Shih-Fan Lin1, Audrey N Beck2, Brian K Finch3. 1. Institute for Behavioral and Community Health, San Diego State University, 9245 Sky Park Court, Suite 220, San Diego, CA 92123, USA; Graduate School of Public Health, San Diego State University, 5500 Campanile Dr. Hardy Tower, Room 119, San Diego, CA 92182-4162, USA. Electronic address: slin@mail.sdsu.edu. 2. Department of Sociology, San Diego State University, 5500 Campanile Dr. Nasatir Hall, Room 224, San Diego, CA 92123, USA. 3. Graduate School of Public Health, San Diego State University, 5500 Campanile Dr. Hardy Tower, Room 119, San Diego, CA 92182-4162, USA; Center for Economic and Social Research USC, Population Research Center, 635 Downey Way, Los Angeles, CA 90089-3332, USA.
Abstract
BACKGROUND: Although evidence has shown that U.S. late-life disability has been declining, studies have also suggested that there has been an increase in chronic diseases between 1984 and 2007. OBJECTIVES: To further illuminate these potentially contradictory trends, we explicate how the contribution of chronic conditions changes across four common types of disability (ADL, IADL, mobility disability, and functional limitations) by age (A), period (P), and birth cohorts (C) among adults aged 20 and above. METHODS: Our data came from seven cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES). We utilize a cross-classified random effect model (CCREM) to simultaneously estimate age, period, and cohort trends for each disability. Each chronic condition was sequentially then simultaneously added to our base models (sociodemographics only). Reductions in predicted probability from the base model were then calculated for each chronic condition by each temporal dimension (A/P/C) to assess the contribution of each chronic condition. RESULTS: There was increasing age-based contribution of chronic conditions to all disabilities. The period-based contribution remained quite stagnant across years while cohort-based contributions showed a continual decline for recent cohorts. Arthritis showed the greatest contribution to disability of all types which was followed by obesity. Cancer was the least important contributor to disabilities. CONCLUSION: Although chronic conditions are becoming less disabling across recent cohorts, other competing risk factors might suggest prevailing causes of disability.
BACKGROUND: Although evidence has shown that U.S. late-life disability has been declining, studies have also suggested that there has been an increase in chronic diseases between 1984 and 2007. OBJECTIVES: To further illuminate these potentially contradictory trends, we explicate how the contribution of chronic conditions changes across four common types of disability (ADL, IADL, mobility disability, and functional limitations) by age (A), period (P), and birth cohorts (C) among adults aged 20 and above. METHODS: Our data came from seven cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES). We utilize a cross-classified random effect model (CCREM) to simultaneously estimate age, period, and cohort trends for each disability. Each chronic condition was sequentially then simultaneously added to our base models (sociodemographics only). Reductions in predicted probability from the base model were then calculated for each chronic condition by each temporal dimension (A/P/C) to assess the contribution of each chronic condition. RESULTS: There was increasing age-based contribution of chronic conditions to all disabilities. The period-based contribution remained quite stagnant across years while cohort-based contributions showed a continual decline for recent cohorts. Arthritis showed the greatest contribution to disability of all types which was followed by obesity. Cancer was the least important contributor to disabilities. CONCLUSION: Although chronic conditions are becoming less disabling across recent cohorts, other competing risk factors might suggest prevailing causes of disability.
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