^{1

3}

Affiliations

¹ Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan, USA.
² Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.
³ Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA.
⁴ Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, Michigan, USA.
⁵ Department of Behavioural Science and Health, University College London, London, UK.
⁶ Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.

Abstract

Objectives: Disability in the United States has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the United States and England, would inform public policy aimed at reducing disparities in disability.

Methods: Using the Health and Retirement Study and the English Longitudinal Study of Ageing, we estimated annual percent change from 2002 to 2016 in disability among community-dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with 5 instrumental activities of daily living and 6 activities of daily living. We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design.

Results: The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002-2016. For ages 55-64 and 65-74, disability prevalence was unchanged in the United States but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55-64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC = -3.60; 95% confidence interval [CI; -6.57, -0.63] for the United States; AAPC = -6.06; 95% CI [-8.77, -3.35] for England).

Discussion: Improvements in disability were more widespread in England than in the United States between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries.

Keywords: ADL limitation; Disability trend; Health disparity; IADL limitation; U.S.–England comparison.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Activities of Daily Living*
Aged
Disability Evaluation
Disabled Persons*
Humans
Income
Independent Living
Longitudinal Studies
Middle Aged
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding