Assessing the Burden of Joint Cognitive and Physical Health Impairment in the US, 1998-2016

Shubhankar Sharma , Max Planck Institute for Demographic Research
Jo Mhairi Hale, University of St Andrews
Mikko Myrskylä, Max Planck Institute for Demographic Research and London School of Economics and Political Science (LSE)
Hill Kulu , University of St Andrews

Background: Although cognitive and physical impairments often co-occur in older individuals, they are typically studied as separate outcomes. We quantify the burden of their co-occurrence (joint impairment) using two key indicators- lifetime risk and expectancy for Americans aged 50 and over. Data and Methods: We use the Health and Retirement Study (n=37,136; 1998-2016) and multistate models to study joint impairment for the overall population and by race/ethnicity/nativity, education and their interactions. Furthermore, we analyze how eliminating racial/ethnic inequalities in educational attainment would mitigate disparities in joint impairment. Results: Overall, 58% of women and 42% of men aged 50 and over are predicted to experience joint impairment in their remaining life expectancy. Women also live longer in joint impairment than men (3.4 vs 1.9 years). Foreign-born Latinas have 83% lifetime risk compared with Whites’ 52% and 3 times more jointly impaired years (8.1 vs 2.7 years). Lower educated men experience 32 percentage points higher lifetime risk and 3 times more joint impairment years than higher educated men. The lowest educated Blacks and Latinx carry the greatest joint impairment burden. The substantial racial disparities in joint impairment reduce considerably once educational differences are eliminated, but some disparities persist. Discussion: This study emphasizes the importance of considering cognitive and physical impairment simultaneously in assessing older-age disability. The substantial disparities in the burden indicate that the U.S. has a long way to go to attain health equity. The evidence that eliminating educational inequalities mitigates some of those disparities can inform policy.

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 Presented in Session 49. Health and Quality of Life of Older People