Transition and duration in disability: New evidence from administrative data

doi:10.1016/j.dhjo.2015.07.006

Disability and Health Journal

Volume 9, Issue 1, January 2016, Pages 26-36

https://doi.org/10.1016/j.dhjo.2015.07.006 Get rights and content

Abstract

Background

In recent decades demographic changes (low fertility rates, increased life expectancy…) in most OECD countries, have brought profound changes in the population pyramid, with several effects in the welfare of society. One of them is the increase in the number of people with disabilities, since age is a determining factor in the emergence of this dependency.

Objective/hypothesis

This paper studies the probability to enter and transit in and from a disability state, as well as its associated mortality, by attending to the distinction between the initial disability level and the process that leads on from it, and by addressing whether and how education, age and income affect this transition.

Methods

Applying a Markov model and a survival analysis to new Spanish administrative data set (Muestra Continua de Vida Laboral (MCVL)) we estimate the probability that a person changes the state of disability and the duration of her progression in each case.

Results

We find that people with an initial state of disability have a higher propensity to change status and take less time to transit amongst different stages than those who have no disability. Men do so more frequently than women and income have negative effects on the transition.

Conclusions

These results may help to incorporate into welfare programs some protection mechanisms for delaying transitions and target the most fragile population groups.

Section snippets

Data

To conduct the analysis we use the Social Security records data (Muestra Continua de Vidas Laborales, MCVL).^c The sample represents the entire reference population each year according to age, sex, residence region and nationality. The information of those individuals selected in the Social Security account for 4% of the Spanish people present in the Social Security system annually. The data are available in two versions: one

Results

In Table 3 we report the simple method of counting procedure of the probability of transition from one state to another by gender, without considering any explanatory variables. At first glance we see that most individuals undergo little change in their state of disability. 11% of them transit from one disability state to another and around 3% of individuals with no disability enter disability during any of the years considered; 5% of individuals with 33% disability have a transition, most of

Discussion

The Social Security program on disabilities in Spain is quite similar to that of most of EU countries. There are two basic types of permanent disability benefits: contributory, which covers individuals who have contributed to the Social Security system, and universal, for those who never did contribute. These two systems are offered to an individual who enters into a disability state in order to maintain a certain amount of income.30, 31^,ⁱ

Conclusions

A small change in the prevalence of present disability rates can have substantial impact on future expenditure on health care and social services, particularly in a fast-growing older population such as the Spanish one, for which it is projected that the population over 65 years old will have doubled by 2060.³² In order to face this impact, we need a better understanding of the main mechanisms on disability among population. In this study we have contributed to this by showing that gender, age,

Acknowledgement

We are grateful for anonymous referees' comments and to the additional comments of the Editor.

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Recent world population predictions show that the world population aged >=65 years will increase from 10% in 2022 to 16% in 2050. Population aging is accompanied by an increase in people with disability. It is important to pay special attention to people with disability, as these people are at high risk of adverse outcomes. Our study aimed to investigate the transitions of disability among Dutch community-dwelling older people aged 75 years or older, using a follow-up of nine years. We used socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events to predict the disability transitions over time.
We used a sample of 484 people that was randomly drawn from the municipality of Roosendaal (the Netherlands), a municipality with 78,000 inhabitants. A subset of people who completed part A of the Tilburg Frailty Indicator (TFI) at baseline and the Groningen Activity Restriction Scale (GARS) questionnaires was used with a nine-year follow-up. Paired Wilcoxon tests were used to compare the consecutive measurements. Socio-demographic factors gender, age, marital status, education, and income, but also lifestyle, diseases, and life events were included to predict the disability transitions over time. For the univariable and multivariable analysis of the measurements over time with the predictor variables, we used generalized estimation equations (GEE). A p-value <0.05 was considered significant. R version 3.4.4 was used for all analyses.
Of the participants, 65% were younger than 80 years, 50% were married or cohabiting, 87% reported a healthy lifestyle, and 63% had no diseases or chronic disorders. Each year, more participants changed from status not disabled to disabled than vice versa. The GEE analyses showed that lifestyle (‘not healthy’) and diseases or chronic disorders (‘two or more’) were significant in the multivariable analysis for the disability score and only diseases or chronic disorders (‘two or more’) was significant in the multivariable analysis for the dichotomous disability score.
The transition of the disability score is strongly influenced by lifestyle and diseases or disorders. This applies to a lesser extent to the dichotomous disability score. There, only diseases or disorders are an important predictor. For health care professionals our study provides starting points for interventions focused on the prevention of worsening disability and for community-dwelling older people >= 75, the most important recommendation is: live healthy!
Disability type–specific mortality patterns and life expectancy among disabled people in South Korea using 10-year combined data between 2008 and 2017
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Although a previous study reported a decrease in the life expectancy gap between non-disabled and disabled men and women in South Korea (hereafter, Korea), the magnitude of the difference was still very high, at 16.4 years in 2017 (Bahk et al., 2019a). Disabled people are not a homogeneous group of people, but encompass a wide variety of disability types, because various health conditions over the life course may lead to disability (Becker, 2006; Casasnovas and Nicodemo, 2016; Jamoom et al., 2008). Health disadvantages among disabled people compared with non-disabled people have been reported (Bahk et al., 2019a; Dammeyer and Chapman, 2018; Glover et al., 2017; Jung et al., 2020; Park et al., 2017).
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This finding is in agreement with previous report that hospitalization was a robust predictor of functional decline (here, of nonrecovery).32 Also in agreement with previous report, maintenance and recovery were found to be associated with younger age at baseline,11,15,33 having someone that could be counted on (found in unadjusted analysis),17 and living in a larger household. Although we might assume that larger households may provide more support that aids recovery (social contacts, help with meals, keeping medical appointments), we have no direct evidence of that occurring here.
Focus on decline in performance of activities of daily living (ADL) has not been matched by studies of recovery of function. Advised by a broad conceptual model of physical resilience, we ascertain characteristics that identify (1) maintenance, (2) decline, and (3) recovery of personal self-maintenance activities over six years in an older, community representative, African American and white sample.
Longitudinal study, analyses included descriptive statistics and repeated measures proportional hazards.
Community-representative participants of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE), unimpaired at baseline (n = 3187; 46% white, 54% African American; 64% female, 36% male), followed annually for up to 6 years.
Data included information on basic activities of daily living (BADL), demographic characteristics, health status, social services provided and received, household size, neighborhood safety, and survival status.
Over 6 years, ∼75% remained unimpaired, of whom 30% were unimpaired when they dropped out or died. Of ∼25% who became impaired, just under half recovered. Controlled analyses indicated that those who became impaired were in poorer health, younger, and more likely to be African American. Characteristics of recovery included younger age, not hospitalized in the previous year, and larger household size.
Maintenance of health status facilitated continued unimpaired BADL. While decline was associated with poorer health, younger age, and being African American, recovery was also associated with younger age, together with larger household size, and no further deterioration in health as measured here. Maintenance of good health is preferred, but following decline in functioning, increased effort to improve health and avoid further decline, which takes into account not only physical but also personal social conditions, is needed.
Disability Transitions in Dutch Community-Dwelling Older People Aged 75 Years or Older
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: This paper is developed within the Plan Nacional Research activity for the project ECO2012-37496, titled “Los equilibrios intergeneracionales del bienestar social,” funded by the Spanish Ministry of Economics and Competition.

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Review ArticleTransition and duration in disability: New evidence from administrative data

Abstract

Background

Objective/hypothesis

Methods

Results

Conclusions

Section snippets

Data

Results

Discussion

Conclusions

Acknowledgement

J Health Econ

Soc Sci Med

Soc Sci Med

Disabil Health J

J Econom

Health Wanted? Providing and Paying for Long-term Care

Trends in Severe Disability Among Elderly People: Assessing the Evidence in 12 OECD Countries and the Future Implications

Financing Long-term Care in Europe: Institutions, Markets and Models

The ACA and preventive health care services for people with disabilities

Disabil Health J

The potential for technology to enhance independence for those aging with a disability

Disabil Health J

Comparing health inequality in men and women: choice of indicator is important

Br Med J

Socio-demographic differences in the onset and progression of disability in early old age: a longitudinal study

Age Ageing

Charter School Operations and Performance: Evidence From California

Disability and the transition to adulthood

Oxford J Soc Sci Soc Forces

Estimating Markov Transition Probabilities Between Health States in the HRS Dataset

Dynamic analysis of disability in Spain using the European Community Household Panel

Estud Econ Aplicada

How large is the bias in self-reported disability?

J Appl Econ

Review Article
Transition and duration in disability: New evidence from administrative data