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Pathways to Disability: Predicting Health Trajectories

In: Health at Older Ages: The Causes and Consequences of Declining Disability among the Elderly

  • Florian Heiss
  • Axel Börsch-Supan
  • Michael Hurd
  • David A. Wise

The paper considers transitions in the health and disability status of persons as they age. In particular, we explore the relationship between health and disability at younger ages (say 50) and health and disability in future ages. We consider for example, the future health path of persons who are in good health at age 50 compared to the future health path of persons who are in poor health at age 50. To do this, we develop a model that jointly considers health and mortality. The key feature of the model is the assumption of underlying “latent†health that determines both mortality and self-reported responses to categorical health and disability questions. Latent health allows for heterogeneity among individuals and allows for correlation of health status over time, thus allowing for state dependence as well as heterogeneity. The model also allows for classification errors in self-reported response to categorical health and disability questions. All of these are important features of health and disability data, as we show with descriptive data. The model accommodates the strong relationship between self-reported health status and mortality, which is critical to an understanding of the paths of health and disability of the survivors who are observed in panel data files. Our empirical analysis is based on all four cohorts of the Health and Retirement Study (HRS) -- the HRS, AHEAD, CODA and WB cohorts). We find that self-reported health and self-reported disability correspond very closely to one another in the HRS. We find that both self-reported health and disability are strong predictors of mortality. Health and disability at younger ages are strongly related to future health and disability paths of persons as they age. There are important differences in health and disability paths by education level, race, and gender.

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This chapter was published in:
  • David M. Cutler & David A. Wise, 2009. "Health at Older Ages: The Causes and Consequences of Declining Disability among the Elderly," NBER Books, National Bureau of Economic Research, Inc, number cutl08-1.
  • This item is provided by National Bureau of Economic Research, Inc in its series NBER Chapters with number 11112.
    Handle: RePEc:nbr:nberch:11112
    Contact details of provider: Postal: National Bureau of Economic Research, 1050 Massachusetts Avenue Cambridge, MA 02138, U.S.A.
    Phone: 617-868-3900
    Web page: http://www.nber.org
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    1. Pierre-Carl Michaud & Arthur van Soest, 2004. "Health and Wealth of Elderly Couples: Causality Tests Using Dynamic Panel Data Models," Working Papers 191, RAND Corporation Publications Department.
    2. Adda, Jerome & Chandola, Tarani & Marmot, Michael, 2003. "Socio-economic status and health: causality and pathways," Journal of Econometrics, Elsevier, vol. 112(1), pages 57-63, January.
    3. James P. Smith, 2005. "Unraveling the SES-Health Connection," Labor and Demography 0505018, EconWPA.
    4. Gruber, Jonathan & Wise, David A. (ed.), 1999. "Social Security and Retirement around the World," National Bureau of Economic Research Books, University of Chicago Press, edition 1, number 9780226310114.
    5. Peter Adams & Michael D. Hurd & Daniel L. McFadden & Angela Merrill & Tiago Ribeiro, 2004. "Healthy, Wealthy, and Wise? Tests for Direct Causal Paths between Health and Socioeconomic Status," NBER Chapters, in: Perspectives on the Economics of Aging, pages 415-526 National Bureau of Economic Research, Inc.
    6. Michael Hurd & Arie Kapteyn, 2003. "Health, Wealth, and the Role of Institutions," Working Papers 03-09, RAND Corporation Publications Department.
    7. Meer, Jonathan & Miller, Douglas L. & Rosen, Harvey S., 2003. "Exploring the health-wealth nexus," Journal of Health Economics, Elsevier, vol. 22(5), pages 713-730, September.
    8. Heiss, Florian, 2006. "Nonlinear State-Space Models for Microeconometric Panel Data," Discussion Papers in Economics 1157, University of Munich, Department of Economics.
    9. Börsch-Supan, Axel, 2001. "Incentive Effects of Social Security Under an Uncertain Disability Option," Sonderforschungsbereich 504 Publications 01-42, Sonderforschungsbereich 504, Universität Mannheim;Sonderforschungsbereich 504, University of Mannheim.
    10. Contoyannis, Paul & Jones, Andrew M., 2004. "Socio-economic status, health and lifestyle," Journal of Health Economics, Elsevier, vol. 23(5), pages 965-995, September.
    11. Axel H. Boersch-Supan, 2001. "Incentive Effects of Social Security under an Uncertain Disability Option," NBER Chapters, in: Themes in the Economics of Aging, pages 281-310 National Bureau of Economic Research, Inc.
    12. Michael Hurd & Daniel McFadden & Angela Merrill, 1999. "Predictors of Mortality Among the Elderly," NBER Working Papers 7440, National Bureau of Economic Research, Inc.
    13. Borg, Vilhelm & Kristensen, Tage S., 2000. "Social class and self-rated health: can the gradient be explained by differences in life style or work environment?," Social Science & Medicine, Elsevier, vol. 51(7), pages 1019-1030, October.
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