Understanding the Twentieth Century Decline in Chronic Conditions Among Older Men

Abstract

I use a sample of Union Army veterans to trace the impact of a high infant mortality rate in area of enlistment, such infectious disease as acute respiratory infections, measles, typhoid fever, tuberculosis, rheumatic fever, diarrhea, and malaria while in the army, occupation at enlistment, and occupation at older ages on chronic respiratory problems, various heart conditions, and joint and back problems at older ages. I find that between 1900 and the present the prevalence of respiratory conditions at older ages fell by 70 percent, that of arrhythmias, murmurs, and valvular heart disease by 90 percent, atherosclerosis by 60 percent, and joint and back problems by 30 percent. Occupational shifts accounted for 15 percent of the decline in joint problems, over 75 percent of the decline in back problems, and 25 percent of the decline in respiratory difficulties. Reduced exposure to infectious disease accounted for at least 10 to 25 percent of the decline in chronic conditions. I also find that the duration of chronic conditions has remained unchanged since the early 1900s but that if disability is measured by difficulty in walking, men with chronic conditions are now less disabled than they were in the past.