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Health care is a crucial factor in US economic growth, because growing health care costs have made US corporations less competitive than their counterparts in countries where central governments assume most of those costs. In this paper we illustrate a second. possibly more powerful, effect of health care expenditures on the long term pace of US economic growth, i.e., that such investments in aging populations helps preserve human capital to later ages. In addition, as current investment in health care improves health and functional status, the future demand for health care as well as future health care costs will be constrained. These are crucial factors in countries experiencing rapid population aging. US labor force projections do not directly represent the effects of health care investment on the health of the future labor force, and federal health cost projections do not reflect the trajectory of health changes. Health dynamic projections suggest the effects of health care investment are large and growth stimulating. Projections done for the time period used by the Congressional Budget Office in budget mark-ups (2010-2020) are presented in the supporting information. [ABSTRACT FROM AUTHOR]

To determine optimal future National Institutes of Health (NIH) funding levels, the longitudinal correlation of the level of investment in NIH research with population changes in the risk of specific diseases should be analyzed. This is because NIH research is the primary source of new therapies and treatments for major chronic diseases, many of which were viewed as relatively untreatable in the 1950s. NIH research is also important in developing preventative and screening strategies to support public health interventions. These correlations are examined 1938 to 2004 for 4 major chronic diseases [cardiovascular disease (CVD), stroke, cancer, and diabetes] and the NIH institutes responsible for research for those diseases. This analysis shows consistent non-linear temporal correlations of funding to mortality rates across diseases. The economic implications of this are discussed assuming that improved health at later ages will allow projected declines in the rate of growth of the US labor force to be partly offset by a higher rate of labor force participation in the US elderly population due to reduced chronic disease risks and functional impairment. [ABSTRACT FROM AUTHOR]

Objectives. To understand declines in chronic disability prevalence in the U.S. elderly population, we examined cohort changes in active life expectancy, a health measure relating population disability and longevity dynamics. Methods. We computed active life expectancy and life expectancy using the six National Long-Term Care Surveys done from 1982 to 2004 and linked to continuous-time Medicare service data for the same time period by using a stochastic process model based on disability scores calculated using grade of membership analyses. We simultaneously estimated continuous-time disability dynamic and mortality functions to calculate life tables for specific disability states and for temporally changing mixtures of disability states. Results. Disability dynamics, measured as changes in grade of membership scores, showed significant variation across two birth cohorts followed for 24 years. Disability dynamics and disability-specific hazard functions were significantly improved in the younger cohort (persons aged 65-74 in 1982). Discussion. Our results, supporting the hypothesis of morbidity compression, indicate that younger cohorts of elderly persons are living longer in better health. The methods describe individual disability transitions and mortality and other factors associated with disability changes, making it possible to better evaluate interventions to promote future declines in disability. [ABSTRACT FROM AUTHOR]

As U.S. life expectancy has increased, questions arise as to how the quality of health and functioning in the elderly population as changed. Data from the 1082-2004 National Z~)ng-TerrnC arc Survey (N1,TCS) suggested that chronic disability prevalence above age 65 declined at an increasing rate with a 2.2% per annum rate of decline from 1099 to 2004 (71). Inflation-adjusted per capita Medicare expenditure rates in nondisabled persons also declined, 0.9% per and~l~firio m 1982 to 2 0 0 4 , which suggests that declines in disability were driven by improving health-not by increases in per capita health expenditures. declines in disability prevalence were found in other U.S. national health surveys. Analyses of U.S. Civil War veterans suggest recent disability declines were continuations of declines in both chronic disease and disability cxcumng over the past century due to improved nutrition, sanitation, and education. Concerns exist about whether disability declines will continue recent increases in obesity prevalence. [ABSTRACT FROM AUTHOR]

The proportion of the United States labor force ⩾65 years of age is projected to increase between 2004 and 2014 by the passing of age 65 of the large post-World War II baby boom cohorts starting in 2010 and their greater longevity, income, education, and health [Toossi M (2005) Mon Labor Rev 128(11):25–44]. The aging of the U.S. labor force will continue to at least 2034, when the largest of the baby boom cohorts reaches age 70. Thus, the average health and functional capacity of persons age 65+ must improve for sufficient numbers of elderly persons to be physically and cognitively capable of work. This will require greater investments in research, public health, and health care. We examine how disability declines and improved health may increase human capital at later ages and stimulate the growth of gross domestic product and national wealth. [ABSTRACT FROM AUTHOR]

Objective: The authors examine how trends in disability prevalence and in inflation-adjusted per capita, per annum Medicare costs. 1982 to 1999 and 1989 to 1999, affected total Medicare costs projected to 2004 and 2009. Method: To describe disability trends, the authors applied grade of membership analyses to 27 measures of disability from the 1982 to 1999 National Long Term Care Surveys (NLTCS). This identified seven disability profiles for which individual scores were calculated. These were used to calculate sample weighted Medicare costs and cost trends. Results: Significant declines (up to 19%) in Medicare costs were found in 2004 and 2009 assuming continuation of the 1982 to 1999 disability declines and Medicare cost trends. In addition to declines in disability prevalence, inflation-adjusted per capita, per annum Medicare costs declined for nondisabled persons aged 65 to 84. Discussion: Preserving health in the growing nondisabled population did not require increased health care expenditures. [ABSTRACT FROM AUTHOR]

Presents letters to the editor published in the January 1, 2004 issue of the periodical "Health Affairs," which focus on increasing cost of medical care in the U.S., population ageing and Medicare et al. Letter by explaining possible reasons for hospital spending increases; Assertion of a reader that population aging is not the cause of increase in medical care; Major challenges faced by Medicare.

Reports on changes in the prevalence of chronic disability in the United States black and nonblack population above age 65 from 1982 to 1999. Major implications for the fiscal stability of Medicare and Social Security programs; Growth in assisted-care living facilities; Percentage decline in chronic disability prevalence for the 1982-1994 period.

An increment-decrement stochastic-process life table model that continuously mixes measures of functional change is developed to represent age transitions among highly refined disability states interacting simultaneously with mortality. The model is applied to data from the National Long Term Care Surveys of elderly persons in the years 1982 to 1996 to produce active life expectancy estimates based on completed-cohort life tables. At ages 65 and 85, comparisons with extant period estimates for 1990 show that our active life expectancy estimates are larger for both males and females than are extant period estimates based on coarse disability states. [ABSTRACT FROM AUTHOR]

Examines the changes in home care use by chronically disabled elderly in the United States from 1982 to 1994. Sources of home care services; Combination of paid and informal home health care; Impact of disability and age on the amount spent for formal care; Association of home health care use with informal care use.

Discusses long-term care (LTC) and the need for new forms of payment to cover the costs. Agreement that the current system is no longer acceptable; Difficulties in the expansion in LTC insurance; Examination of the bioactuarial data available in three large nationally representative surveys and discussion of how these data could be best employed to inform the design of private LTC insurance products; Medicaid coverage.

Examines how changes in morbidity, disability and mortality may affect the demand for long-term care. How long individuals need long-term care; Trends in health and functioning among the elderly; Changes in the delivery of post-acute services by Medicare.

The rapid growth of the U .S. elderly (age 65+) and oldest-old (age 851) populations. combined with their high per capita acute health and long-term care (LTC) service needs, raises concerns about existing health care payment systems. Adapting and designing new types of health insurance and existing health policies require accurate data on the elderly's health and functional characteristics. Strengths and weaknesses of five national health surveys in providing such data are evaluated. Methodological issues arising in surveying elderly populations and analyzing data from those surveys are discussed, with implications for de signing private LTC insurance and for reducing future LTC service burden. [ABSTRACT FROM AUTHOR]

Provides information on a study on the effects of health changes on projections of health service needs for the elderly population of the United States. Methodology; Materials used in the study; Results; Discussion.

Studies chronic disability trends among the elderly in the United States from 1982-1994. Importance of chronic disability time series in monitoring age-specific changes in population health and biological fitness; Long-term changes in chronic disease prevalence.

This article examines the long-term cohort effects on chronic disease and mortality in the United States and presents information about factors potentially affecting cohort health and mortality. It is important to understand the ebbs and flows of cause-specific mortality rates because general life expectancy trends are the product of interactions of multiple dynamic period and cohort factors. Consequently, researchers first review potentially affecting cohort health back to 1880 and explore how that history might affect the current and future cohort mortality risks of major chronic diseases. Simultaneous with public health programs were major changes in the U.S. health care system. Medicare, which started in 1965, now covers 98.3 percent of persons aged 65 years and older, but it is often supplemented by private insurance. Joint coverage increased 11.1 percent from 1980 to 1993, increasing most for those aged 85 years and older. Cohort differences could be more accurately assessed with data on additional older and younger cohorts. Effects of changes in health care might be observed using data on older cohorts, for example, effects of Medicare are limited by the amount of time the cohort lives past 1965. Effects of increased vitamin B6 reduced vitamin D and changes in health care might be observed using data on younger cohorts, who spent more time in the period when such nutritional changes occurred.

Examines the changes in the prevalence and incidence of chronic disability using the 1982, 1984 and 1989 National Long Term Care Surveys. Increase in adult life expectancy; Decline in the total prevalence of United States chronically disabled elderly populations; Variation over level of disability.

Assesses the effect of education on life expectancy and disability among Americans. Factors that contributed to the increased life expectancy since 1968; Sampling data from the National Long Term Care Surveys and Medicare records; Discussion on methods for analyzing survival exist for multivariate Gaussian diffusion processes.

Analyzes the 1982, 1984, 1989 and 1994 National Long term Care Survey (NLTCS) to identify the dimensions of chronic disability from multivariate analyses of measures of the ability to perform specific activities. Evaluation of the rate of age-related losses of specific functions; Dimensions describing the changes in the age dependence of activities of daily living; Correlation between disability declines and reductions in select health conditions.

Examines changes in human extinct cohort life tables and age at death distributions to search for evidence for the effects of a biological life span limit in current mortality patters and produce lower bound estimates of the limit. Changes in cause-specific age at death distributions; Cohort size and mortality effects on the maximum expected age at death.

Studies multiple comorbidities and functional limitations of elderly residents of nursing homes in the United States. Use of the analytic procedure Grade of Membership (GoM) in identifying profiles of health and functioning measures; Prediction on the differentials in nursing home length of stay and service use by various classes of caregivers.

Examines the changes in reported prevalence of 16 medical conditions in the U.S. population age 65 and above using data from the 1982, 1984 and 1989 National Long Term Care Surveys. Decline in the net prevalence of the 16 medical conditions; Changes in disability, age and gender groups; Declines in morbidity.

Abstract: The contribution of hypertension to total mortality in the United States in 1968 and 1977 is assessed through multiple cause death rates for all mentions of hypertension and the death certificate prevalence of hypertension. Age-adjusted declines in the hypertension death rate, were 32.8 per ¢ for non-White females. 30.4 per ¢ for non-White males. 30.3 per ¢ for White females, and 25.2 per ¢ for While males. Decline, for younger non-Whites were the greatest, about 50 per ¢, although their rate, were more than twice the White rates in both years, Death certificate prevalence also declined for all four groups with the greatest (16.5 per ¢) for non-White males and the least (10.4 per ¢) for White males, who only showed declines at older ages. The age trajectory of death certificate prevalence reached a peak at ages 50-69 for non-Whites, and ages, 60-79 for Whites. with lower prevalence at the most advanced ages. Large declines in the contribution of hypertension to mortality observed in death certificate data are particularly striking in light of the probability that any bias would be toward better detection and reporting over the 10 years. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, records of all medical conditions on death certificates are used to evaluate hypertension-related mortality in North Carolina over the decade 1968-1977. Use of both an inclusive hypertension recode category and multiple cause data resulted in gains in information of over 750 per ¢ in all four race/sex groups compared to the commonly used underlying cause, hypertensive disease category. Race, sex and age specific 10-year trends in death rates for all mentions of hypertension are analyzed, with comparisons to underlying cause mortality from ischemic heart disease and stroke. Age-adjusted declines of 19 to 24 per ¢ between I968 and 1977 were observed for all race/sex groups, although non-White declines occurred mainly at younger ages while White declines (especially White males) occurred mainly at older ages. The non-White excess of hypertension mentions (compared to Whites) increased for males and decreased for females. The decline in hypertension mentions, in spite of the increased awareness of hypertension as a public health problem which would make it more likely to be mentioned on death certificates, suggests that there was a real reduction in the contribution of hypertension to total mortality over the period. (Am J Public Health 1981: 71:823-830.) [ABSTRACT FROM AUTHOR]

Evaluates the performance of long-term care demonstrations by assessing outcomes in social/health maintenance organizations and Medicare fee-for-service care using a multivariate model to estimate active life expectancy. Stochastic health changes and modality; Mortality functions; Age-specific proportions in case-mix states; Outcome differences by site and gender.

Examines the functional and health characteristics of nursing home residents in New York State using a multivariate classification procedure. Use of the grade of membership (GOM) to describe complex medical diagnosis and symptom patterns; Identification of GOM types of nursing home residents; Association of multivariate patient dimensions.

The analysis of multivariate event history data with both observed and unobserved covariates usually requires strong parametric assumptions about the distribution of unobserved covariates affecting the process and the nature of the functions describing the time dependency of the transition rates. In social science applications, there is frequently inadequate theory to specify the parametric form of either the mixing distribution or the hazard fund ion. In this paper, we present an analytic strategy to describe such processes in very general terms, without having to make either type of parametric specification. The use of "fuzzy set" logic to describe the complex multivariate state for individuals enables us to make estimates without such specification. The illustrate the model, we analyze data on the use of long-term care and residential services from a large California study population followed for 4.5 years. The analysis illustrates the model`s basic structure, its ability to describe very general types of multivariate discrete-state/discrete time stochastic processes, and its ability to deal with analytic problems like dependent competing risks, missing data, and the confounding of experimental conditions in a nonrandomized selection of cases and controls. [ABSTRACT FROM AUTHOR]

Provides information on the Longitudinal Retirement History Survey (LRHS) by the U.S. Social Security Administration. Significance of the LRHS; Details of the LRHS sampling; Review of LRHS-based publications.

Examines age-related changes in functional status by calculating active life expectancy (ALE). Calculation of ALE; Relationship between ALE and health costs and service use; Analysis of physical disability among elderly persons.

This article examines the evidence for two propositions: that health and ability to function can often be sustained into advanced old age through interventions that (1) control risk factors among people already old and (2) improve lifelong health behaviors and life-styles starting with people currently still young. Beginning with a general model of age-related changes in health, function, and survival, the article shows how the interrelationship between the three varies between two extreme types of diseases: the fast, lethal type, where death occurs early and rapidly, with few years spent in unhealthy or disabled conditions; and the slow, degenerative type, where prolonged survival allows for added years in unhealthy or disabled conditions. Since this latter type is predominant among older people in the United States today, interventions to prevent morbidity and functional loss are of critical importance. The need for an improved research base to guide such interventions is strongly urged. [ABSTRACT FROM AUTHOR]

Assessing the impact of chronic disability on the U.S. economy in general, and health expenditures in particular, involves a number of complex data and analytic problems. One involves measurement. Disability varies over individuals, both in content (i.e., there are multiple dimensions of physical and cognitive functioning) and intensity. Moreover, in contrast to most chronic diseases, there is no well established metric or 'staging' of chronic disability. One solution to the measurement problem has been to discount life expectancy subjectively by the perceived degree of functional loss manifest at specific ages. However, such subjective evaluations of quality of life have the problem that they vary tremendously depending upon the values and perspectives of the evaluator (e.g., Medicare, health-care providers, the patient) or, even more difficult, of the same evaluator in performing different social and economic roles (e.g., a health-system administrator who evaluates benefits in one way for a plan he manages and in a different way when, as a consumer, he is evaluating the benefits of an expensive treatment for a member of his family). [ABSTRACT FROM AUTHOR]

An analysis is made of the mortality trends over the period 1968 to 1977 indicated by two types of cause-specific mortality data. The first type of data is "underlying cause" of death data--the data heretofore used in national vital statistics reports on cause-specific mortality. The second type of data is "multiple cause" data which contain a listing of all medical conditions recorded on the death certificate. A comparison of trends in the two types of data yields useful insights on mortality declines over the study period for two reasons. First, these declines were largely due to a reduction in the mortality rates of circulatory diseases. Second, the multiple cause data contain considerably more information than the underlying cause data on the role of circulatory diseases, and many other chronic diseases, in causing death. This additional information is especially useful in examining mortality patterns among the elderly, where the prevalence at death of chronic degenerative diseases is high. [ABSTRACT FROM AUTHOR]

It is difficult to obtain direct empirical estimates of chronic disease prevalence in the U.S. population. The available estimates are usually derived from epidemiological studies of selected populations. In this paper we present strategies for estimating morbidity distributions in the national population using auxiliary biomedical evidence and theory to estimate transitions to morbidity states from a cohort mortality time series. We present computational methods which employ these estimates of morbid state transitions to produce life table functions for both primary (morbidity) and secondary (mortality) decrements. These methods are illustrated using data on stomach cancer mortality for nine white male cohorts, aged 30 to 70 in 1950, observed for a 28-year period (1950 to 1977). [ABSTRACT FROM AUTHOR]

Methods are presented which produce Maximum Likelihood Estimates (MLE) of the degree of heterogeneity in individual mortality risks under a variety of assumptions about the age trajectory of those mortality risks. With these estimates of the degree of population heterogeneity it is possible to adjust comparisons of mortality risks across populations for the effects of population heterogeneity, differential mortality selection, and different age trajectories of the force of mortality. These methods are demonstrated by applying a variety of standard assumptions about the age trajectory of the force of mortality to the analysis of a broad range of cohort mortality data for the U.S. and Swedish populations. The estimates of the degree of heterogeneity, produced under all of the selected force of mortality models, consistently indicated a considerable degree of heterogeneity in mortality risks. [ABSTRACT FROM AUTHOR]

Cause elimination life tables estimated from multiple cause of death data for four race/sex groups are presented for the U.S. population in 1969. These "multiple cause" life tables are then compared to cause elimination life tables where the mortality risk eliminated is that of the cause of death only in its occurrence as the underlying cause of death. An evaluation is made of the possible effects of the multiple cause data on our perception of the relative importance of the major causes of death. The reconceptualization of mortality risks made possible by the multiple cause of death data is also assessed in terms of its providing further insight into the "Taeuber paradox." [ABSTRACT FROM AUTHOR]

An analysis of the effects of diabetes and generalized atherosclerosis on death due to ischemic heart disease or stroke was conducted using multiple cause mortality statistics. Specifically, all U.S. deaths in 1969 were classified into two groups on the basis of whether diabetes or generalized atherosclerosis was mentioned anywhere on the death certificate. Then race and sex specific analyses were made of ischemic heart disease deaths (or alternately of stroke deaths) using modified life table techniques for each group (one with the specified chronic disease and one without). Comparisons were made of mortality due to the acute circulatory events (ischemic heart disease or stroke) in the two groups to determine the implications of the chronic disease for the progression of the circulatory disease events. It was found, according to expectations, that diabetes and generalized atherosclerosis play very different roles in deaths due to stroke and ischemic heart disease. [ABSTRACT FROM AUTHOR]

A study is made of the effects of associated causes of death, and of dependency among causes of death, by observing the relative importance of one cause of death when another is eliminated under various competing risk models. Two disease pairs, cancer and infectious disease and stroke and ischemic heart disease, are selected for analysis because they represent different types of disease dependence. Crude probabilities of death for each disease are calculated for the U.S. white male population in 1969. Next, the effects of the complementary disease in a pair are hypothetically eliminated in one of three ways: (a) a standard competing risk adjustment for cause elimination when deaths are singly caused (Chiang, 1968), (b) lethal defect-pattern of failure computations for multiply caused death when no causal order is inferred (Manton et al., 1976), and (c) relative susceptibility, computations for multiply caused deaths when causes are ordered (Wong, 1977). The paper closes with a discussion of the relative merits of the three types of adjustments. [ABSTRACT FROM AUTHOR]

Examines expectations for the United States health care system as the baby boom portion of society ages. Projected health care costs in 2015 to the federal government; Medicare solvency through 2070; Aspects to solving the solvency issue; Impact of new health care technology on the economy; Declining disability of people over 65; Changing paradigms of medicine; Paradox of extended longevity; Pharmaceutical research.

Background: early studies reported controversial findings on association of apolipoprotein E (APOE) polymorphism with disability., Objective: to analyse sex-specific associations of APOE genotypes with impairments in (instrumental) activities of daily living [(I)ADL] and mortality., Design: population-based 1999 National Long Term Care Survey (NLTCS) of the US older (65+) individuals., Participants: genetic data are available for 1,805 individuals., Methods: each of six genotypes of three common alleles of the APOE locus (epsilon 2, epsilon 3 and epsilon 4) was tested on the association with a disability index or mortality., Results: APOE epsilon 3/epsilon 3 genotype significantly decreases odds ratio (OR) for IADL disability in males [OR = 0.48; 95% Confidence Interval (CI) 0.31-0.76] while it exhibits no association in females. The OR for ADL disability is 0.19 (CI 0.04-0.99) for epsilon 4/epsilon 4 female carriers. The epsilon 2/epsilon 3 genotype increases the chances of IADL disability for males (OR = 2.33; CI 1.28-4.25). No significant association between APOE polymorphism and mortality was found. A surprising observation was that epsilon 4/epsilon 4 female carriers have a 5.3 times lower chance of having ADL disability than non-epsilon 4/epsilon 4-carriers., Conclusions: association of the APOE polymorphism with disability and lack of association with mortality support the view that APOE gene actions may be more significant as modulators of frailty than of longevity.

Changes in the health and functioning of the Medicare-enrolled population aged 65+ are tracked by using the 1982-2004/2005 National Long-Term Care Surveys. We found a significant rate of decline in the prevalence of chronic disability that accelerated from 1982 to 2004. These declines are significant for both persons with less severe chronic disability, which might be compensated by modifying the built environment and providing assistive devices, and for persons with more serious disability, which may be affected by reductions in the incidence and severity of disease through biomedical interventions. Declines in chronic disability continued over the 22-year period at a rate fast enough (i.e., 1.52% per annum) to contribute significantly to the long-term fiscal stability of the Medicare (and Medicaid) programs. Changes in the rate and substance of disability declines seem consistent with the intentions of policy interventions in Medicare and Medicaid.

Objectives: To analyse disability trends over the 1980s-1990s in gender and race groups of early retirement ages in USA., Methods: Disability trends for white and black males and females aged 65-69 and 70+ are analysed using the 1982-1999 NLTCS. Disability is analysed at three levels (instrumental activities of daily living (IADL), activities of daily living (ADL), and institutionalisation)., Results: 1) A larger increase in proportions of non-disabled blacks aged 65-69 compared with whites and males compared with females. 2) Differences in disability trends among gender and race groups. 3) A faster absolute decline in non-institutionalised disabled aged 65-69. 4) A larger absolute decline and a smaller relative decline in proportions of disabled aged 70+ compared with 65-69. 5) A significant decrease in the proportion of ADL disabled blacks and an increase of ADL disabled white females in the age group 70+., Conclusions: Americans aged 65-69 years manifest a significant improvement in health over the 1980s-1990s but the dynamics differs in gender and race groups. Possible reasons for these differences are discussed.