Abstract
ObjectivesTo extend existing research on the US health disadvantage relative to Europe by studying the relationships of disability with age from midlife to old age in the US and four European regions (England/Northern and Western Europe/Southern Europe/Eastern Europe) including their wealth-related differences, using a flexible statistical approach to model the age-functions.MethodsWe used data from three studies on aging, with nationally representative samples of adults aged 50 to 85 from 15 countries (N = 48225): the US-American Health and Retirement Study (HRS), the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Outcomes were mobility limitations and limitations in instrumental activities of daily living. We applied fractional polynomials of age to determine best fitting functional forms for age on disability in each region, while controlling for socio-demographic characteristics and important risk factors (hypertension, diabetes, obesity, smoking, physical inactivity).ResultsFindings showed high levels of disability in the US with small age-related changes between 50 and 85. Levels of disability were generally lower in Eastern Europe, followed by England and Southern Europe and lowest in Northern and Western Europe. In these latter countries age-related increases of disability, though, were steeper than in the US, especially in Eastern and Southern Europe. For all countries and at all ages, disability levels were higher among adults with low wealth compared to those with high wealth, with largest wealth-related differences among those in early old age in the USA.ConclusionsThis paper illustrates considerable variations of disability and its relationship with age. It supports the hypothesis that less developed social policies and more pronounced socioeconomic inequalities are related to higher levels of disability and an earlier onset of disability.
Highlights
The ‘compression of morbidity’ hypothesis claims that the age of onset of major chronic diseases and of disability has been postponed in recent years, with a sharpening increase in later life and most of the morbidity in life squeezed into the years before death [1]
We investigate the agedisability relationship across five major regions (US in Health and Retirement Study (HRS), England in English Longitudinal Study of Ageing (ELSA), Northern and Western Europe, Southern, and Eastern Europe in SHARE) by applying a statistical approach that allows for flexible modulation of the age function for each region
We reduced our sample to respondents aged 50 to 85 years and excluded individuals with missing data on measures of disability and the remaining covariates, resulting in a total sample of 48,225 men and women (SHARE = 30,395, ELSA = 6,141, HRS = 11,689)
Summary
The ‘compression of morbidity’ hypothesis claims that the age of onset of major chronic diseases and of disability has been postponed in recent years, with a sharpening increase in later life and most of the morbidity in life squeezed into the years before death [1]. A growing body of research compared health between the US, England and continental European countries, demonstrating important health disadvantages of older adults in the US compared to their European counterparts [6,7,8,9,10]. These differences exist for distinct chronic diseases (for example diabetes, hypertension and stroke) [6,7,8] and for disability and functional limitations [6,9]. While these studies compare the overall health levels of broad age groups, less information so far is available on age-related increases of poor health, and in particular on the age-function of disability
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