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This paper provides the first nationally representative estimates of vulnerability to severe com-plications from COVID-19 overall and across race-ethnicity and socioeconomic status. We use the Panel Study of Income Dynamics (PSID) to examine the prevalence of specific health condi-tions associated with complications from COVID-19 and to calculate, for each individual, an index of the risk of severe complications from respiratory infections developed by DeCaprio et al. (2020). We show large disparities across race-ethnicity and socioeconomic status in the prev-alence of conditions which are associated with the risk of severe complications from COVID-19. Moreover, we show that these disparities emerge early in life, prior to age 65, leading to higher vulnerability to such complications. While vulnerability is highest among older adults regardless of their race-ethnicity or socioeconomic status, our results suggest particular attention should also be given to the risk of adverse outcomes in midlife for non-Hispanic Blacks, adults with a high school degree or less, and low-income Americans.

This cross-sectional survey study assesses whether adults with risk factors for COVID-19 complications perceive an elevated chance of complications and undertake fewer higher infection risk behaviors., Key Points Question Do adults with risk factors for COVID-19 complications understand their elevated risk and undertake fewer higher infection risk behaviors? Findings In this survey study of 6084 US adults, those with 7 of 9 medical risk factors for COVID-19 complications reported higher perceived chance of hospitalization or death from COVID-19 if infected compared with those without the factor. While nearly all adults reported recent mask wearing, during several common activities the majority, including susceptible adults, did not consistently wear masks. Meaning Adults with medical risk factors for COVID-19 complications understood their risks were higher, but consistent mask wearing remained low., Importance It is unknown whether adults who are susceptible to severe complications from COVID-19 recognize their susceptibility and modify behavior to reduce exposure. Objective To determine whether adults with risk factors for COVID-19 complications perceive an elevated chance of complications and undertake fewer higher infection risk behaviors. Design, Setting, and Participants This cross-sectional analysis, adjusted for sociodemographic characteristics, included civilian noninstitutionalized US adults of wave 18 of the Understanding America Study collected from November 11 to December 9, 2020. Exposures US Centers for Disease Control and Prevention–identified medical risk factors for COVID-19 complications and older age. Main Outcomes and Measures Primary outcomes were perceived percentage chance of infection and hospitalization and death if infected; whether 9 potentially higher infection risk activities were undertaken in the past week and, if so, whether a mask was worn; whether a mask was worn anywhere in the past week; and attitudes toward 12 aspects of mask wearing. Results In Understanding America Study wave 18 (n = 5910 participants with nonmissing data), the mean age was 48 years, and 52% were women. The response rate was 77%. Adults with 7 of 9 medical risk factors and aged 70 years and older reported a higher perceived chance of complications if infected. Adjusted mean perceived chance of hospitalization if infected ranged from 23.9% (95% CI, 22.2%-25.5%) for those with high blood pressure to 40.4% (95% CI, 34.6%-46.2%) for those with chronic lung disease and was associated with number of medical risk factors: 17.6% (95% CI, 16.4%-18.8%) and 41.8% (95% CI, 38.7%-45.0%) for adults with 0 vs 3 or more medical risk factors, respectively. Fewer potentially higher infection risk activities were undertaken by adults with 3 or more vs 0 risk factors: 2.83 (95% CI, 2.66-2.99) vs 3.12 (95% CI, 3.02-3.22). Wearing a mask sometime last week was nearly universal (90.1%). But during only 1 specific activity (visiting a grocery store or pharmacy) did more than half always wear a mask, and for only 1 activity (visiting a grocery store or pharmacy) was mask wearing more common among adults with 3 or more vs 0 conditions. Conclusions and Relevance In this cross-sectional survey study, adults with risk factors for COVID-19 complications reported higher perceived susceptibility to complications. During common activities, including visiting with friends, the majority of adults, including the highly susceptible, did not consistently wear masks.

Household wealth and its distribution are topics of broad public debate and increasing scholarly interest. We compare the relative strength of two of the main data sources used in research on the wealth holdings of U.S. households, the Survey of Consumer Finances (SCF) and the Panel Study of Income Dynamics (PSID), by providing a description and explanation of differences in the level and distribution of wealth captured in these two surveys. We identify the factors that account for differences in average net worth but also show that estimates of net worth are similar throughout most of the distribution. Median net worth in the SCF is 6% higher than in the PSID and the largest differences between the two surveys are concentrated in the 1-2 percent wealthiest households, leading to a different view of wealth concentration at the very top but similar results for wealth inequality across most of the distribution.

The COVID-19 pandemic has magnified U.S. health disparities. Though disparities in COVID-19 hospitalization by race-ethnicity are large, disparities by income and education have not been studied. Using an index based on preexisting health conditions and age, we estimate disparities in vulnerability to hospitalization from COVID-19 by income, education, and race-ethnicity for U.S. adults. The index uses estimates of health condition and age effects on hospitalization for respiratory distress prior to the pandemic validated on COVID-19 hospitalizations. We find vulnerability arising from preexisting conditions is nearly three times higher for bottom versus top income quartile adults and 60 % higher for those with a high-school degree relative to a college degree. Though non-Hispanic Blacks are more vulnerable than non-Hispanic Whites at comparable ages, among all adults the groups are equally vulnerable because non-Hispanic Blacks are younger. Hispanics are the least vulnerable. Results suggest that income and education disparities in hospitalization are likely large and should be examined directly to further understand the unequal impact of the pandemic.

Importance Socioeconomic differences in life expectancy, health, and disability have been found in European countries as well as in the US. Identifying the extent and pattern of health disparities, both within and across the US and England, may be important for informing public health and public policy aimed at reducing these disparities. Objective To compare the health of US adults aged 55 to 64 years with the health of their peers in England across the high and low ranges of income in each country. Design, Setting, and Participants Using data from the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) for 2008-2016, a pooled cross-sectional analysis of comparably measured health outcomes, with adjustment for demographic characteristics and socioeconomic status, was conducted. The analysis sample included community-dwelling adults aged 55 to 64 years from the HRS and ELSA, resulting in 46 887 person-years of observations. Data analysis was conducted from September 17, 2019, to May 12, 2020. Exposures Residence in the US or England and yearly income. Main Outcomes and Measures Sixteen health outcomes were compared, including 5 self-assessed outcomes, 3 directly measured outcomes, and 8 self-reported physician-diagnosed health conditions. Results This cross-sectional study included 12 879 individuals and 31 928 person-years from HRS (mean [SD] age, 59.2 [2.8] years; 51.9% women) and 5693 individuals and 14 959 person-years from ELSA (mean [SD] age, 59.3 [2.9] years; 51.0% women). After adjusting for individual-level demographic characteristics and socioeconomic status, a substantial health gap between lower-income and higher-income adults was found in both countries, but the health gap between the bottom 20% and the top 20% of the income distribution was significantly greater in the US than England on 13 of 16 measures. The adjusted US-England difference in the prevalence gap between the bottom 20% and the top 20% ranged from 3.6 percentage points (95% CI, 2.0-5.2 percentage points) in stroke to 9.7 percentage points (95% CI, 5.4-13.9 percentage points) for functional limitation. Among individuals in the lowest income group in each country, those in the US group vs the England group had significantly worse outcomes on many health measures (10 of 16 outcomes in the bottom income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the bottom income decile ranged from 7.6% (95% CI, 6.0%-9.3%) vs 3.8% (95% CI, 2.6%-4.9%) for stroke to 75.7% (95% CI, 72.7%-78.8%) vs 59.5% (95% CI, 56.3%-62.7%) for functional limitation. Among individuals in the highest income group, those in the US group vs England group had worse outcomes on fewer health measures (4 of 16 outcomes in the top income decile); the significant differences in adjusted prevalence of health problems in the US vs England for the top income decile ranged from 36.9% (95% CI, 33.4%-40.4%) vs 30.0% (95% CI, 27.2%-32.7%) for hypertension to 35.4% (95% CI, 32.0%-38.7%) vs 22.5% (95% CI, 19.9%-25.1%) for arthritis. Conclusions and Relevance For most health outcomes examined in this cross-sectional study, the health gap between adults with low vs high income appeared to be larger in the US than in England, and the health disadvantages in the US compared with England are apparently more pronounced among individuals with low income. Public policy and public health interventions aimed at improving the health of adults with lower income should be a priority in the US.

BACKGROUND Cancer presents a substantial hardship for patients and their families in multiple domains beyond health and survival. Relatively little is known about the economic impact of cancer. The authors present estimates of the aggregate effects of a cancer diagnosis on employment and income in a prospective, nationally representative sample of US adults. METHODS The authors used data from the 1990 through 2009 waves of the Panel Study of Income Dynamics, a nationally representative, prospective, population-based observational study with high-quality individual and family-level economic information. Age-adjusted, sex-stratified, individual fixed-effects regression models were used to derive estimates of the impact of cancer on employment, hours worked, individual income, and total family income. RESULTS Significant effects of cancer on all 4 outcomes were observed. The probability of a cancer patient being employed dropped by almost 10 percentage points, and hours worked declined by up to 200 hours in the first year after diagnosis. Annual labor-market earnings dropped almost 40% within 2 years after diagnosis and remained low, whereas total family income declined by 20%, although it recovered within 4 years after the diagnosis. These economic impacts on survivors were driven by effects among men; the effects among women largely were not statistically significant. CONCLUSIONS A cancer diagnosis has substantial effects on the economic well-being of affected adults and their families. With the increasing number of cancer survivors in the US population, there is a growing need for examining the long-term implications for economic well-being and ways to mitigate the economic hardship associated with cancer. Cancer 2015;121:4425–32. © 2015 American Cancer Society.

China has the world's largest oldest-old population, but information on trends in late-life disability is lacking. We use data from the Chinese Longitudinal Healthy Longevity Survey for 1998 to 2008 to determine whether prevalence of limitations with physical functions and daily activities has changed recently among the Chinese population aged 80 to 105 and, if so, to investigate the factors associated with the change. We find that prevalence of need for assistance with activities of daily living and inability to independently conduct instrumental activities of daily living declined substantially. Males did not experience improvement in ability to carry out underlying physical functions over the same period, but females did. Variables associated with trends in one or more of these outcomes were adequacy of medical care as a child, childhood hunger, father's occupation in agriculture, main occupation before age 60 in agriculture, adequacy of current medical care, and body weight.

To assess changes in family residential proximity after a first cardiovascular (CV) event among older adults and to identify families most likely to experience such moves.Using a nationally representative longitudinal study of older adults in the United States, we identified respondents with no prior diagnosis of CV disease (CVD). We examined subsequent development of stroke, heart attack, and/or heart failure among these older adults and examined changes in their residential proximity to their closest child before and after the CV event. We then compared the likelihood of changes in proximity between families with and without CV events. Finally, we determined which types of families are most likely to relocate following a CV event.Having a first CV event increases the 2-year predicted probability of children and adult parents moving in with and closer to each other (relative risk ratio = 1.61 and 1.55, respectively). Families are especially likely to move after a first CV event if the older person experiencing the event is spouseless or has a daughter.CVD is a leading cause of disability, which in turn creates a significant need for personal care among older adults. Assessment of changes in family residential proximity responding to CV events is important to fully understand the consequences of older adults' CV events including the cost of caregiving.

To examine the potential role of child and spousal availability in facilitating community-based care for disabled older adults.We used the Health and Retirement Study, a nationally representative longitudinal study of older adults. The analysis sample included older adults who were nondisabled at baseline, but who then developed at least one activity of daily living (ADL) limitation over the subsequent 2-year period (N = 2,094). Using multivariate, multinomial logistic regression, we examined the association of child and spouse availability prior to disablement of the older adults with ADL care receipt status after the onset of disablement, after adjusting for other sociodemographic and clinical characteristics.Lower socioeconomic status (SES) was associated with less availability of a spouse but greater availability of children at baseline. Compared with older adults who had no children nearby (i.e., all children lived further than 30 miles), older adults who had at least one child living with or near them prior to the onset of the ADL limitation were less likely to go to a nursing home (adjusted odds ratio [AOR]: 0.26 for coresident; AOR: 0.44 for 1- 30 miles) and less likely to depend on formal care (AOR: 0.39 for coresident; AOR: 0.51 for 1-30 miles) after the onset of new ADL limitation/s.Understanding SES variations in the informal care resources, and potential role of child geographic availability, may inform the development of cost-effective community-based care programs and policies.

It has been well documented that response rates to cross-sectional surveys have declined over the past few decades. It is less clear whether response rates to longitudinal surveys have experienced similar changes over time. This article examines trends in response rates in several major, national longitudinal surveys in the United States and abroad. The authors find that for most of these surveys, the wave-to-wave response rate has not declined. This article also describes the various approaches that these surveys use to minimize attrition.

This article updates trends from five national U.S. surveys to determine whether the prevalence of activity limitations among the older population continued to decline in the first decade of the twenty-first century. Findings across studies suggest that personal care and domestic activity limitations may have continued to decline for those ages 85 and older from 2000 to 2008, but generally were flat since 2000 for those ages 65–84. Modest increases were observed for the 55- to 64-year-old group approaching late life, although prevalence remained low for this age group. Inclusion of the institutional population is important for assessing trends among those ages 85 and older in particular.

Little consensus exists regarding the relationship between socioeconomic status (SES) and substance use. This study examined the associations of three indicators of family SES during childhood--income, wealth, and parental education--with smoking, alcohol use, and marijuana use during young adulthood.Data were obtained from the national Panel Study of Income Dynamics, a survey of U.S. families that incorporates data from parents and their children. In 2005 and 2007, the Panel Study of Income Dynamics was supplemented with two waves of Transition into Adulthood data drawn from a national sample of young adults, 18-23 years old. Data from the young adults (N = 1,203; 66.1% White; 51.5% female) on their current use of alcohol, cigarettes, and marijuana were used as outcome variables in logistic regressions. Socioeconomic background was calculated from parental reports of education, wealth, and income during the respondent's childhood (birth through age 17 years).Smoking in young adulthood was associated with lower childhood family SES, although the association was explained by demographic and social role covariates. Alcohol use and marijuana use in young adulthood were associated with higher childhood family SES, even after controlling for covariates.Findings based on three indicators of family background SES--income, wealth, and parental education--converged in describing unique patterns for smoking and for alcohol and marijuana use among young adults, although functional relationships across SES measures varied. Young adults with the highest family background SES were most prone to alcohol and marijuana use.

BackgroundRecently, late-life disability rates have declined in several countries of the Organisation for Economic Co-operation, but no national-level trend analysis for England has been available. The authors provide such analysis, including measures both early and late in the disablement process, and the authors investigate the extent to which temporal trends are associated with population changes in socioeconomic position (SEP).MethodsThe authors fit logistic models of trends in self-reports and nurse measures of 16 health indicators, based on cross-sectional data from those aged 65 years and older from the 1992 to 2007 Health Survey for England.ResultsOverall, prevalence rates of limitations in seeing, hearing and usual activities declined (pConclusionsRecent trends in late-life health and functioning in England have been mixed. A better understanding of which specific activities pose challenges, how the environment in which activities are conducted influences functioning and the causes of relatively worse trends for some SEP groups is needed.

Objectives. We examined the relation between low birth weight and childhood family and neighborhood socioeconomic disadvantage and disease onset in adulthood. Methods. Using US nationally representative longitudinal data, we estimated hazard models of the onset of asthma, hypertension, diabetes, and stroke, heart attack, or heart disease. The sample contained 4387 children who were members of the Panel Study of Income Dynamics in 1968; they were followed up to 2007, when they were aged 39 to 56 years. Our research design included sibling comparisons of disease onset among siblings with different birth weights. Results. The odds ratios of having asthma, hypertension, diabetes, and stroke, heart attack, or heart disease by age 50 years for low–birth weight babies vs others were 1.64 (P < .01), 1.51 (P < .01), 2.09 (P < .01), and 2.16 (P < .01), respectively. Adult disease prevalence differed substantially by childhood socioeconomic status (SES). After accounting for childhood socioeconomic factors, we found a substantial hazard ratio of disease onset associated with low birth weight, which persisted for sibling comparisons. Conclusions. Childhood SES is strongly associated with the onset of chronic disease in adulthood. Low birth weight plays an important role in disease onset; this relation persists after an array of childhood socioeconomic factors is accounted for.

Examination of intergenerational asthma beyond maternal asthma has been limited. The association between childhood asthma and intergenerational asthma status among a national cohort of children was examined. The genealogical sample (2552 children) participating in the Child Development Supplement of the Panel Study of Income Dynamics was studied. Multivariate regression was used to determine intergenerational asthma. Children with a parent with asthma were almost twice as likely (odds ratio [OR] = 1.96) to have asthma compared with those without a parent with asthma. Children with a parent and grandparent with asthma were more than 4 times more likely to have asthma compared with those without a parent and grandparent with asthma (OR = 4.27). Children with a grandparent with asthma were more likely to have asthma (OR = 1.52). A family history of asthma was a significant predictor of physician diagnosed asthma in children regardless of race/ethnicity and socioeconomic status. Findings support the collection of family history, including grandparent asthma status.

The decline in late-life disability prevalence in the United States was one of the most important developments in the well-being of older Americans in the 1980s and 1990s, but there is no guarantee that it will continue into the future. We review the past literature on trends in disability and other health indicators and then estimate the most recent trends in biomarkers and limitations for both the population aged 65 and older and those aged 40 to 64, the future elderly. We then investigate the extent to which trends in education, smoking, and obesity can account for recent trends in limitations and discuss how these three factors might influence future prospects for late-life health. We find that improvements in the health of the older population generally have continued into the first decade of the twenty-first century. The recent increase in the proportion of the younger population needing help with activities of daily living is concerning, as is the doubling of obesity in the last few decades. However, the increase in obesity has recently paused, and favorable trends in education and smoking are encouraging.

This chapter discusses the current evidence base for policies that could address socioeconomic status (SES) health gradientsintheUnitedStates.Thepresentvolumehasdocumentedanenormousamountofresearchonthelinkages betweenSESandhealth,buttherearestillrelativelyfewstudiesthatrigorouslyestablishtheeffectivenessofparticular policies or interventions in reducing those gradients. Given the difficulty in developing randomized evidence for many types of interventions related to social determinants of health, we argue for conducting policy analysis from a Bayesianperspective.ThisBayesianapproachcombinesinformationonbestavailabletheoryandevidenceregarding probable health benefits and costs of an intervention, providing a framework that also incorporates the probable costs of inaction. The second half of the chapter adopts a ladder metaphor to classify policies and interventions that could reduce SES gradients in population health. Using this framework, we consider the evidence base for various types of policies, focusing primarily on the social determinants of health, under the rubric that “all policy is health policy.” We conclude by discussing promising strategies for future strengthening of the evidence base for policy, including the role of health impact assessment.

THE consequences of declines in mortality for the health and functioning of the nation's older adults have been the subject of much interest over the last quarter century. Indeed, spurred by Manton, Corder, and Stallard's (1993) analysis of the National Long Term Care Survey, a vast literature has developed that explicitly focuses on trends in health and disability in late life. Although initially there was disagreement, a consensus has emerged among researchers in the field that there have been improvements in most measures of late-life functioning (see, e.g., Crimmins, 2004; Cutler, 2001; Freedman, Martin, & Schoeni, 2002; Freedman et al., 2004; Kramarow, Lubitz, Lentzner, & Gorina, 2007; Manton, Gu, & Lamb, 2006; Waidmann & Liu, 2000). A recent report by the Institute of Medicine on the future of disability in America (Field & Jette, 2007) suggests that despite these improvements, the numbers of adults with disabilities will likely swell in the coming years as the large Baby Boom generation—those born during the years 1946–1964—reaches the ages associated with the highest rates of morbidity and disability. Undoubtedly, such a trend would have important implications for the provision of medical and social services, for the ability of future older adults to participate fully in society, including the workplace, and more generally for their quality of life. However, although the number of adults reaching older ages and thus experiencing elevated risks for debilitating conditions will certainly grow, there is debate about whether the Baby Boom cohort will enter later life with better or worse age-specific rates of morbidity and disability than earlier cohorts. Only a handful of studies have taken up the question of trends in health and functioning of the adult population in the decades approaching retirement, and results have been conflicting. One study, using data from the National Health Interview Survey (NHIS), found from 1984 to 1996 an increase in the prevalence of needing help with personal care and routine household activities among adults aged 40–49 and 50–59 years, although the rates of such disability were very low (Lakdawalla, Bhattacharya, & Goldman, 2004). Another study, by Zack, Moriarty, Stroup, Ford, and Mokdad (2004), using data from the Behavioral Risk Factor Surveillance System (BRFSS), found an increase from 1993 to 2001 in the proportion of those aged 35–44, 45–54, and 55–64 years who reported poor or fair health. A third study, which relied on data from the Health and Retirement Study (HRS), suggested worse health and functioning among people aged 51–56 years in 2004 compared with 1992 (Soldo, Mitchell, Tfaily, & McCabe, 2007). However, Weir (2007) concluded from his analysis of the same cohorts using a different recode of the HRS data that although early Baby Boomers were more likely to report poor or fair health than the cohort born 12 years earlier, objectively their overall health and functioning were similar. Other recent analyses of health trends among the middle-aged adult population have been more positive. Using the NHIS, Martin, Schoeni, Freedman, and Andreski (2007) found a downward trend from 1982 to 2003 in reports of poor or fair health among adults aged 40–49 and 50–59 years. Mortality rates among adults also have continued to decline in recent decades (National Center for Health Statistics, 2007). Several lessons have emerged from studying late-life health and functioning trends that are relevant to this new and growing literature focused on adults under age 65 years. First, trends are best assessed over a relatively long time horizon with multiple observations (Freedman et al., 2002); given annual variation, two data points may not necessarily constitute a trend (Crimmins, 1996). Second, different measures may move in different directions (Crimmins, 1996, 2004). For example, despite declines in most measures of late-life disability, reports of many chronic conditions among older adults have increased in recent decades (Crimmins, 2004; Crimmins & Saito, 2000; Freedman & Martin, 2000; Freedman, Martin, Schoeni, & Cornman, 2007). There are many reasons for such divergences, not the least of which is that no single indicator is a pure measure of health. For example, self-reports of chronic diseases may be influenced by access to health care, which in turn is a function of socioeconomic status. Moreover, indicators of functioning reflect the gap between an individual's capacity and the environment in which activities are carried out. Accordingly, breadth of measurement is important before drawing conclusions about the health and functioning of a cohort. Third, care must be taken to ensure that methodological threats to validity—such as low response rates, use of screening questions, changes in question wording, changes in response rates, or omission of important groups such as the institutionalized population—do not bias conclusions (Freedman et al., 2002). In this paper, we heed these lessons and expand on existing studies by assessing trends in mortality and multiple nonclinical indicators of health and functioning (including general health status, health conditions, physical functional limitations, and need for help with daily activities); by using annual data spanning from one to more than two decades, depending on the measure; and by covering the full age range of the Baby Boom. Our goal is to investigate whether the health and functioning of Baby Boomers are better or worse than those of previous cohorts in middle age.

Community-based studies have suggested a multigenerational pattern of obesity affecting children's risk of overweight, but no national data have substantiated such a pattern. Our objective was to examine the prevalence of overweight [body mass index (BMI)or=95th percentile for age and sex] among children aged 5 to 19 in a national sample, stratified by the obesity status of their parents and grandparents.We used a secondary analysis of the Panel Study of Income Dynamics, Child Development Supplement, a multigenerational, genealogical, prospective cohort study of the US population. Self-report height and weight data from adults and measured height and weight data for children were used to calculate BMI. The prevalence of child overweight was calculated for different possible combinations of parental and grandparental BMI status, including missing status.The sample included 2,591 children aged 5 to 19 years, for whom parental BMI data were available for 94% and grandparental BMI data were available for 61%. Prevalence of childhood overweight (18.6%) in the sample was comparable with contemporaneous measured national data from other sources. Among children with normal-weight parents and normal-weight grandparents, 7.9% were overweight. In contrast, among children with overweight parents (BMI 25-29.9) and normal-weight grandparents, 17.9% were overweight, and among children with obese parents (BMIor=30) and normal-weight grandparents, 31.9% were overweight (P.0001). Importantly, when parents were normal weight, if grandparents were obese, then the prevalence of child overweight was 17.4% (P.0001). The prevalence of child overweight was similarly elevated (16.4%) when parents were normal weight and grandparental BMI was missing.This is the first national study to find an association of child weight status with grandparental obesity, distinct from parental obesity. Primary care physicians may find it helpful to consider grandparents' weight status in judging risk of childhood overweight for their patients, especially when parents' weight is normal.

Disability prevalence rates have declined dramatically among older Americans during the past quarter century (Freedman, Martin, and Schoeni 2002; Freedman et al. 2004; Manton, Gu, and Lamb 2006; Waidmann and Liu 2000). If these rates continue to fall, a greater number of older Americans could remain economically and socially active, and fewer would need medical and long-term care (Cutler 2001; Lubitz et al. 2001; Singer and Manton 1998). Despite these implications for policy and society, however, there currently is very little evidence indicating why these declines have occurred (Freedman 2006). The reason may be that disability in late life is affected by a complex set of biological, medical, behavioral, economic, social, and environmental determinants throughout the life course. Determining the reasons for the declines in late-life disability is more than an academic exercise. Because the first baby boomers will turn sixty-five in 2011, it is imperative that we understand the prospects for additional reductions in disability rates. An understanding of past trends can help improve predictions of future changes in disability and can also give policymakers and clinicians an idea of the costs of achieving these reductions and where in the disablement process any interventions might be most effective. Understanding this decline also would enable us to determine the likely effects of competing factors influencing health and disability. For example, although millions of people with specific diseases and conditions have clearly benefited from medical advances, health care tends to account for only a relatively small variation in a population's health (McGinnis, Williams-Russo, and Knickman 2002). Accordingly, economic, social, and environmental factors have long been recognized as major determinants of a population's health (McKeown 1979; McKinlay and McKinlay 1977; Preston 1977). In this article, therefore, we take a broad perspective that integrates medical, behavioral, economic, social, and environmental factors throughout the life course, assessing the extent to which each accounts for the drop in disability rates. Unfortunately, no single available data source covers the breadth of possible explanations. Largely because of this limitation, the decline in disability rates cannot be explained with a single monolithic study design that produces precise results based on a handful of coefficient estimates. Moreover, even when data are available and individual-level factors are identified as likely influences, changes in these factors may themselves be driven by other, more basic causes, such as changes in social and economic policies. Furthermore, our confidence that the estimates represent true causal effects, as opposed to a simple accounting for the trends, varies with the factors considered. We thus address these challenges by piecing together evidence from a variety of sources, some more convincing and some less, some based on original analyses and some drawn from other scientists' work. Before assessing the evidence, we begin by briefly describing the trends in disability that we are trying to explain. We focus on changes at the level of the U.S. population during the last two to three decades, which have been the focus of most of, but not all (Costa 2002), the recent work on old-age disability trends. The facts of these trends are more broadly accepted for this period, and the data available for assessing the causes are richer. We then describe a framework for understanding the diverse factors that may influence disability and hence account for these trends. With this framework as our guide, we consider the empirical evidence that supports or refutes the particular factors. Finally, we synthesize the evidence, dismissing some factors and pointing to others as explaining the remarkable declines in late-life disability.

Objectives This study examines changes in functional and activity limitations 1998–2012 for individuals 55–69. Methods Logistic models are used to estimate trends in limitations in vision, hearing, physical and cognitive functioning, IADLs, and ADLs. Additional models assess the extent to which trends are associated with and differ by education, smoking, and BMI. Results Changes in prevalence of limitations in vision, hearing, cognitive functioning, and ADLs are not statistically significant. Limitations in physical functioning declined by 0.37% per year. IADL limitations increased by 1.33% per year, but most of the increase occurred between 2008 and 2010/2012, and are associated with economic hardship during the Great Recession. Increases in education are especially beneficially associated with trends in limitations, but reductions in smoking also appear to be advantageous for some outcomes. Increases in BMI are associated with trends in physical functioning, IADL, and ADL limitation. Discussion For Americans 55–69, functional and activity limitations were largely unchanged 1998–2012. Our results suggest that if educational attainment had not increased, most functional and activity limitations potentially could have worsened substantially. Future change in educational attainment is not expected to be so positive. Continued monitoring of trends in activity limitations might well include greater focus on the explanatory roles of environmental factors, including economic circumstances.

We introduce this special issue on the critical matter of whether the existing household panel surveys in the U.S. are adequate to address the important emerging social science and policy questions of the next few decades. We summarize the conference papers which address this issue in different domains. The papers detail many new and important emerging research questions but also identify key limitations in existing panels in addressing those questions. To address these limitations, we consider the advantages and disadvantages of initiating a new, general-purpose omnibus household panel in the U.S. We also discuss the particular benefits of starting new panels that have specific targeted domains such as child development, population health and health care. We also develop a list of valuable enhancements to existing panels which could address many of their limitations.

A central theme of welfare reform is that recipients are required to engage in work activities. In many states, these work requirements apply to mothers whose children are a few months old, which may increase the costs and decrease the prevalence of breast-feeding. Given the substantial benefits of breast-feeding, any reduction represents an important negative consequence of these requirements. Our results suggest that in the absence of welfare reform, the national breast-feeding rate six months after birth would have been 5.5% higher in 2000. Such negative consequences of these policies must be weighed against potential benefits as states refine their welfare programs.

We investigate whether declines in the age difference between spouses has influenced widowhood and nursing home demand. We first use life-table methods to simulate the impact of the declining age gap on the risk of widowhood. We then use the Medicare Current Beneficiary Survey and the Census Public Use Microdata Samples to estimate the impact of widowhood, and other characteristics, on the probability of nursing home entrance. These help us estimate the impact of the declining age gap on nursing home use. We estimate that the decline in the difference in ages between spouses that took place between the birth cohorts of 1900 and 1955 may raise women's annual nursing home expenditures by about $1.4 billion, but lower men's expenditures by about $600 million.

While the 1990’s were a good decade for many U.S. families, there has been an ongoing debate about how children, particularly poor children, have been faring. Child poverty rates did not fall substantially in the economic expansion of the 1980’s and rose to the very high rate of 23 percent in 1993. Furthermore, substantial changes in public assistance programs were implemented over this decade; major legislative reform in 1996 increased work mandates on welfare-recipient families and gave states much greater discretion to enforce these mandates and actually terminate assistance. These changes could make at least some poor families worse off if they lost public assistance and were unable to find steady employment. We propose to investigate changes in the entire distribution of children’s family income over the 1990’s, which allows us to observe the relative changes in income experienced among children in higherand lower-income families. We are particularly interested in two questions: (i) How has the economic status of children changed at different points in the income distribution? (ii) Is there any evidence that welfare reform contributed to the observed changes? Some evidence on changes in child wellbeing over the 1990’s suggests good news. Child poverty rates fell to 16 percent by 2001, and poverty rates among black children hit a historical low of 30 percent in that year. Blank (2002) and Jeffrey Grogger et al. (2002) provide a complete set of citations to the growing literature that looks at changes in income and consumption over the past decade. At least some of this research indicates that not all low-income families experienced economic gains. In this paper, we use data on children’s household income from the March Current Population Survey (CPS) and average together information from 1992–1995 and 1997–2000. By averaging four years of data, we have an adequate number of observations to observe income reliably at each centile (1/100) in the distribution. We focus on these comparison years because they both bracket the economic expansion of the 1990’s and they bracket the 1996 legislative changes in welfare programs. To account for differences in family size across families, our focus is on the income-to-needs ratio (defined as the income level of the child’s family divided by the official poverty line for that family), rather than on actual income levels. We compare data from two samples, one that includes all children and another that includes only children in families without both parents present. This latter sample is largely composed of children in single-parent families but also includes children who live with neither parent (about 3 percent of all children in the mid-1990’s).

This study examines the contribution of wives' earnings to the distribution of married couples' earnings in 10 developed countries. There is substantial variation among countries in wives' labor force participation, the relative earnings of husbands and wives, the distribution of earnings, and the correlation of spouses' earnings. Even though these countries differ on these dimensions, wives' earnings mitigate inequality in the earnings of married couples. For the countries we are able to analyze over time, the labor force participation of wives married to high earning husbands increased more than the labor force participation of wives married to middle-earning men. Despite this trend, the mitigating effect of wives' earnings actually increased slightly in all countries examined. Moreover, all other things equal, the correlation of spouses' earnings would have to experience an unprecedented increase in order for wives' earnings to become disequalizing.

Downward trends in activity limitations among the older U.S. population have recently plateaued, while activity limitation among the pre-retirement population has increased.Update temporal trends in limitations in sensory and physical functions, instrumental activities of daily living (IADLs), and activities of daily living (ADLs) for the 40-64 and 65-and-over U.S. populations; assess the extent to which trends in education, smoking, and obesity could account for the trends in limitations; and examine trends in conditions cited as causes of limitations, their durations, and proportion of life spent with them.Multivariate analysis of the 1997-2010 National Health Interview Survey.For the younger group, there have been increases in all limitations, except trouble hearing, which has declined. Increased obesity could account for the increases in vision, physical function, and IADL limitations. Musculoskeletal conditions, such as arthritis and back/neck problems, are frequently cited as causes of limitation, and there are growing roles for depression and nervous system conditions. For the 65-and-over group, there have been decreases in all limitations, except difficulty with physical functions, which is up. Increased education could account for the decline in ADL limitation, and increased obesity could account for increased difficulty with physical functions. Musculoskeletal conditions are also frequently cited as causes of limitation, but declines in heart- and vision-related limitations have been important.Trends should continue to be monitored closely for both groups, since younger people have not experienced the improvements of the older group, but are its future members.

The authors investigate whether omitted family background variables are responsible for high returns to schooling estimated in Brazil. Returns to schooling fall by about one-third when parental schooling is added to wage equations. Surprisingly, the schooling of fathers-in-law has larger effects on wages than the schooling of fathers. On the basis of a model of assortative mating, the authors interpret this as evidence that parental characteristics represent unobservable worker attributes rather than nepotism in the labor market. They conclude that the 'family background bias' in returns to schooling is modest and need not imply returns to family connections. Copyright 1993 by University of Chicago Press.

Background Many epidemiological studies rely on self-reported information, the accuracy of which is critical for unbiased estimates of population health. Previously, accuracy has been analyzed by comparing self-reports to other sources, such as cancer registries. Cancer is believed to be a well-reported condition. This paper uses novel panel data to test the consistency of cancer reports for respondents with repeated self-reports. Methods Data come from 978 adults who reported having been diagnosed with cancer in at least one of four waves of the Panel Study of Income Dynamics, 1999-2005. Consistency of cancer occurrence reports and precision of timing of onset were studied as a function of individual and cancer-related characteristics using logistic and ordered logistic models. Results Almost 30% of respondents gave inconsistent cancer reports, meaning they said they never had cancer after having said they did have cancer in a previous interview; 50% reported the year of diagnosis with a discrepancy of two or more years. More recent cancers were reported with a higher consistency and timing precision; cervical cancer was reported more inaccurately than other cancer types. Demographic and socio-economic factors were only weak predictors of reporting quality. Conclusions Results suggest that retrospective reports of cancer contain significant measurement error. The errors, however, are fairly random across different social groups, meaning that the results based on the data are not systematically biased by socio-economic factors. Even for health events as salient as cancer, researchers should exercise caution about the presumed accuracy of self-reports, especially if the timing of diagnosis is an important covariate.

Although still below 2 percent, the proportion of people ages 50–64 who reported needing help with personal care activities increased significantly from 1997 to 2007. The proportions needing help with routine household chores and indicating difficulty with physical functions were stable. These patterns contrast with recently reported declines in disability among the population ages 65 and older. Particularly concerning among those ages 50–64 are significant increases of limitations in specific mobility-related activities, such as getting into and out of bed and climbing ten steps. Musculoskeletal conditions remained the most commonly cited as causes of disability at these ages. There were also substantial increases in the attributions of disability to depression, diabetes, and nervous system conditions.

To the Editor: We read with interest the article by Fuller-Thomson and colleagues (1) and their conclusion that estimates from the American Community Survey (ACS) showed an increase in difficulty with activities of daily living (ADLs) and a plateau in physical activity limitation between 2000 and 2005 for the U.S. population aged 65 years and older. Although the authors provided caveats in their interpretation of their findings, we believe that additional caution is warranted. We recently considered using the 2000–2007 ACS to assess late-life disability trends. However, we decided that because of changes in survey administration over time, we could not reliably estimate trends from the ACS. Our greatest concern was the change in interview mode. The proportion of ACS interviews that were completed via mail declined from 58% in 2000 to 52% in 2005 (and to 48% in 2007), and the proportion completed through computer-assisted interviews concomitantly increased (2–4). For people aged 16–64 years, estimates of limitation are higher using computer-assisted interviews versus mail. For example, in 2003, the differences for ADL limitation (difficulty dressing, bathing, or getting around inside) were 1.9% versus 1.8%, respectively, and for physical functional limitation (substantial limitation in walking, climbing stairs, reaching, lifting, or carrying) were 7.4% versus 6.5%, respectively (5). We were not able to find mode-specific estimates for the older population. However, if the older group experienced similar patterns, the increase in the proportion of computer-assisted interviews would likely account for some of the estimated increase in limitations. Unfortunately, the public ACS micro data sets do not provide an indicator of interview mode to use in modeling trends. Accordingly, we chose not to use the ACS. Another factor that appears to have contributed to an upward bias in the trends found by Fuller-Thompson and colleagues is aging of the population. They mentioned in their discussion the changes in the age distribution within the population aged 65 years and older from 2000 to 2005, especially the rapid increase of those aged 80 years and older. But they were not able to adjust for age in their analyses because they simply fitted regression lines across the published aggregate prevalences of limitations for each of the six survey years. We were not able to access from the internet the prevalence figures that Fuller-Thompson and colleagues used, but based on the micro data sets for each year, we calculated our own estimates of the aggregate prevalences for those aged 65 years and older, which track closely the data points graphed in figure 1 of their article. Indeed, when we fitted trend regression models using our prevalences, we found that ADL limitation increased at a rate of 1.56% per year in comparison to the 1.81% per year found by Fuller-Thomson and colleagues (calculated by dividing their regression coefficient on [year−2000] of .16 by the intercept of 8.84). However, when we calculated age-specific prevalences by 5-year age groups from the micro data, standardized the overall 65+ annual prevalence rates to the 5-year age distribution from various populations (2000, 2005, and an average of 2000–2005), and then estimated models based on these standardized prevalences, we found for ADL limitation that the p value on the trend coefficient was reduced from .005 to a range from .07 to .09, and the estimated annual change was reduced to 0.7%–0.8%. For functional limitations, the results of Fuller-Thomson and colleagues implied an annual increase of 0.37%, and we found annual change of 0.24% in our model of unadjusted prevalences and −0.14% to −0.16% for our models of age-standardized prevalences [none of the trend coefficients for functional limitations significantly different from 0, as in (1)]. As an alternative test of the importance of adjusting for age, we ran logit regressions of individual-level ADL and functional limitations on trend using the micro data set. For ADLs, our results implied an annual change of 1.67% in the unadjusted model and 0.85% in the model with 5-year age group controls. For functional limitations, the estimates were 0.34% and −0.23%, respectively. (All logit trend coefficients were statistically different from 0.) Accordingly, it appears that controlling for age results in a halving of the rate of increase for ADLs and in a trend downward, as opposed to upward, for functional limitations. We applaud Fuller-Thomson and colleagues for their attempt to shed light on the most recent disability trends and especially for their care in accounting for the institutionalized population. We also agree that tracking trends going forward is critical. However, estimated trends may be contaminated by changes over time in a variety of factors, some of which they note, such as survey design and administration, use of proxies, population coverage, question wording, and age distribution (6). Moreover, differences across surveys may also affect comparisons of trends (7). In sum, we do not think that the analysis of the ACS by Fuller-Thomson and colleagues provides sufficient evidence to reach even tentative conclusions about recent late-life disability trends.

Using data from the 1997–2004 National Health Interview Survey (NHIS), we examine the role of chronic conditions in recent declines in late-life disability prevalence. Building upon prior studies, we decompose disability declines into changes in the prevalence of chronic conditions and in the risk of disability given a condition. In doing so, we extend Kitigawa’s (1955) classical decomposition technique to take advantage of the annual data points in the NHIS. Then we use respondents’ reports of conditions causing their disability to repartition these traditional decomposition components. We find a general pattern of increasing prevalence of chronic conditions accompanied by declines in the percentage reporting disability among those with a given condition. We also find declines in heart and circulatory conditions, vision impairments, and possibly arthritis and increases in obesity as reported causes of disability. Based on decomposition analyses, we conclude that heart and circulatory conditions as well as vision limitations played a major role in recent declines in late-life disability prevalence and that arthritis may also be a contributing factor. We discuss these findings in light of improvements in treatments and changes in the environments of older adults.

Investigations into the reasons for declines in late-life disability have largely focused on the role of contemporaneous factors. Adopting a life-course perspective as a backdrop, in this paper we ask whether there also has been a role for selected early- and mid-life factors in the decline, and if so whether these factors have been operating through changes in the risks of disability onset or recovery. Drawing on five waves from 1995 to 2004 of the U.S. Health and Retirement Study, we found for the 75 years and older population in the United States that the prevalence of difficulty with activities of daily living (ADL) declined from 30.2% in 1995 to 26.0% in 2004, whereas the trend in difficulty with instrumental activities of daily living (IADL) was flat. Onset of ADL limitations also was reduced during this period while recovery increased. Changes in the educational composition of the older population were linked to declines in the prevalence of ADL limitations, but there were also modest contributions of changes in mother's education, self-rated childhood health, and lifetime occupation. Declines in late-life vision impairments and increases in wealth also contributed substantially to the downward trend, and had chronic conditions not increased, it would have been even larger. Reductions in the onset of ADL limitations were partly driven by changes in educational attainment of respondents and their mothers and, in late-life, better vision and wealth. In contrast, the recovery trend was not accounted for by changes in early- or mid-life factors. We conclude that early- and mid-life factors have contributed along with late-life factors to U.S. late-life disability trends mainly through their influence on the onset of, rather than recovery from, limitations.

Disability is a burden to individuals and society. Population ageing, combined with the fact that disability is most common among the elderly, has focused attention on trends in old-age disability. This study estimates trends in functioning and disability among Japanese elderly from 1993 to 2002 and contrasts the patterns with those found in the USA. Japan is an especially interesting country because its age structure is relatively old, and it currently has the highest life expectancy in the world despite the fact that just 50 years ago its life expectancy was in the bottom half of all countries. As in the USA, disability rates have fallen. If it were not for the gains in disability between 1993 and 2002, there would have been 1.1 million more disabled elderly in 2002. The reductions were experienced broadly across socio-demographic and economic groups. Increases in education across cohorts are associated with the declines in disability.

Objective. We sought to determine whether socioeconomic and racial/ethnic disparities in prevalence of disability over age 70 have widened or narrowed during the past 2 decades. Methods. We used data from the 1982–2002 National Health Interview Surveys, which are nationally representative cross-sectional surveys of the noninstitutionalized population of the United States. Participants included 172227 people aged 70 years and older. The primary outcome measure was the average annual percentage change in the prevalence of 2 self-reported disability measures: the need for help with activities of daily living (“ADL disability”) and need for help with either ADL or instrumental activities of daily living (“any disability”). Results. All groups experienced declines in the age- and gender-adjusted prevalence of any disability during the 1982 to 2002 period. However, the average annual percent declines were smaller for the least advantaged socioeconomic groups. Differences in trends across racial/ethnic groups were not statistically significant. ADL disability prevalence decreased for the more advantaged groups but increased among the lowest income and education groups. Non-Hispanic Whites and minorities experienced similar average annual percent declines in ADL disability. Conclusions. Racial/ethnic disparities in old-age disability have persisted over the last 20 years, whereas socioeconomic disparities have increased.

In September 2002, a technical working group met to resolve previously published inconsistencies across national surveys in trends in activity limitations among the older population. The 12-person panel prepared estimates from five national data sets and investigated methodological sources of the inconsistencies among the population aged 70 and older from the early 1980s to 2001. Although the evidence was mixed for the 1980s and it is difficult to pinpoint when in the 1990s the decline began, during the mid- and late 1990s, the panel found consistent declines on the order of 1%–2.5% per year for two commonly used measures in the disability literature: difficulty with daily activities and help with daily activities. Mixed evidence was found for a third measure: the use of help or equipment with daily activities. The panel also found agreement across surveys that the proportion of older persons who receive help with bathing has declined at the same time as the proportion who use only equipment (but not personal care) to bathe has increased. In comparing findings across surveys, the panel found that the period, definition of disability, treatment of the institutionalized population, and age standardizing of results were important to consider. The implications of the findings for policy, national survey efforts, and further research are discussed.

Several categories of medical expenditures are not covered by Medicare, including prescription drugs, most nursing home stays, and extended hospital visits. Out-of-pocket costs for these items can be substantial, and what's more, they are likely to be concentrated at the end of life. At the same time, it is well documented that poverty is 3-4 times more common among widows than among similarly aged married women. This study examines the potential link between these two phenomena, asking the question: to what extent do out-of-pocket health care costs of a dying spouse affect the financial position of the survivor? We find that out-of-pocket medical spending increases substantially just prior to death, and that these expenditures are large relative to income for a large share of elderly couples. Simulations investigate the extent to which expansions in insurance coverage to include nursing home care or prescription drug coverage could improve the financial well-being of the surviving spouse.

ContextSeveral well-publicized recent studies have suggested that disability among older Americans has declined in the last decade.ObjectivesTo assess the quality, quantity, and consistency of recent evidence on US trends in the prevalence of self-rated old age disability and physical, cognitive, and sensory limitations during the late 1980s and 1990s and to evaluate the evidence on trends in disparities by major demographic groups.Data SourcesWe searched MEDLINE and AGELINE for relevant articles published from January 1990 through May 2002 and reviewed reference lists in published articles.Study SelectionFrom more than 800 titles reviewed, we selected 16 articles based on 8 unique repeat cross-sectional and cohort surveys of US prevalence trends in disability or functioning among persons generally aged 65 or 70 years or older.Data ExtractionWe evaluated survey quality according to 10 criteria, ranked the surveys as good, fair, or poor, and calculated for each outcome the average annual percent change.Data SynthesisAmong the 8 surveys, 2 were rated as good, 4 as fair, 1 as poor, and 1 as mixed (fair or poor, depending on the outcome) for assessing trends. Analyses of surveys rated fair or good showed consistency of declines in any disability (−1.55% to −0.92% per year), instrumental activities of daily living disability (−2.74% to −0.40% per year), and functional limitations. Surveys provided limited evidence on cognition and conflicting evidence on self-reported ADL (changes ranged from −1.38% to 1.53% per year) and vision trends. Evidence on trends in disparities by age, sex, race, and education was limited and mixed, with no consensus yet emerging.ConclusionsSeveral measures of old age disability and limitations have shown improvements in the last decade. Research into the causes of these improvements is needed to understand the implications for the future demand for medical care.

The Los Angeles County Board of Supervisors (Board) adopted the Long- Term Family Self-Sufficiency (LTFSS) Plan on November 16,1999. The LTFSS Plan consists of 46 projects whose goal is to promote self-sufficiency among families that are participating in the California Work Opportunity and Responsibility to Kids (CalWORKs) program, among former CalWORKs families, and among other low-income families. The Chief Administrative Office (CAO) is the lead agency responsible for implementing the evaluation of the LTFSS Plan. On December 5, 2000, the Board approved the implementation plan for the evaluation of the LTFSS Plan, Project #46. Following an open and competitive bidding process, the Board awarded RAND a contract to conduct a Countywide evaluation of the LTFSS Plan. Responding to new opportunities and new funding, the Los Angeles County Board of Supervisors (Board) adopted a Long-Term Family Self-Sufficiency (LTFSS) Plan on November 16, 1999. The Plan envisions 46 interrelated projects with the common goal of promoting sustained self-sufficiency for California Work Opportunity and Responsibility to Kids (CalWORKS) families, for former CalWORKs families, and for other low-income families in Los Angeles County.

Objective. The purpose of this study was to provide new evidence on disability trends among elderly persons from 1982 to 1996. Methods. The sample includes 124,949 participants aged 70 and older in the 1982‐1996 National Health Interview Surveys. Logistic analysis was used to estimate the trend in disability prevalence after controlling for various sociodemographic factors. Results. We found that: (a) the prevalence of disability has declined, but the gains did not persist throughout the entire period or accelerate over time; (b) only routine care disability has declined, whereas more severe personal care disability shows no improvements; (c) estimates are robust to the exclusion of the nursing home population but may be sensitive to growth in the assisted living population; (d) estimates of decline in disability prevalence are fairly consistent across five national surveys; (e) gains have been concentrated among the most educated elderly persons; and (f) gains in education appear to be an important confounder of the improvements. Discussion. Evidence from several surveys using various measures indicates that disability has declined among elderly persons. Determining the causes of the improvements should be a high priority in future research efforts.

This paper evaluates the effectiveness of recent welfare reforms, investigating the effects of both state-specific waivers in the early 1990s and the 1996 federal reform legislation. Unlike earlier work, we analyze a wide array of indicators, including welfare participation, labor market involvement, earnings, income and poverty, and family formation. While no single methodology is entirely satisfying, the results in this paper are convincing in part because they are consistent across alternative approaches. We find strong evidence that these policy changes reduced public assistance participation and increased family earnings. The result was a rise in total family income and a decline in poverty. The gains from the 1996 reforms were not as broadly distributed across the distribution of less-skilled women as were the effects of waivers. Waivers also increased labor market involvement among the less-skilled, but the 1996 reforms had little additional impact on work behavior after controlling for economic forces. These policies also appeared to have an impact on family structure.

"This paper provides an empirical investigation of a theoretical model of the marriage market. In the model, women are valued more for their ability to bear children and men are valued more for the ability to make money. Men cannot reveal their labor market ability to potential spouses until they enter the labor force. At the same time, the relevant information for evaluating females as spouses is revealed at a younger age. The model predicts that the income of males will be positively associated with age-at-first-marriage. We find empirical support for the model [based on U.S. data]. However, we also find the association between male earnings and age-at-first-marriage becomes negative for those who married after age 30, which was not predicted by the model. Consistent with the model, we do not find a strong relationship between earnings and age-at-first-marriage among females."

Objectives. We addressed three questions: Have recent improvements in old-age disability been mirrored in changes in self-reported general health status? Are general health status trends similar for younger and older Americans? Have changes in general health status been uniform across demographic and socioeconomic groups? Methods. Using logistic regression, we analyzed data from the 1982–2003 National Health Interview Surveys (n ¼ 1,445,872 aged 18–69; n ¼ 178,384 aged 70 and older). Results. The proportion of people aged 70 and older reporting disability declined at 1.38% per year and the proportion 70 and older reporting poor/fair health declined at 1.85% per year. There was less of a decline in reports of poor/fair health at younger ages. Trends for the 18–69 population showed widening health disparities by income but narrowing of the race/ ethnicity and education gaps. In the older population, there was no change for those aged 80–84 and 85 and older, the race/ ethnicity gap persisted, and both education and income differentials widened over time. Discussion. Declines in proportions reporting poor/fair health among the older population in recent decades mirror declines in disability. Although the younger population has not experienced such progress, its prevalence of poor/fair health is low throughout the 21-year analysis period. Of concern are the growing socioeconomic disparities in health for both younger and older populations.

Elderly widows are three times as likely to live in poverty as older married people. This study investigates this gap, as well as the gap in wealth and income more generally, using national panel data from the 1990s in the United States. It is found that 44 percent of the difference in economic status between widows (and widowers) and married elderly is due to differences in economic status that existed between the groups prior to widowhood. The remaining 56 percent is due to issues more directly related to the death of a spouse including the loss of income and expenses associated with dying. This study examines the role of out-of-pocket medical expenditures of the deceased spouse in contributing to the poor financial status of elderly widows. On average, out-of-pocket medical expenditures in the final two years of life are equal to 30 percent of the couple’s annual income. For couples in the bottom quarter of the income distribution, these expenditures are 70 percent of their income. These analyses show that the purchase of health care services for a dying spouse does drive some surviving spouses into poverty. Our estimates indicate that of the 56 percent increase in poverty that is due to widowhood, one-quarter can be attributed to end of life out-of-pocket health care expenditures.

Estimates imply that only one-third of elderly persons who are eligible for food stamps actually participate in the program, which is half the rate that exists among younger people. This study investigates potential reasons for the relatively low take-up rate among the elderly. Analyzing new data, we conclude that the low take-up rate is not explained by measurement error and little is explained by various behavioral factors. Despite this much lower take-up rate, elderly who are eligible for assistance but not enrolled in the program do not appear to be especially needy.

We use comparable surveys from Brazil and the United States to examine "vertical" and "horizontal" connections between families. Motivated by a model of assortative mating and intergenerational transmission of schooling and earnings, we include the schooling of relatives in male wage equations. We find that the effect offather-in-law's schooling is larger than the effect offather's schooling in Brazil, while the opposite is observed in the United States. We interpret these effects as indicators of unobservable worker characteristics, with differences in assortative mating and female labor market activity explaining the differences in the apparent effect of fathers and fathers-in-law in the two countries.