, Volume 44, Issue 3, pp 459–477 | Cite as

Chronic conditions and the decline in late-life disability

  • Vicki A. Freedman
  • Robert F. Schoeni
  • Linda G. Martin
  • Jennifer C. Cornman


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.


Chronic Condition Condition Group National Health Interview Survey Mental Distress Musculoskeletal Condition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Bush, T.L., S.R. Miller, A.L. Golden, and W.E. Hale. 1989. “Self-Report and Medical Record Report Agreement of Selected Medical Conditions in the Elderly.” American Journal of Public Health 79(11):1554–56.CrossRefGoogle Scholar
  2. Crimmins, E.M. 2004. “Trends in the Health of the Elderly.” Annual Review of Public Health 25(1):79–98.CrossRefGoogle Scholar
  3. Crimmins, E.M. and Y. Saito. 2000. “Change in the Prevalence of Diseases Among Older Americans: 1984–1994.” Demographic Research 3(9). Available online at http://www.demographic-research. org/Volumes/Vol3/9/3-9.pdfGoogle Scholar
  4. Crimmins, E.M., Y. Saito, and S.L. Reynolds. 1997. “Further Evidence on Recent Trends in the Prevalence and Incidence of Disability Among Older Americans From Two Sources: the LSOA and the NHIS.” Journals of Gerontology 52(2):S59-S71.Google Scholar
  5. Crystal, S., U. Sambamoorthi, J.T. Walkup, and A. Akincigil. 2003. “Diagnosis and Treatment of Depression in the Elderly Medicare Population: Predictors, Disparities, and Trends.” Journal of the American Geriatrics Society 51(12):1718–28.CrossRefGoogle Scholar
  6. Cutler, D.M. 2001. “Declining Disability Among the Elderly.” Health Affairs 20(6):11–27.CrossRefGoogle Scholar
  7. Cutler, D.M., M.B. Landrum, and K. Stewart. 2006. “Intensive Medical Care and Cardiovascular Disease Disability Reductions.” NBER Working Paper Series No. 12184. National Bureau of Economic Research, Cambridge, MA.Google Scholar
  8. Das Gupta, P. 1993. “Standardization and Decomposition of Rates: A User’s Manual.” Current Population Reports, Series P-23(186). Washington, DC: U.S. Bureau of the Census.Google Scholar
  9. Desai, M., L.A. Pratt, H. Lentzner, and K.N. Robinson. 2001. “Trends in Vision and Hearing Among Older Americans.” Aging Trends (2):1–8.Google Scholar
  10. Ettinger, W.H., Jr., L.P. Fried, T. Harris, L. Shemanski, R. Schulz, and J. Robbins. 1994. “Self-Reported Causes of Physical Disability in Older People: The Cardiovascular Health Study. CHS Collaborative Research Group.” Journal of the American Geriatrics Society 42(10):1035–44.Google Scholar
  11. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. 1997. “Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus.” Diabetes Care 20:1183–97.Google Scholar
  12. Ferraro, K.F. and Y. Su. 2000. “Physician-Evaluated and Self-Reported Morbidity for Predicting Disability.” American Journal of Public Health 90(1):103–108.CrossRefGoogle Scholar
  13. Feyisetan, B. and J.B. Casterline. 2000. “Fertility Preferences and Contraceptive Change in Developing Countries.” International Family Planning Perspectives 26(3):100–109.CrossRefGoogle Scholar
  14. Firebaugh, G. 1989. “Methods for Estimating Cohort Replacement Effects.” Sociological Methodology 19:243–62.CrossRefGoogle Scholar
  15. Freedman, V.A., E. Crimmins, R.F. Schoeni, B.C. Spillman, H. Aykan, E. Kramarow, K. Land, J. Lubitz, K. Manton, L.G. Martin, D. Shinberg, and T. Waidmann. 2004. “Resolving Inconsistencies in Trends in Old-Age Disability: Report From a Technical Working Group.” Demography 41:417–41.CrossRefGoogle Scholar
  16. Freedman, V.A. and L.G. Martin. 1999. “The Role of Education in Explaining and Forecasting Trends in Functional Limitations Among Older Americans.” Demography 36:461–73.CrossRefGoogle Scholar
  17. — 2000. “Contribution of Chronic Conditions to Aggregate Changes in Old-Age Functioning.” American Journal of Public Health 90(11):1755–60.CrossRefGoogle Scholar
  18. Freedman, V.A., L.G. Martin, J.C. Cornman, E.M. Agree, R.F. Schoeni. Forthcoming. “Trends in Assistance With Daily Activities: Racial/Ethnic and Socioeconomic Disparities in the U.S. Older Population Persist,” In Health In Older Ages: The Causes and Consequences of Declining Disability Among the Elderly, edited by D. Cutler and D. Wise. Chicago: University of Chicago Press.Google Scholar
  19. Freedman, V.A., L.G. Martin, and R.F. Schoeni. 2002. “Recent Trends in Disability and Functioning Among Older Adults in the United States: A Systematic Review.” Journal of the American Medical Association 288(24):3137–46.CrossRefGoogle Scholar
  20. Fried, L.P., K. Bandeen-Roche, J.D. Kasper, and J.M. Guralnik. 1999. “Association of Comorbidity With Disability in Older Women: The Women’s Health and Aging Study.” Journal of Clinical Epidemiology 52(1):27–37.CrossRefGoogle Scholar
  21. He, W., M. Sengupta, V. Velkoff, and K. DeBarros. 2005. “65+ in the United States: 2005.” Current Population Reports, Series P23–209. Washington, DC: U.S. Census Bureau.Google Scholar
  22. Himes, C.L. 2000. “Obesity, Disease, and Functional Limitation in Later Life.” Demography 37:73–82.CrossRefGoogle Scholar
  23. Institute of Medicine. 1991. Disability in America: Toward a National Agenda for Prevention. Washington, DC: National Academy Press.Google Scholar
  24. Kessler, R.C., G. Andrews, L.J. Colpe, E. Hiripi, D.K. Mroczek, S.L. Normand, E.E. Walters, and A.M. Zaslavsky. 2002. “Short Screening Scales to Monitor Population Prevalences and Trends in Non-Specific Psychological Distress.” Psychology and Medicine 32:959–76.CrossRefGoogle Scholar
  25. Kitigawa, E.M. 1955. “Components of a Difference Between Two Rates.” Journal of the American Statistical Association 50(272):1168–94.CrossRefGoogle Scholar
  26. Lakdawalla, D., J. Bhattacharya, and D. Goldman. 2003. “Are the Young Becoming More Disabled?” Health Affairs 23(1):168–76.CrossRefGoogle Scholar
  27. Lawrence, R.C., C.G. Helmick, F.C. Arnett, R.A. Deyo, D.T. Felson, E.H. Giannini, S.P. Heyse, R. Hirsch, M.C. Hochberg, G.G. Hunder, M.H. Liang, S.R. Pillemer, V.D. Steen, and F. Wolfe. 1998. “Estimates of the Prevalence of Arthritis and Selected Musculoskeletal Disorders in the United States.” Arthritis & Rheumatism 41:778–99.CrossRefGoogle Scholar
  28. Manton, K.G. 1982. “Changing Concepts of Morbidity and Mortality in the Elderly Population.” Milbank Memorial Fund Quarterly 60:183–244.CrossRefGoogle Scholar
  29. Manton, K.G. and X. Gu. 2001. “Changes in the Prevalence of Chronic Disability in the United States Black and Nonblack Population Above Age 65 From 1982 to 1999.” Proceedings of the National Academy of Sciences 98(11):6354–59.CrossRefGoogle Scholar
  30. Manton, K.G., X. Gu, and V.L. Lamb. 2006. “Change in Chronic Disability from 1982 to 2004–2005 as Measured by Long-Term Changes in Function and Health in the U.S. Elderly Population.” Proceedings of the National Academy of Sciences 103(48):18374–79. Available online at http://www. Scholar
  31. Medicare Payment Advisory Committee. 2004. Healthcare Spending and the Medicare Program: A Data Book. Washington, DC: MEDPAC.Google Scholar
  32. Moeller, J.F., G.E. Miller, and J.S. Banthin. 2004. “Looking Inside the Nation’s Medicine Cabinet: Trends in Outpatient Drug Spending by Medicare Beneficiaries, 1997 and 2001.” Health Affairs 23(5):217–25.CrossRefGoogle Scholar
  33. National Center for Health Statistics. 2003. “Health Care in America: Trends in Utilization.” Hyattsville, MD: National Center for Health Statistics.Google Scholar
  34. Neumann, P.J., S.S. Araki, and E.M. Gutterman. 2000. “The Use of Proxy Respondents in Studies of Older Adults: Lesson, Challenges, and Opportunities.” Journal of the American Geriatric Society 48:1646–54.Google Scholar
  35. Ogden, C.L., M.D. Carroll, L.R. Curtin, M.A. McDowell, C.J. Tabak, and K.M. Flegal. 2006. “Prevalence of Overweight and Obesity in the United States, 1999–2004.” Journal of the American Medical Association 295:1549–52.CrossRefGoogle Scholar
  36. Retherford, R.D. and J.R. Rele. 1989. “A Decomposition of Recent Fertility Changes in South Asia.” Population and Development Review 15:739–47.CrossRefGoogle Scholar
  37. Ross, C.E. and C. Wu. 1995. “The Links Between Education and Health.” American Sociological Review 60:719–45.CrossRefGoogle Scholar
  38. Schoeni, R.F., L.G. Martin, P. Andreski, and V.A. Freedman. 2005. “Growing Disparities in Trends in Old-Age Disability 1982–2001.” American Journal of Public Health 95(11):2065–70.CrossRefGoogle Scholar
  39. Simpson, C.F., C.M. Boyd, M.C. Carlson, M.E. Griswold, J.M. Guralnik, and L.P. Fried. 2004. “Agreement Between Self-Report of Disease Diagnoses and Medical Record Validation in Disabled Older Women: Factors That Modify Agreement.” Journal of the American Geriatrics Society 52(1):123–27.CrossRefGoogle Scholar
  40. Skinner, K.M., D.R. Miller, E. Lincoln, A. Lee, and L.E. Kazis. 2005. “Concordance Between Respondent Self-Reports and Medical Records for Chronic Conditions: Experience From the Veterans Health Study.” Journal of Ambulatory Care Management 28(2):102–10.Google Scholar
  41. Smith, H.L., S.P. Morgan, and T. Koropeckyj-Cox. 1996. “A Decomposition of Trends in the Nonmarital Fertility Ratios of Blacks and Whites in the United States, 1960–1992.” Demography 33:141–51.CrossRefGoogle Scholar
  42. Spillman, B.C. 2004. “Changes in Elderly Disability Rates and the Implications for Health Care Utilization and Cost.” The Milbank Quarterly 82:157–94.CrossRefGoogle Scholar
  43. Sturm, R., J.S. Ringel, and T. Andreyeva. 2004. “Increasing Obesity Rates and Disability Trends.” Health Affairs 23(2):199–205.CrossRefGoogle Scholar
  44. U.S. Department of Health and Human Services. 2000. Healthy People 2010, Understanding and Improving Health, Vol. II, 2nd ed. Washington, DC: U.S. Government Printing Office.Google Scholar
  45. Verbrugge, L.M., J.M. Lepkowski, and Y. Imanaka. 1989. “Comorbidity and Its Impact on Disability.” Milbank Memorial Fund Quarterly 67(3–4):450–84.Google Scholar
  46. Wolf, D.A., K. Hunt, and J. Knickman. 2005. “Perspectives on the Recent Decline in Disability at Older Ages.” The Milbank Quarterly 83:365–95.CrossRefGoogle Scholar
  47. World Health Organization (WHO). 2002. “Towards a Common Language for Functioning, Disability, and Health: ICF.” Geneva: WHO. Available online at who_icf_2002.pdfGoogle Scholar
  48. Zuvekas, S.H. 2001. “Trends in Mental Health Services Use and Spending, 1987–1996.” Health Affairs 20(2):214–24.CrossRefGoogle Scholar

Copyright information

© Population Association of America 2007

Authors and Affiliations

  • Vicki A. Freedman
    • 1
  • Robert F. Schoeni
    • 2
  • Linda G. Martin
    • 3
  • Jennifer C. Cornman
    • 1
  1. 1.Department of Health Systems and PolicyUniversity of Medicine and Dentistry of New Jersey-School of Public HealthNew Brunswick
  2. 2.Institute for Social Research and Ford School of Public PolicyUniversity of MichiganUSA
  3. 3.Institute of MedicineNational AcademiesUSA

Personalised recommendations