Research Paper
Unemployment, disability and life expectancy in the United States: A life course study

https://doi.org/10.1016/j.dhjo.2015.08.003Get rights and content

Abstract

Background

Unemployment may be associated with health through factors including stress, depression, unhealthy behaviors, reduced health care, and loss of social networks. Little is known about associations of total lifetime unemployment with disability and life expectancy.

Hypothesis

People with high unemployment (≥the median) will live shorter lives with more disability than those with less unemployment.

Methods

Data were nationally representative of African Americans and non-Hispanic whites, from the Panel Study of Income Dynamics (37 waves 1968–2011, n = 7,970, mean work years = 24.7). Seven waves (1999–2011, 58,268 person-years) measured disability in activities of daily living. We estimated monthly probabilities of disability and death associated with unemployment using multinomial logistic Markov models adjusted for age, sex, race/ethnicity, education, health status at baseline and throughout work life, and social support. We used the probabilities to create large populations with microsimulation, each individual having known monthly disability status, age 40 to death. We analyzed the populations to measure outcomes.

Results

Respectively for African American and white women and African American and white men, life expectancies (with 95% confidence intervals) from age 40 with low unemployment were ages: 77.1 (75.0–78.3), 80.6 (78.4–81.4), 71.4 (69.6–72.5), and 76.9 (74.9–77.9). Corresponding high unemployment results were: 73.7 (71.7–75.0), 77.5 (75.1–78.0), 68.4 (66.8–69.0), and 73.7 (71.5–74.3). The percentage of life disabled from age 40 was greater with high unemployment for the same groups, by 23.9%, 21.0%, 21.3%, and 21.1% (all p < 0.01).

Conclusions

High lifetime unemployment may be associated with a larger proportion of later life with disability and lower life expectancy.

Section snippets

Pathways linking unemployment with health

Researchers often attribute poor health associated with unemployment to stress.4, 5, 8, 17 Research has suggested associations between unemployment and arthritis,7 dementia,7 depression,5, 11, 18, 19, 20, 21 heart attack,13 heart disease,13, 22 hypertension,23 obesity,24 stroke,12 high cortisol and inflammation,25, 26 poorer self-rated health,7, 22 and suicide.5 Arthritis, dementia, depression, heart disease, obesity, and stroke have been linked with higher risks of impairments in activities of

Unemployment and health for African Americans and whites

There is substantial evidence of disparities in health, disability, and life expectancy between African Americans and non-Hispanic whites (hereafter referred to as whites).25, 37, 38, 39, 40, 41, 42, 43 If unemployment is differently associated with health for these groups, unemployment may be associated with those disparities. Hypotheses regarding unemployment and health for African Americans and whites include “double jeopardy,” more health consequences for African Americans due to social and

Study contributions and hypotheses

We modeled the association of unemployment with the joint dynamics of disability and death, the active life expectancy analysis, using panel survey data that followed individuals for 43 years. We hypothesized that people with high lifetime unemployment would have shorter lives with more disability than those with less unemployment. We controlled for health prior to the period when we measured unemployment, and also during that period. We controlled for educational attainment, which is

Data source and sample

We used data from the Panel Study of Income Dynamics (PSID), the longest-running household panel study in the world.45 The data were a nationally representative United States sample of African Americans and whites (n = 7970), who were 94.3% of the American population when the PSID began collecting data in 1968.46 The PSID interviewed participants every year from 1968 through 1997, and every two years since then.

Measuring disability and death

We identified ADL disability for the active life expectancy analysis from

Descriptive results

The analytic data used for the active life expectancy analysis had 28,974 records, representing 58,268 person-years for the outcome measurement period beginning with 1999. In weighted nationally representative results that accounted for the survey design, the mean age when we began measuring disability in 1999 was 53.4 years (standard error, SE, 0.3). Women were 54.7% of the weighted sample (SE < 0.1). The PSID over-sampled African Americans, who were 31.9% of the unweighted sample, 12.4% when

Discussion

Consistent with our hypothesis, African American and white women and men with high unemployment had shorter lives than those with low unemployment. Also consistent with our hypothesis, all groups with high unemployment were disabled through more of later life than those with low unemployment. There were no meaningful differences between African Americans and whites in the association of unemployment with either life expectancy or the proportion of remaining life with disability.

We found

Acknowledgment

We thank two anonymous reviewers for useful suggestions about this research.

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    Authors contribution: Both authors participated in the conception and design of the study, the analysis of the data and interpretation of the results, drafting the manuscript, and final approval of the manuscript for submission.

    Disclosure: The authors have no conflicts of interest.

    Funding: The authors received no financial support for the research or authorship of this manuscript.

    Presentations: Portions of preliminary results of this study were presented at the Department of Public Health Sciences Seminar Series, Medical University of South Carolina, Charleston, South Carolina, on September 21, 2014, titled “Treats All ’Round: Using Multinomial Markov Modeling and Microsimulation to Address Missing Data in Longitudinal Analysis in a Study of Unemployment and Active Life Expectancy.” Portions of preliminary results of this study were presented as a peer reviewed poster at the annual meetings of the Gerontological Society of America, Washington, DC, November 5–9, 2014, titled, “Associations between Unemployment and Active Life Expectancy: Four Decades of Panel Survey Evidence.”

    The data used for this study are available from the Panel Study of Income Dynamics, http://simba.isr.umich.edu/data/data.aspx.

    The collection of data used in this study was partly supported by the National Institutes of Health under grant number R01 HD069609, and the National Science Foundation under award number 1157698.

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