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%0 Thesis %B Economics %D 2019 %T The Impact of Medicare Part D on Mortality and Financial Stability %A Toran, Katherine %K Economics %K Health Economics %K Health Insurance %K Life Expectancy %K Medicare Part D %K Public Economics %K Racial Disparities %X Using the Health and Retirement Study Panel core files from 1996 to 2014, I analyze how Medicare Part D impacted access to prescription drug coverage by various demographic factors such as race, gender, and income. In Chapter 1, I find the highest take-up rates for those who were white, female, and with higher incomes. However, increases in coverage were high across the board, such that Medicare Part D also improved drug insurance coverage for those who were black, male, and with lower income. Thus, although Medicare Part D did increase prescription drug insurance coverage for seniors across the board, I also find potential for improvement in enrollment for difficult-to-reach groups. Next, Chapter 2 examines the impact of Medicare Part D on mortality. Although I do not find an impact on the life expectancy of respondents as a whole, I do find a significant positive effect for black respondents, indicating that Medicare Part D may have mattered more for disadvantaged groups. The largest impact is for black men, who have an additional 9 percentage point chance of living to age 73 for an additional 8 years of coverage (significant at the 5% level). When looking only at cardiovascular mortality, which is more likely to be influenced by drug coverage, I find improvements in life expectancy for the total population, with stronger effects for minorities and men. Overall, my findings suggest that Medicare Part D did move the needle on its goal: to improve the health of those who, without government intervention, had the most difficulty paying for prescription drugs. Chapter 3 looks at the impact of Medicare Part D prescription drug coverage on cost-related medication adherence, food insecurity, and finances among seniors. It would be reasonable to assume that Medicare Part D, which led to near-universal drug coverage among senior citizens, could allow seniors to shift money previously spent on drug expenditures to other areas. The strongest effect of Medicare Part D is on cost-related medication nonadherence, leading to a 21% decrease for an additional 8 years of Medicare Part D coverage. The impact is even stronger for the black male population (30%). I fail to reject the null hypothesis that Medicare Part D did not reduce food insecurity or household debt. Overall, Medicare Part D appears to have improved the financial stability of seniors. %B Economics %I University of Kentucky %C Lexington, United States %V Doctor of Philosophy %P 168 %8 2019 %G eng %U https://uknowledge.uky.edu/economics_etds/45/ %R https://doi.org/10.13023/etd.2019.325 %0 Newspaper Article %B Prince George Citizen %D 2019 %T Poverty report links wealth to life expectancy %K americans %K Bernard %K compounded %K divide %K General Interest Periodicals–United States %K Home ownership %K Households %K Income distribution %K Life Expectancy %K Mongolia %K Sanders %K stark %K survive %K United States–US %K Virginia %K West Virginia %X Poorer Americans are much less likely to survive into their 70s and 80s than rich Americans, a stark lifeexpectancy divide compounded by the nation's growing disparities in wealth, according to a U.S. report. Over three-quarters of the richest 50-somethings in 1991 were still alive 23 years later, in 2014, the report found. But among the poorest 20 per cent of that cohort, the survival rate was less than 50 per cent, according to the analysis by the Government Accountability Office, a nonpartisan congressional research agency. The report finds that while average life expectancy increased over that period, it "has not increased uniformly across all income groups, and people who have lower incomes tend to have shorter lives than those with higher incomes." %B Prince George Citizen %C British Columbia %G eng %U https://proxy.lib.umich.edu/login?url=https://search.proquest.com/docview/2292028778?accountid=14667 %0 Web Page %D 2018 %T Loss of life savings is a killer, say researchers: Health Study [Europe Region] %A Cookson, Clive %K Cardiovascular disease %K Life Expectancy %K Mortality %K Savings %I Financial Times %C London, UK %V 2018 %G eng %0 Journal Article %J PLOS ONE %D 2018 %T Poverty dynamics, poverty thresholds and mortality: An age-stage Markovian model %A Bernstein, Shayna Fae %A David H. Rehkopf %A Tuljapurkar, Shripad %A Horvitz, Carol C. %E Komarova, Natalia L. %K Life Expectancy %K Mortality %K Poverty %K Socioeconomic factors %X Recent studies have examined the risk of poverty throughout the life course, but few have considered how transitioning in and out of poverty shape the dynamic heterogeneity and mortality disparities of a cohort at each age. Here we use state-by-age modeling to capture individual heterogeneity in crossing one of three different poverty thresholds (defined as 1×, 2× or 3× the "official" poverty threshold) at each age. We examine age-specific state structure, the remaining life expectancy, its variance, and cohort simulations for those above and below each threshold. Survival and transitioning probabilities are statistically estimated by regression analyses of data from the Health and Retirement Survey RAND data-set, and the National Longitudinal Survey of Youth. Using the results of these regression analyses, we parameterize discrete state, discrete age matrix models. We found that individuals above all three thresholds have higher annual survival than those in poverty, especially for mid-ages to about age 80. The advantage is greatest when we classify individuals based on 1× the "official" poverty threshold. The greatest discrepancy in average remaining life expectancy and its variance between those above and in poverty occurs at mid-ages for all three thresholds. And fewer individuals are in poverty between ages 40-60 for all three thresholds. Our findings are consistent with results based on other data sets, but also suggest that dynamic heterogeneity in poverty and the transience of the poverty state is associated with income-related mortality disparities (less transience, especially of those above poverty, more disparities). This paper applies the approach of age-by-stage matrix models to human demography and individual poverty dynamics. In so doing we extend the literature on individual poverty dynamics across the life course. %B PLOS ONE %V 13 %P e0195734 %8 Apr-05-2019 %G eng %U http://dx.doi.org/10.1371/journal.pone.0195734 %N 5 %! PLoS ONE %R 10.1371/journal.pone.0195734 %0 Journal Article %J The B.E. Journal of Economic Analysis & Policy %D 2018 %T Widowhood and Retirement Timing: Evidence from the Health and Retirement Study %A Schreiber, Philipp %K Life Expectancy %K Retirement Age %K Social Security %K Widowhood %X The combination of an increasing life expectancy, low fertility rates, and an early effective retirement age creates a pressure to act for governments and organizations. The pay-as-you-go social security systems of many countries are troubled by the increasing ratio of retirees to working people. In addition, many organizations face difficulties caused by a shrinking workforce and the accompanied shortage of skilled workers. To counteract, it is essential to create an environment in which older workers are encouraged to stay in the workforce. Therefore, it is important to understand which factors influence the retirement timing decision of workers. This study analyzes how widowhood and changes in demographic, health-related, and financial factors lead to changes in retirement plans of Health and Retirement Study (HRS) respondents. I compare respondents' actual retirement age with their retirement plans elicited in the HRS wave prior to retirement. The strongest change in retirement timing is caused by widowhood. Respondents who become widowed retire on average 1.7 years earlier than previously planned. The estimated effect of widowhood goes beyond the deterioration of physical health and mental health. My findings suggest that an intervention in an early stage after widowhood by the employer or by health and social care services can help the widowed employee to overcome the temporary adverse effects of widowhood and to prevent a precipitous retirement decision. %B The B.E. Journal of Economic Analysis & Policy %V 18 %8 Sep-06-2019 %G eng %U https://search.proquest.com/docview/2091249748/ED9FE239DE41490BPQ?accountid=14667 %N 3 %R 10.1515/bejeap-2017-0178 %0 Journal Article %J The Journals of Gerontology Series A: Biological Sciences and Medical Sciences %D 2017 %T Genome-wide Association Study of Parental Life Span %A Toshiko Tanaka %A Ambarish Dutta %A Luke C. Pilling %A Xue, Luting %A Kathryn L. Lunetta %A Joanne M Murabito %A Bandinelli, Stefania %A Robert B. Wallace %A David Melzer %A Luigi Ferrucci %K Genome %K Genome-Wide Association Study %K Life Expectancy %K Longevity %K Older Adults %K Parents %X BACKGROUND: Having longer lived parents has been shown to be an important predictor of health trajectories and life span. As such, parental life span is an important phenotype that may uncover genes that affect longevity. METHODS: A genome-wide association study of parental life span in participants of European and African ancestry from the Health and Retirement Study was conducted. RESULTS: A genome-wide significant association was observed for rs35715456 (log10BF = 6.3) on chromosome 18 for the dichotomous trait of having at least one long-lived parent versus not having any long-lived parent. This association was not replicated in an independent sample from the InCHIANTI and Framingham Heart Study. The most significant association among single nucleotide polymorphisms in longevity candidate genes (APOE, MINIPP1, FOXO3, EBF1, CAMKIV, and OTOL1) was observed in the EBF1 gene region (rs17056207, p = .0002). CONCLUSIONS: A promising genetic signal for parental life span was identified but was not replicated in independent samples. %B The Journals of Gerontology Series A: Biological Sciences and Medical Sciences %V 72 %P 1407-1410 %8 10/2017 %G eng %U http://biomedgerontology.oxfordjournals.org/lookup/doi/10.1093/gerona/glw206https://academic.oup.com/biomedgerontology/article/2422264/Genomewide-Association-Study-of-Parental-Life-Span %N 10 %! GERONA %R 10.1093/gerona/glw206 %0 Journal Article %J The Geneva Papers on Risk and Insurance - Issues and Practice %D 2017 %T How the growing gap in life expectancy may affect retirement benefits and reforms %A Auerbach, Alan %A Kerwin K. Charles %A Courtney Coile %A William G. Gale %A Dana Goldman %A Lee, Ronald %A Lucas, Charles %A Orszag, Peter R. %A Sheiner, Louise %A Tysinger, Bryan %A Weil, David %A Wolfers, Justin %A R. Wong %K Life Expectancy %K Mortality %K Retirement Planning and Satisfaction %K Social Security %B The Geneva Papers on Risk and Insurance - Issues and Practice %V 42 %P 475-499 %8 Jan-07-2017 %G eng %U http://link.springer.com/10.1057/s41288-017-0057-0http://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdfhttp://link.springer.com/article/10.1057/s41288-017-0057-0/fulltext.htmlhttp://link.springer.com/content/pdf/10.1057/s41288-017-0057-0.pdf %N 3 %! Geneva Pap Risk Insur Issues Pract %R 10.1057/s41288-017-0057-0 %0 Report %D 2017 %T How the Growing Gap in Life Expectancy May Affect Retirement Benefits and Reforms %A Auerbach, Alan %A Kerwin K. Charles %A Courtney Coile %A William G. Gale %A Dana Goldman %A Lee, Ronald %A Lucas, Charles %A Orszag, Peter R. %A Sheiner, Louise %A Tysinger, Bryan %A Weil, David %A Wolfers, Justin %A R. Wong %K Life Expectancy %K Mortality %K Retirement benefits %X Older Americans have experienced dramatic gains in life expectancy in recent decades, but an emerging literature reveals that these gains are accumulating mostly to those at the top of the income distribution. We explore how growing inequality in life expectancy affects lifetime benefits from Social Security, Medicare, and other programs and how this phenomenon interacts with possible program reforms. We first project that life expectancy at age 50 for males in the two highest income quintiles will rise by 7 to 8 years between the 1930 and 1960 birth cohorts, but that the two lowest income quintiles will experience little to no increase over that time period. This divergence in life expectancy will cause the gap between average lifetime program benefits received by men in the highest and lowest quintiles to widen by $130,000 (in $2009) over this period. Finally we simulate the effect of Social Security reforms such as raising the normal retirement age and changing the benefit formula to see whether they mitigate or enhance the reduced progressivity resulting from the widening gap in life expectancy. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %8 04/2017 %G eng %U http://www.nber.org/papers/w23329.pdf %R 10.3386/w23329 %0 Journal Article %J Health Affairs %D 2017 %T The population health benefits of a healthy lifestyle: Life expectancy increased and onset of disability delayed. %A Mehta, Neil K. %A Mikko Myrskyla %K Disabilities %K Life Expectancy %K Mortality %K Population Health %X A key determinant of population health is the behavioral profile of a population. Nearly 80 percent of Americans reach their fifties having smoked cigarettes, been obese, or both. It is unknown to what extent risky behaviors (for example, smoking, having a poor diet, being physically inactive, and consuming an excessive amount of alcohol) collectively are reducing the health and life expectancy of the US population, or what improvements might be achievable in their absence. Using data from the Health and Retirement Study, we studied people ages fifty and older who had never smoked, who were not obese, and who consumed alcohol moderately. Compared to the whole US population, those with such a favorable behavioral profile had a life expectancy at age fifty that was seven years longer, and they experienced a delay in the onset of disability of up to six years. These results provide a benchmark for evaluating the massively damaging effects that behavioral risks have on health at older ages and the importance of prioritizing policies to implement behavioral-based interventions. %B Health Affairs %V 36 %P 1495-1502 %G eng %N 8 %1 http://www.ncbi.nlm.nih.gov/pubmed/28724530?dopt=Abstract %R 10.1377/hlthaff.2016.1569 %0 Journal Article %J J Epidemiol Community Health %D 2016 %T Association of retirement age with mortality: a population-based longitudinal study among older adults in the USA. %A Wu, Chenkai %A Odden, Michelle C %A Fisher, Gwenith G %A Stawski, Robert S %K Adult %K Aged %K Female %K Health Status %K Humans %K Life Expectancy %K Life Style %K Longitudinal Studies %K Male %K Middle Aged %K Mortality, Premature %K Retirement %K Risk Factors %K United States %X
BACKGROUND: Retirement is an important transitional process in later life. Despite a large body of research examining the impacts of health on retirement, questions still remain regarding the association of retirement age with survival. We aimed to examine the association between retirement age and mortality among healthy and unhealthy retirees and to investigate whether sociodemographic factors modified this association.
METHODS: On the basis of the Health and Retirement Study, 2956 participants who were working at baseline (1992) and completely retired during the follow-up period from 1992 to 2010 were included. Healthy retirees (n=1934) were defined as individuals who self-reported health was not an important reason to retire. The association of retirement age with all-cause mortality was analysed using the Cox model. Sociodemographic effect modifiers of the relation were examined.
RESULTS: Over the study period, 234 healthy and 262 unhealthy retirees died. Among healthy retirees, a 1-year older age at retirement was associated with an 11% lower risk of all-cause mortality (95% CI 8% to 15%), independent of a wide range of sociodemographic, lifestyle and health confounders. Similarly, unhealthy retirees (n=1022) had a lower all-cause mortality risk when retiring later (HR 0.91, 95% CI 0.88 to 0.94). None of the sociodemographic factors were found to modify the association of retirement age with all-cause mortality.
CONCLUSIONS: Early retirement may be a risk factor for mortality and prolonged working life may provide survival benefits among US adults.%B J Epidemiol Community Health %V 70 %P 917-23 %8 2016 Sep %G eng %U http://jech.bmj.com/content/early/2016/03/21/jech-2015-207097.abstract %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/27001669?dopt=Abstract %$ 999999 %R 10.1136/jech-2015-207097 %0 Journal Article %J SSM - Population Health %D 2016 %T Change in cognitively healthy and cognitively impaired life expectancy in the United States: 2000–2010 %A Eileen M. Crimmins %A Saito, Yasuhiko %A Jung Ki Kim %K CIND %K Life Expectancy %K Longevity %K Older Adults %X OBJECTIVE: To determine how cognitively healthy and cognitively impaired life expectancy have changed from 2000 to 2010 among American men and women 65 years of age and over. METHODS: The prevalence of dementia, cognitive impairment without dementia (CIND), and normal cognition is determined from the nationally representative data from the U.S. Health and Retirement Study (HRS). Mortality rates are from U.S. Decennial Life Table for 2000 and the U.S. annual life table for 2010. Life expectancy by cognitive status is estimated using the Sullivan method. RESULTS: Most of the increase in life expectancy has been concentrated in cognitively healthy years in this 10 year period. The increase in expected years cognitively intact at age 65, which exceeded that in total life expectancy, was 1.8 for men and 1.6 for women. CONCLUSION: This study provides evidence suggesting that there has been a compression of cognitive morbidity. %B SSM - Population Health %V 2 %P 793 - 797 %8 Jan-12-2016 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S2352827316301148http://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/plainhttp://api.elsevier.com/content/article/PII:S2352827316301148?httpAccept=text/xml %! SSM - Population Health %R 10.1016/j.ssmph.2016.10.007 %0 Journal Article %J Journal of Aging & Health %D 2016 %T A Comparison of Educational Differences on Physical Health, Mortality, and Healthy Life Expectancy in Japan and the United States. %A Chi-Tsun Chiu %A Mark D. Hayward %A Saito, Yasuhiko %K Cross-National %K Education %K Health Conditions and Status %K Life Expectancy %K Mortality %K Older Adults %X
OBJECTIVE: This study examined the educational gradient of health and mortality between two long-lived populations: Japan and the United States.
METHOD: This analysis is based on the Nihon University Japanese Longitudinal Study of Aging and the Health and Retirement Study to compare educational gradients in multiple aspects of population health-life expectancy with/without disability, functional limitations, or chronic diseases, using prevalence-based Sullivan life tables.
RESULTS: Our results show that education coefficients from physical health and mortality models are similar for both Japan and American populations, and older Japanese have better mortality and health profiles.
DISCUSSION: Japan's compulsory national health service system since April 1961 and living arrangements with adult children may play an important role for its superior health profile compared with that of the United States.%B Journal of Aging & Health %V 28 %P 1256-78 %8 2016 Oct %G eng %N 7 %R 10.1177/0898264316656505 %0 Journal Article %J The lancet. Diabetes & endocrinology %D 2016 %T Compression of disability between two birth cohorts of US adults with diabetes, 1992-2012: a prospective longitudinal analysis. %A Barbara H. Bardenheier %A Ji Lin %A Zhuo, Xiaohui %A Mohammed K. Ali %A Theodore J. Thompson %A Yiling J. Cheng %A Edward W. Gregg %K Diabetes %K Disabilities %K Life Expectancy %K Mortality %X
BACKGROUND: The life expectancy of the average American with diabetes has increased, but the quality of health and functioning during those extra years are unknown. We aimed to investigate the net effect of recent trends in diabetes incidence, disability, and mortality on the average age of disability onset and the number of healthy and disabled years lived by adults with and without diabetes in the USA. We assessed whether disability expanded or was compressed in the population with diabetes and compared the findings with those for the population without diabetes in two consecutive US birth cohorts aged 50-70 years.
METHODS: In this prospective longitudinal analysis, we analysed data for two cohorts of US adults aged 50-70 years from the Health and Retirement Study, including 1367 people with diabetes and 11 414 without diabetes. We assessed incident disability, remission from disability, and mortality between population-based cohort 1 (born 1931-41, follow-up 1992-2002) and cohort 2 (born 1942-47, follow up 2002-12). Disability was defined by mobility loss, difficulty with one or more instrumental activities of daily living, and difficulty with one or more activities of daily living. We entered age-specific probabilities representing the two birth cohorts into a five-state Markov model to estimate the number of years of disabled and disability-free life and life-years lost by age 70 years.
FINDINGS: In people with diabetes, compared with cohort 1 (n=1067), cohort 2 (n=300) had more disability-free and total years of life, later onset of disability, and fewer disabled years. Simulations of the Markov models suggest that in men with diabetes aged 50 years, this difference between cohorts amounted to a 0·8-2·3 year delay in disability across the three metrics (mobility, 63·0 [95% CI 62·3-63·6] to 64·8 [63·6-65·7], p=0·01; instrumental activities of daily living, 63·5 [63·0-64·0] to 64·3 [63·0-65·3], p=0·24; activities of daily living, 62·7 [62·1-63·3] to 65·0 [63·5-65·9], p<0·0001) and 1·3 fewer life-years lost (ie, fewer remaining life-years up to age 70 years; from 2·8 [2·5-3·2] to 1·5 [1·3-1·9]; p<0·0001 for all three measures of disability). Among women with diabetes aged 50 years, this difference between cohorts amounted to a 1·1-2·3 year delay in disability across the three metrics (mobility, 61·3 [95% CI 60·5-62·1] to 63·2 [61·5-64·5], p=0·0416; instrumental activities of daily living, 63·0 [62·4-63·7] to 64·1 [62·7-65·2], p=0·16; activities of daily living, 62·3 [61·6-63·0] to 64·6 [63·1-65·6], p<0·0001) and 0·8 fewer life-years lost by age 70 years (1·9 [1·7-2·2] to 1·1 [0·9-1·5]; p<0·0001 for all three measures of disability). Parallel improvements were gained between cohorts of adults without diabetes (cohort 1, n=8687; cohort 2, n=2727); within both cohorts, those without diabetes had significantly more disability-free years than those with diabetes (p<0·0001 for all comparisons).
INTERPRETATION: Irrespective of diabetes status, US adults saw a compression of disability and gains in disability-free life-years. The decrease in disability onset due to primary prevention of diabetes could play an important part in achieving longer disability-free life-years.
FUNDING: US Department of Health & Human Services and the US Centers for Disease Control and Prevention.%B The lancet. Diabetes & endocrinology %V 4 %P 686-694 %8 2016 Aug %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27298181 %N 8 %R 10.1016/S2213-8587(16)30090-0 %0 Journal Article %J J Gerontol A Biol Sci Med Sci %D 2016 %T Life Expectancy With and Without Pain in the U.S. Elderly Population. %A Zimmer, Zachary %A Rubin, Sara %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Aging %K Disabled Persons %K Female %K Health Status Indicators %K Humans %K Incidence %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K pain %K Quality of Life %K Risk Factors %K Surveys and Questionnaires %K United States %X
BACKGROUND: This study contributes to dialogue on quality versus quantity of life by examining years older persons can expect to live in various states of pain.
METHODS: Data from seven waves of the Health and Retirement Study; N = 26,896; age 55+. Estimations using the Interpolative Markov Chain approach apply probability transitions to multistate life table functions. Two estimates are interpreted: (i) population-based, which provide population averages aggregated across baseline states and (ii) status-based, which provide independent estimates by baseline state. Age- and sex-specific years with no pain, milder nonlimiting, and severe or limiting pain are reported as is percent of life in states of pain.
RESULTS: Females have higher life expectancy than males but similar expectations of pain-free life. Total life expectancy varies only slightly by baseline pain states but pain-free life expectancy varies greatly. For example, an 85-year-old female pain-free at baseline expects 7.04 more years, 5.28 being pain-free. An 85-year-old female with severe pain at baseline expects 6.42 years with only 2.66 pain-free. Percent of life with pain decreases by age for those pain-free at baseline and increases for those with pain at baseline.
CONCLUSION: Pain is moderately associated with quantity of or total life but substantially and importantly associated with quality of or pain-free life.%B J Gerontol A Biol Sci Med Sci %V 71 %P 1171-6 %8 2016 09 %G eng %U http://biomedgerontology.oxfordjournals.org/content/early/2016/03/17/gerona.glw028.abstract %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/26988661?dopt=Abstract %4 Aging/Longevity/Demography/Health and Retirement Survey/Multistate life tables/Interpolative Markov Chains/Quality of life %$ 999999 %R 10.1093/gerona/glw028 %0 Newspaper Article %B The New York Times %D 2016 %T Life Spans of the Rich Leave the Poor Behind %A Tavernise, Sabrina %K Income %K Life Expectancy %K Older Adults %K Wage gap %B The New York Times %7 February 13, 2016 %G eng %U http://www.nytimes.com/2016/02/13/health/disparity-in-life-spans-of-the-rich-and-the-poor-is-growing.html %! Disparity in Life Spans of the Rich and the Poor Is Growing %& A %0 Journal Article %J BMJ %D 2016 %T Management of diabetes mellitus in older people with comorbidities. %A Huang, Elbert S %K Diabetes %K Hospitalization %K Life Expectancy %K Older Adults %X
Diabetes mellitus is a chronic disease of aging that affects more than 20% of people over 65. In older patients with diabetes, comorbidities are highly prevalent and their presence may alter the relative importance, effectiveness, and safety of treatments for diabetes. Randomized controlled trials have shown that intensive glucose control produces microvascular and cardiovascular benefits but typically after extended treatment periods (five to nine years) and with exposure to short term risks such as mortality (in one trial) and hypoglycemia. Decision analysis, health economics, and observational studies have helped to illustrate the importance of acknowledging life expectancy, hypoglycemia, and treatment burden when setting goals in diabetes. Guidelines recommend that physicians individualize the intensity of glucose control and treatments on the basis of the prognosis (for example, three tiers based on comorbidities and functional impairments) and preferences of individual patients. Very few studies have attempted to formally implement and study these concepts in clinical practice. To better meet the treatment needs of older patients with diabetes and comorbidities, more research is needed to determine the risks and benefits of intensifying, maintaining, or de-intensifying treatments in this population. This research effort should extend to the development and study of decision support tools as well as targeted care management.%B BMJ %V 353 %P i2200 %8 2016 %G eng %U https://www.ncbi.nlm.nih.gov/pubmed/27307175 %R 10.1136/bmj.i2200 %0 Report %D 2016 %T Mortality Inequality: The Good News from a County-Level Approach %A Currie, Janet %A Schwandt, Hannes %K Childhood adversity %K Life Expectancy %K Mortality %K Socioeconomic factors %X Analysts who have concluded that inequality in life expectancy is increasing have generally focused on life expectancy at age 40 to 50. However, we show that among infants, children, and young adults, mortality has been falling more quickly in poorer areas with the result that inequality in mortality has fallen substantially over time. This is an important result given the growing literature showing that good health in childhood predicts better health in adulthood and suggests that today's children are likely to face considerably less inequality in mortality as they age than current adults. We also show that there have been stunning declines in mortality rates for African-Americans between 1990 and 2010, especially for black men. The fact that inequality in mortality has been moving in opposite directions for the young and the old, as well as for some segments of the African-American and non-African-American populations argues against a single driver of trends in mortality inequality, such as rising income inequality. Rather, there are likely to be multiple specific causes affecting different segments of the population. %I National Bureau of Economic Research %C Cambridge, MA %P 1-54 %8 04/2016 %G eng %U http://www.nber.org/papers/w22199.pdf %R 10.3386/w22199 %0 Report %D 2016 %T The Rise in Life Expectancy, Health Trends among the Elderly, and the Demand for Care - A Selected Literature Review %A Lindgren, Bjorn %K Caregiving %K Health Trajectories %K Life Expectancy %K Literature Review %K Meta-analyses %K Older Adults %X The objective is to review the evidence on (a) ageing and health and (b) the demand for health- and social services among the elderly. Issues are: does health status of the elderly improve over time, and how do the trends in health status of the elderly affect the demand for health- and elderly care? It is not a complete review, but it covers most of recent empirical studies. %B NBER Working Paper Series %I National Bureau of Economic Research %C Cambridge, MA %P 1-31 %8 08/2016 %G eng %U http://www.nber.org/papers/w22521.pdf %R 10.3386/w22521 %0 Journal Article %J Journal of the American Geriatrics Society %D 2016 %T Skin Cancer in U.S. Elderly Adults: Does Life Expectancy Play a Role in Treatment Decisions? %A Linos, Eleni %A Chren, Mary-Margaret %A Irena Cenzer %A Kenneth E. Covinsky %K Cancer screenings %K Life Expectancy %K Medicare/Medicaid/Health Insurance %K Older Adults %X
OBJECTIVES: To examine whether life expectancy influences treatment pattern of nonmelanoma skin cancer, or keratinocyte carcinoma (KC), the most common malignancy and the fifth most costly cancer to Medicare.
DESIGN: Nationally representative cross-sectional study.
SETTING: Nationally representative Health and Retirement Study linked to Medicare claims.
PARTICIPANTS: Treatments (N = 9,653) from individuals aged 65 and older treated for basal or squamous cell carcinoma between 1992 and 2012 (N = 2,702) were included.
MEASUREMENTS: Limited life expectancy defined according to aged 85 and older, medical comorbidities, Charlson Comorbidity Index score of 3 or greater, difficulty in at least one activity of daily living (ADL), and a Lee index of 13 or greater. Treatment type (Mohs micrographic surgery (MMS) (most intensive, highest cost), excision, or electrodesiccation and curettage (ED&C) (least intensive, lowest cost)), according to procedure code.
RESULTS: Most KCs (61%) were treated surgically. Rates of MMS (19%), excision (42%), and ED&C (39%) were no different in participants with limited life expectancy and those with normal life expectancy. For example, 19% of participants with difficulty or dependence in ADLs, 20% of those with a Charlson comorbidity score greater than 3, and 15% of those in their last year of life underwent MMS; participants who died within 1 year of diagnosis were treated in the same way as those who lived longer.
CONCLUSION: A one-size-fits-all approach in which advanced age, health status, functional status, and prognosis are not associated with intensiveness of treatment appears to guide treatment for KC, a generally nonfatal condition. Although intensive treatment of skin cancer when it causes symptoms may be indicated regardless of life expectancy, persons with limited life expectancy should be given choices to ensure that the treatment matches their goals and preferences.%B Journal of the American Geriatrics Society %V 64 %P 1610-1615 %8 2016 Jun 15 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/27303932 %N 8 %R 10.1111/jgs.14202 %0 Thesis %B Economics %D 2016 %T Three essays in life-cycle labor supply and human capital formation %A Han, Joseph %K Annuitization %K Employment and Labor Force %K Life Expectancy %K Older Adults %K Retirement Planning and Satisfaction %X This dissertation consists of three independent essays on earnings dynamics, educational production function, and retirement. Each chapter explains labor supply and human capital formation from a life-cycle perspective. In the first chapter, I investigate how two different kinds of uncertainty jointly affect young workers' decisions. This paper introduces the possibility of multidimensional learning about worker ability and job match quality into a model of work decisions. This mechanism has a unique prediction, negative sorting into job mobility that fades away over time, which is verified in the NLSY79 data if the AFQT score carries over some information unused by workers and employers. I estimate the structural model, which also has flexible skill accumulation, by indirect inference. From simulation results on earnings dynamics, I find that the contribution of job shopping to average earnings growth is higher than previous estimates; also, individual heterogeneity in earnings growth is mostly explained by the process of resolving uncertainties. In the second chapter, which is joint work with Keunkwan Ryu, we estimate the effects of high school class size on college entrance exam scores, using Korean administrative data. For the identification, we exploit quasi-experimental variation in class size arising from distinct institutional settings in Korea: especially, students are separately educated by major from grade 11 with different class sizes between majors. By using multi-level differencing and instrumental variable techniques, we find the effects of high school class size reduction on the test scores are positive but small. In the third chapter, I examine the effects of life expectancy on retirement and related decisions. I construct a structural model which has a realistic description of complicated dynamic incentives facing the elderly, including Social Security. Furthermore, individual heterogeneity in survival beliefs are flexibly modeled, directly using subjective survival probabilities in the Health and Retirement Study (HRS) data. The estimated model suggests that many people in the data believed their wealth was over-annuitized; they would have chosen to work and save less if their average life expectancy had increased. This result partially explains the early retirement puzzle in the last century. %B Economics %I The University of Wisconsin - Madison %C Madison %V Ph.D. %P 137 %@ 9781339835891 %G eng %U http://proxy.lib.umich.edu/login?url=http://search.proquest.com/docview/1796375588?accountid=14667 %9 Dissertation %0 Newspaper Article %B The Washington Post %D 2016 %T U.S. life expectancy declines for the first time since 1993 %A Lenny Bernstein %K Life Expectancy %K Meta-analyses %K Older Adults %B The Washington Post %C Washington, D.C. %8 12/08/2016 %G eng %U https://www.washingtonpost.com/national/health-science/us-life-expectancy-declines-for-the-first-time-since-1993/2016/12/07/7dcdc7b4-bc93-11e6-91ee-1adddfe36cbe_story.html %0 Journal Article %J The Lancet %D 2016 %T The World report on ageing and health: a policy framework for healthy ageing %A Beard, John R %A Officer, Alana %A de Carvalho, Islene Araujo %A Sadana, Ritu %A Pot, Anne Margriet %A Michel, Jean-Pierre %A Lloyd-Sherlock, Peter %A Epping-Jordan, JoAnne E %A G. M. E. E. Peeters %A Mahanani, Wahyu Retno %A Thiyagarajan, Jotheeswaran Amuthavalli %A Chatterji, Somnath %K Aging %K Life Expectancy %K Mortality %K Older Adults %X Although populations around the world are rapidly ageing, evidence that increasing longevity is being accompanied by an extended period of good health is scarce. A coherent and focused public health response that spans multiple sectors and stakeholders is urgently needed. To guide this global response, WHO has released the first World report on ageing and health, reviewing current knowledge and gaps and providing a public health framework for action. The report is built around a redefinition of healthy ageing that centres on the notion of functional ability: the combination of the intrinsic capacity of the individual, relevant environmental characteristics, and the interactions between the individual and these characteristics. This Health Policy highlights key findings and recommendations from the report. %B The Lancet %V 387 %P 2145 - 2154 %8 Jan-05-2016 %G eng %U http://linkinghub.elsevier.com/retrieve/pii/S0140673615005164http://api.elsevier.com/content/article/PII:S0140673615005164?httpAccept=text/xmlhttp://api.elsevier.com/content/article/PII:S0140673615005164?httpAccept=text/plain %N 10033 %! The Lancet %R 10.1016/S0140-6736(15)00516-4 %0 Journal Article %J JAMA %D 2013 %T Predicting 10-year mortality for older adults. %A Cruz, Marisa %A Covinsky, Kenneth %A Widera, Eric W %A Stijacic-Cenzer, Irena %A Lee, Sei J %K Aged %K Aged, 80 and over %K Cohort Studies %K Female %K Forecasting %K Humans %K Kaplan-Meier Estimate %K Life Expectancy %K Male %K Middle Aged %K Mortality %K Risk Assessment %K United States %B JAMA %I 309 %V 309 %P 874-6 %8 2013 Mar 06 %G eng %N 9 %1 http://www.ncbi.nlm.nih.gov/pubmed/23462780?dopt=Abstract %2 PMC3760279 %4 mortality/cancer screening/Diabetes/glycemic control/glycemic control/preventive interventions %$ 69310 %R 10.1001/jama.2013.1184 %0 Journal Article %J Demography %D 2012 %T The significance of education for mortality compression in the United States. %A Brown, Dustin C %A Hayward, Mark D %A Montez, Jennifer Karas %A Hummer, Robert A %A Chiu, Chi-Tsun %A Hidajat, Mira M %K Aged %K Aged, 80 and over %K Aging %K Educational Status %K Female %K Health Status Disparities %K Humans %K Life Expectancy %K Male %K Middle Aged %K Mortality %K Mortality, Premature %K Sex Distribution %K Socioeconomic factors %K United States %X
Recent studies of old-age mortality trends assess whether longevity improvements over time are linked to increasing compression of mortality at advanced ages. The historical backdrop of these studies is the long-term improvement in a population's socioeconomic resources that fueled longevity gains. We extend this line of inquiry by examining whether socioeconomic differences in longevity within a population are accompanied by old-age mortality compression. Specifically, we document educational differences in longevity and mortality compression for older men and women in the United States. Drawing on the fundamental cause of disease framework, we hypothesize that both longevity and compression increase with higher levels of education and that women with the highest levels of education will exhibit the greatest degree of longevity and compression. Results based on the Health and Retirement Study and the National Health Interview Survey Linked Mortality File confirm a strong educational gradient in both longevity and mortality compression. We also find that mortality is more compressed within educational groups among women than men. The results suggest that educational attainment in the United States maximizes life chances by delaying the biological aging process.%B Demography %I 49 %V 49 %P 819-40 %8 2012 Aug %G eng %U http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?did=2712630621andFmt=7andclientId=17822andRQT=309andVName=PQD %N 3 %1 http://www.ncbi.nlm.nih.gov/pubmed/22556045?dopt=Abstract %2 PMC3500099 %4 Studies/Socioeconomic factors/Mortality/Educational attainment/Gender differences %$ 69502 %R 10.1007/s13524-012-0104-1 %0 Journal Article %J Soc Sci Med %D 2011 %T Differences in health between Americans and Western Europeans: Effects on longevity and public finance. %A Michaud, Pierre-Carl %A Goldman, Dana %A Lakdawalla, Darius %A Gailey, Adam %A Zheng, Yuhui %K Activities of Daily Living %K Adult %K Aged %K Body Mass Index %K Cross-Cultural Comparison %K Disabled Persons %K Europe %K Female %K Health Expenditures %K health policy %K Health Status Disparities %K Health Surveys %K Humans %K Internationality %K Life Expectancy %K Male %K Middle Aged %K Models, Economic %K Models, Statistical %K Mortality %K Public Health %K United States %X
In 1975, 50-year-old Americans could expect to live slightly longer than most of their Western European counterparts. By 2005, American life expectancy had fallen behind that of most Western European countries. We find that this growing longevity gap is primarily due to real declines in the health of near-elderly Americans, relative to their Western European peers. We use a microsimulation approach to project what US longevity would look like, if US health trends approximated those in Western Europe. The model implies that differences in health can explain most of the growing gap in remaining life expectancy. In addition, we quantify the public finance consequences of this deterioration in health. The model predicts that gradually moving American cohorts to the health status enjoyed by Western Europeans could save up to $1.1 trillion in discounted total health expenditures from 2004 to 2050.%B Soc Sci Med %I 73 %V 73 %P 254-63 %8 2011 Jul %G eng %N 2 %1 http://www.ncbi.nlm.nih.gov/pubmed/21719178?dopt=Abstract %2 PMC3383030 %4 disability/disability/mortality/international comparisons/Cross-national/microsimulation/Europe/SHARE/ELSA_/longevity %$ 69616 %R 10.1016/j.socscimed.2011.05.027 %0 Journal Article %J Eur J Epidemiol %D 2011 %T Higher education delays and shortens cognitive impairment: a multistate life table analysis of the US Health and Retirement Study. %A Reuser, Mieke %A Willekens, Frans J %A Bonneux, Luc %K Age Factors %K Aged %K Aged, 80 and over %K Body Mass Index %K Cognition Disorders %K Educational Status %K Female %K Health Surveys %K Humans %K Incidence %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Prevalence %K Proportional Hazards Models %K Retirement %K Sex Factors %K Smoking %K Time Factors %K United States %X
Improved health may extend or shorten the duration of cognitive impairment by postponing incidence or death. We assess the duration of cognitive impairment in the US Health and Retirement Study (1992-2004) by self reported BMI, smoking and levels of education in men and women and three ethnic groups. We define multistate life tables by the transition rates to cognitive impairment, recovery and death and estimate Cox proportional hazard ratios for the studied determinants. 95% confidence intervals are obtained by bootstrapping. 55 year old white men and women expect to live 25.4 and 30.0 years, of which 1.7 [95% confidence intervals 1.5; 1.9] years and 2.7 [2.4; 2.9] years with cognitive impairment. Both black men and women live 3.7 [2.9; 4.5] years longer with cognitive impairment than whites, Hispanic men and women 3.2 [1.9; 4.6] and 5.8 [4.2; 7.5] years. BMI makes no difference. Smoking decreases the duration of cognitive impairment with 0.8 [0.4; 1.3] years by high mortality. Highly educated men and women live longer, but 1.6 years [1.1; 2.2] and 1.9 years [1.6; 2.6] shorter with cognitive impairment than lowly educated men and women. The effect of education is more pronounced among ethnic minorities. Higher life expectancy goes together with a longer period of cognitive impairment, but not for higher levels of education: that extends life in good cognitive health but shortens the period of cognitive impairment. The increased duration of cognitive impairment in minority ethnic groups needs further study, also in Europe.%B Eur J Epidemiol %I 26 %V 26 %P 395-403 %8 2011 May %G eng %N 5 %1 http://www.ncbi.nlm.nih.gov/pubmed/21337033?dopt=Abstract %2 PMC3109265 %4 Cognitive ability/Life tables/Body mass index/Smoking/Educational attainment/Minority groups/ethnic Groups %$ 69390 %R 10.1007/s10654-011-9553-x %0 Journal Article %J Soc Sci Med %D 2011 %T Socioeconomic inequalities in old-age mortality: a comparison of Denmark and the USA. %A Hoffmann, Rasmus %K Aged %K Aged, 80 and over %K Analysis of Variance %K Cross-Cultural Comparison %K Denmark %K Educational Status %K Female %K Health Expenditures %K Humans %K Income %K Life Expectancy %K Male %K Middle Aged %K Mortality %K Political Systems %K Social Class %K Social Welfare %K United States %X
Previous studies have reported important variations in the magnitude of health inequalities between countries that belong to different welfare systems. This suggests that there is scope for reducing health inequalities by means of country-level interventions. The present study adds to this literature by exploring whether the magnitude of socioeconomic inequalities in mortality is associated with social inequality levels. Denmark and the USA belong to fundamentally different welfare systems (social democratic and liberal) and our study thereby contributes to the ongoing debate on whether welfare systems are linked to health inequalities. We analyze Denmark and the USA in terms of socioeconomic differences in mortality above age 58. The data sources were Danish register data from 1980 to 2002 (n = 2,029,324), and survey data from the US Health and Retirement Study (HRS) from 1992 to 2006 (n = 9374). Survival analysis was used to study the impact of socioeconomic status on mortality and the magnitude of mortality differences between the two countries was compared. The results showed surprisingly that mortality differentials were larger in Denmark than in the USA even after controlling for a number of covariates: The poorest 10 percent of the Danish elderly population have a mortality rate ratio of 3.32 (men) and 3.70 (women) compared to the richest 25 percent. In the USA the corresponding rate ratios are 1.67 and 1.56. Low income seems to be a more powerful risk factor for mortality than low education. A number of possible explanations for higher mortality differences in Denmark are discussed: unintended positive correlation between generous health services and health inequality, early life influences, mortality selection, and relative deprivation.%B Soc Sci Med %I 72 %V 72 %P 1986-92 %8 2011 Jun %G eng %N 12 %1 http://www.ncbi.nlm.nih.gov/pubmed/21636194?dopt=Abstract %3 21636194 %4 Socioeconomic factors/Inequality/Mortality/Older people/Cross Cultural Comparison %$ 69360 %R 10.1016/j.socscimed.2011.04.019 %0 Journal Article %J J Econ Perspect %D 2011 %T Who pays for obesity? %A Bhattacharya, Jay %A Sood, Neeraj %K Adult %K Cost of Illness %K Financing, Personal %K Health Benefit Plans, Employee %K Health Care Costs %K health policy %K Humans %K Income %K Insurance Coverage %K Insurance Pools %K Insurance, Health %K Life Expectancy %K Models, Econometric %K Obesity %K Prevalence %K Private Sector %K Public Sector %K Risk Adjustment %K Social Control Policies %K United States %X
Adult obesity is a growing problem. From 1962 to 2006, obesity prevalence nearly tripled to 35.1 percent of adults. The rising prevalence of obesity is not limited to a particular socioeconomic group and is not unique to the United States. Should this widespread obesity epidemic be a cause for alarm? From a personal health perspective, the answer is an emphatic "yes." But when it comes to justifications of public policy for reducing obesity, the analysis becomes more complex. A common starting point is the assertion that those who are obese impose higher health costs on the rest of the population—a statement which is then taken to justify public policy interventions. But the question of who pays for obesity is an empirical one, and it involves analysis of how obese people fare in labor markets and health insurance markets. We will argue that the existing literature on these topics suggests that obese people on average do bear the costs and benefits of their eating and exercise habits. We begin by estimating the lifetime costs of obesity. We then discuss the extent to which private health insurance pools together obese and thin, whether health insurance causes obesity, and whether being fat might actually cause positive externalities for those who are not obese. If public policy to reduce obesity is not justified on the grounds of external costs imposed on others, then the remaining potential justification would need to be on the basis of helping people to address problems of ignorance or self-control that lead to obesity. In the conclusion, we offer a few thoughts about some complexities of such a justification.%B J Econ Perspect %I 25 %V 25 %P 139-58 %8 2011 Winter %G eng %N 1 %1 http://www.ncbi.nlm.nih.gov/pubmed/21598459?dopt=Abstract %3 21598459 %4 Future Elderly Model/obesity/labor force participation/health insurance/public policy/Moral hazard/Public Policy %$ 69614 %R 10.1257/JEP.25.1.139 %0 Journal Article %J Obesity (Silver Spring) %D 2009 %T Smoking kills, obesity disables: a multistate approach of the US Health and Retirement Survey. %A Reuser, Mieke %A Bonneux, Luc G %A Willekens, Frans J %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Body Mass Index %K Disability Evaluation %K Educational Status %K European Continental Ancestry Group %K Female %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Obesity %K Proportional Hazards Models %K Prospective Studies %K Smoking %K United States %X
Increasing BMI causes concerns about the consequences for health care. Decreasing cardiovascular mortality has lowered obesity-related mortality, extending duration of disability. We hypothesized increased duration of disability among overweight and obese individuals. We estimated age-, risk-, and state-dependent probabilities of activities of daily living (ADL) disability and death and calculated multistate life tables, resulting in the comprehensive measure of life years with and without ADL disability. We used prospective data of 16,176 white adults of the Health and Retirement Survey (HRS). Exposures were self-reported BMI and for comparison smoking status and levels of education. Outcomes were years to live with and without ADL disability at age 55. The reference categories were high normal weight (BMI: 23-24.9), nonsmoking and high education. Mild obesity (BMI: 30-34.9) did not change total life expectancy (LE) but exchanged disabled for disability-free years. Mild obesity decreased disability-free LE with 2.7 (95% confidence limits 1.2; 3.2) year but increased LE with disability with 2.0 (0.6; 3.4) years among men. Among women, BMI of 30 to 34.9 decreased disability-free LE with 3.6 (2.1; 5.1) year but increased LE with disability with 3.2 (1.6;4.8) years. Overweight (BMI: 25-29.9) increases LE with disability for women only, by 2.1 (0.8; 3.3) years). Smoking compressed disability by high mortality. Smoking decreased LE with 7.2 years, and LE with disability with 1.3 (0.5; 2.5) years (men) and 1.4 (0.3; 2.6) years (women). A lower education decreased disability-free life, but not duration of ADL disability. In the aging baby boom, higher BMI will further increase care dependence.%B Obesity (Silver Spring) %I 17 %V 17 %P 783-9 %8 2009 Apr %G eng %N 4 %L newpubs20100129 %1 http://www.ncbi.nlm.nih.gov/pubmed/19165165?dopt=Abstract %3 19165165 %4 Obesity/Smoking/Body Mass Index/DISABILITY/DISABILITY/Mortality %$ 21690 %R 10.1038/oby.2008.640 %0 Journal Article %J Eur J Epidemiol %D 2008 %T The burden of mortality of obesity at middle and old age is small. A life table analysis of the US Health and Retirement Survey. %A Reuser, Mieke %A Bonneux, Luc %A Willekens, Frans %K Aged %K Aged, 80 and over %K Body Mass Index %K Educational Status %K Female %K Health Surveys %K Humans %K Life Expectancy %K Life Tables %K Male %K Middle Aged %K Multivariate Analysis %K Obesity %K Proportional Hazards Models %K Smoking %K United States %K Weight Gain %K Weight Loss %X
The evidence of effect of overweight and obesity on mortality at middle and old age is conflicting. The increased relative risk of cardiovascular disease and diabetes for overweight and obese individuals compared to normal weight is well documented, but the absolute risk of cardiovascular death has decreased spectacularly since the 1980s. We estimate the burden of mortality of obesity among middle and old aged adults in the Health and Retirement Survey (HRS), a US prospective longitudinal study. We calculate univariate and multivariate age-specific probabilities and proportional hazard ratios of death in relation to self-reported body mass index (BMI), smoking and education. The life table translates age specific adjusted event rates in survival times, dependent on risk factor distributions (smoking, levels of education and self reported BMI). 95% confidence intervals are calculated by bootstrapping. The highest life expectancy at age 55 was found in overweight (BMI 25-29.9), highly educated non smokers: 30.7 (29.5-31.9) years (men) and 33.2 (32.1-34.3) (women), slightly higher than a BMI 23-24.9 in both sexes. Smoking decreased the population life expectancy with 3.5 (2.7-4.4) years (men) and 1.8 (1.0-2.5) years (women). Less than optimal education cost men and women respectively 2.8 (2.1-3.6) and 2.6 (1.6-3.6) years. Obesity and low normal weight decreased population life expectancy respectively by 0.8 (0.2-1.3) and 0.8 (0.0-1.5) years for men and women in a contemporary, US population. The burden of mortality of obesity is limited, compared to smoking and low education.%B Eur J Epidemiol %I 23 %V 23 %P 601-7 %8 2008 %G eng %N 9 %L newpubs20081014_Reuser_EJEP_2008.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18584293?dopt=Abstract %3 18584293 %4 Mortality/Obesity/Education/Smoking/Life Expectancy %$ 19400 %R 10.1007/s10654-008-9269-8 %0 Journal Article %J J Aging Health %D 2008 %T Educational differentials in life expectancy with cognitive impairment among the elderly in the United States. %A Lièvre, Agnès %A Alley, Dawn %A Crimmins, Eileen M %K Aged %K Aged, 80 and over %K Cognition Disorders %K Educational Status %K Female %K Humans %K Life Expectancy %K Male %K United States %X
OBJECTIVE: This article provides estimates of education differentials in life expectancy with and without cognitive impairment for the noninstitutionalized population aged 70 years and older in the United States.
METHOD: Life expectancy with cognitive impairment was calculated using multistate models, allowing transitions between cognitively intact and cognitively impaired states and from each of these states to death and allowing transition rates to vary across age and education. Four waves of the Assets and Health Dynamics of the Oldest Old survey were used.
RESULTS: Those with low levels of education are more likely to become cognitively impaired and do so at an earlier age. After age 70, persons with low educational levels can expect to live 11.6 years, and persons with high education 14.1 years, without cognitive impairment. Length of life with cognitive impairment differs by education (1.6 years and 1.0 years at age 70, respectively) but differs little by age.
DISCUSSION: Although those with higher education have lower rates of both cognitive impairment and mortality, those who do become cognitively impaired appear to be in poorer health, leading to a reduced probability of improved cognition and increased probability of mortality relative to those with lower educational levels.%B J Aging Health %I 20 %V 20 %P 456-77 %8 2008 Jun %G eng %N 4 %L newpubs20101112_Lievre %1 http://www.ncbi.nlm.nih.gov/pubmed/18448687?dopt=Abstract %2 PMC2966893 %4 cognition Disorders/cognitive Impairment/educational Status/life Expectancy/education/MORTALITY %$ 23790 %R 10.1177/0898264308315857 %0 Journal Article %J Med Decis Making %D 2008 %T End-of-life medical treatment choices: do survival chances and out-of-pocket costs matter? %A Chao, Li-Wei %A Pagán, José A %A Soldo, Beth J %K Aged %K Choice Behavior %K Female %K Financing, Personal %K Health Care Costs %K Humans %K Life Expectancy %K Male %K Medicare %K Neoplasms %K Socioeconomic factors %K Terminal Care %K United States %X
BACKGROUND: Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion.
OBJECTIVES: To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs.
METHODS: Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s.
RESULTS: Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects.
CONCLUSIONS: Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.%B Med Decis Making %I 28 %V 28 %P 511-23 %8 2008 Jul-Aug %G eng %N 4 %L newpubs20090302_Chao_etal.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18441252?dopt=Abstract %2 PMC2587497 %4 Economics of the Elderly/Medical Expenditures/Survival/Survivors/Saving %$ 19770 %R 10.1177/0272989X07312713 %0 Journal Article %J J Health Econ %D 2008 %T Health status and health dynamics in an empirical model of expected longevity. %A Benítez-Silva, Hugo %A Ni, Huan %K Chronic disease %K Delivery of Health Care %K Empirical Research %K Female %K Health Expenditures %K Health Status %K Humans %K Life Expectancy %K Longevity %K Male %K Models, Econometric %X
Expected longevity is an important factor influencing older individuals' decisions such as consumption, savings, purchase of life insurance and annuities, claiming of Social Security benefits, and labor supply. It has also been shown to be a good predictor of actual longevity, which in turn is highly correlated with health status. A relatively new literature on health investments under uncertainty, which builds upon the seminal work by Grossman [Grossman, M., 1972. On the concept of health capital and demand for health. Journal of Political Economy 80, 223-255] has directly linked longevity with characteristics, behaviors, and decisions by utility maximizing agents. Our empirical model can be understood within that theoretical framework as estimating a production function of longevity. Using longitudinal data from the Health and Retirement Study, we directly incorporate health dynamics in explaining the variation in expected longevities, and compare two alternative measures of health dynamics: the self-reported health change, and the computed health change based on self-reports of health status. In 38% of the reports in our sample, computed health changes are inconsistent with the direct report on health changes over time. And another 15% of the sample can suffer from information losses if computed changes are used to assess changes in actual health. These potentially serious problems raise doubts regarding the use and interpretation of the computed health changes and even the lagged measures of self-reported health as controls for health dynamics in a variety of empirical settings. Our empirical results, controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, suggest that self-reported health changes are a preferred measure of health dynamics.%B J Health Econ %I 27 %V 27 %P 564-84 %8 2008 May %G eng %N 3 %L newpubs20080822_JnlHealthEcon %1 http://www.ncbi.nlm.nih.gov/pubmed/18187217?dopt=Abstract %2 PMC2862058 %4 Longevity/PREDICTIVE MODEL/HEALTH %$ 19140 %R 10.1016/j.jhealeco.2007.09.008 %0 Journal Article %J J Women Aging %D 2008 %T Life with and without heart disease among women and men over 50. %A Crimmins, Eileen M %A Hayward, Mark D %A Ueda, Hiroshi %A Saito, Yasuhiko %A Kim, Jung Ki %K Activities of Daily Living %K Aged %K Female %K Health Status %K Heart Diseases %K Humans %K Life Expectancy %K Male %K Middle Aged %K Myocardial Infarction %K Patient Education as Topic %K Prejudice %K Risk Factors %K United States %K Women's Health %K Women's Health Services %X
This article uses a demographic approach and data from the Health and Retirement Survey, a nationally representative sample of the U.S. population, to investigate sex differences in the length of life lived with heart disease and after a heart attack for persons in the United States age 50 and older. On average, women live longer than men with heart disease. At age 50 women can expect to live 7.9 years and men 6.7 years with heart disease. The average woman experiences heart disease onset three years older and heart attacks 4.4 years older than men.%B J Women Aging %I 20 %V 20 %P 5-19 %8 2008 %G eng %U http://sfx.lib.umich.edu:9003/sfx_local?sid=Entrez 3APubMed;id=pmid 3A18581697 %N 1-2 %L newpubs20101112_Crimmins2.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18581697?dopt=Abstract %2 PMC2994551 %4 Activities of Daily Living/health Status/Heart disease/life Expectancy/EDUCATION/risk factors/WOMEN %$ 23780 %0 Journal Article %J Demography %D 2008 %T Using subjective expectations to forecast longevity: do survey respondents know something we don't know? %A Perozek, Maria %K Aged %K Aged, 80 and over %K Aging %K Data collection %K Demography %K Female %K health policy %K Humans %K Life Expectancy %K Life Tables %K Longevity %K Male %K Middle Aged %K Mortality %K Risk Factors %K Sex Factors %K United States %X
Old-age mortality is notoriously difficult to predict because it requires not only an understanding of the process of senescence-which is influenced by genetic, environmental, and behavioral factors-but also a prediction of how these factors will evolve. In this paper I argue that individuals are uniquely qualified to predict their own mortality based on their own genetic background, as well as environmental and behavioral risk factors that are often known only to the individual. Given this private information, individuals form expectations about survival probabilities that may provide additional information to demographers and policymakers in their challenge to predict mortality. From expectations data from the 1992 Health and Retirement Study (HRS), I construct subjective, cohort life tables that are shown to predict the unusual direction of revisions to U.S. life expectancy by gender between 1992 and 2004: that is, for these cohorts, the Social Security Actuary (SSA) raised male life expectancy in 2004 and at the same lowered female life expectancy, narrowing the gender gap in longevity by 25% over this period. Further, although the subjective life expectancies for men appear to be roughly in line with the 2004 life tables, the subjective expectations of women suggest that female life expectancies estimated by the SSA might still be on the high side.%B Demography %I 45 %V 45 %P 95-113 %8 2008 Feb %G eng %N 1 %L newpubs20080229_Perozek.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/18390293?dopt=Abstract %2 PMC2831383 %4 Life Expectancy/Subjective Probabilities of Survival/Mortality/Actuarial Analysis %$ 18710 %R 10.1353/dem.2008.0010 %0 Journal Article %J Soc Sci Med %D 1999 %T The influence of personal care and assistive devices on the measurement of disability. %A Agree, E M %K Activities of Daily Living %K Aged %K Aged, 80 and over %K Disability Evaluation %K Female %K Humans %K Life Expectancy %K Logistic Models %K Long-term Care %K Male %K Self-Help Devices %X
The goal of all long-term care arrangements is to reduce the disabling effects of physical impairments and functional limitations. However, the means with which individuals cope with disability may not be equivalent and these differences may influence self-reports of disability in surveys. This paper examines assistive devices and personal care as factors in the measurement of disability among persons aged 70 and older in the community using the 1994 Survey of Asset and Health Dynamics of the Oldest Old (AHEAD) in the US. The use of assistive technology differs from personal care on a fundamental level. It does not require the ongoing cooperation or coordination of other people and therefore increases the sense of independence with which a disabled individual can meet their long-term care needs. Results indicate that older individuals can expect to spend most of their remaining years in good functional health, but up to two-thirds of disabled years will be spent with unmet ADL needs. Among those who are disabled, those who use only equipment and no personal care report less residual difficulty with mobility than those who use personal assistance (either alone or in combination with equipment) but the use of equipment alone is most effective for those with the least severe limitations.%B Soc Sci Med %I 48 %V 48 %P 427-43 %8 1999 Feb %G eng %U http://www.sciencedirect.com/science/article/pii/S0277953698003694 %N 4 %L pubs_1999_Agree_ESocSciandMed.pdf %1 http://www.ncbi.nlm.nih.gov/pubmed/10075170?dopt=Abstract %R 10.1016/s0277-9536(98)00369-4


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CBSE Class 11 Accountancy Question Paper Set 4 Solved. Students can download the last year board exams question papers using the link below. Free download of examination question papers with solutions. Last 10 year question papers should be practised to get better marks in examinations. 1 Godrej Ltd imported from Germany one machinery for sale in India and another machinery for production purposes. Which will be treated as goods and which as fixed asset? 2 'Charity given through cash' - State its effect on Accounting equation. 3 How is Accounting information useful for 'Investors and
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View Job
Human Resources Business Partner
Stericycle | Orlando FL 32899 USA | Part Time | Posted: 12/13/2019
Job Descriptiontop
Position Description:
Develop strong working relationships and establish appropriate communication channels while providing proactive human resources management support in relation to overall operational objectives. This position will be responsible for managing various HR projects, in addition to assisting with the direct HR tasks and employee relations issues, escalating more complex issues to HR Director. May be responsible for an assigned territory or division, working directly with the business leaders and HRDs as a strategic partner providing strong leadership to the organization.
Key Job Activities:
**Fluently bilungual in written and spoken Spanish is a must. Position will support Puerto Rico.**
Interpret and assists in developing human resources policies and procedures for consistency, compliance and efficiency.
Leads talent management initiatives, including employee reviews and performance based compensation adjustments. Advises and coaches employees and managers on development of performance related issues. Drives Annual Goal Setting and Performance Management Process, Succession Planning, 9 Box Model, and related talent management activities.
Supports communications of HR and business initiatives including benefit plans and plan changes, legal requirements, staffing, and compensation, as appropriate.
Collaborates with managers and employees to resolve employee relations issues; investigates and guides to wise decisions, prepares/helps prepare corrective actions, facilitates involuntary terminations. Monitors employee relations throughout assigned area for development or in analyzing actual trends, issues and problems, and assists local management with addressing issues.
Investigates and resolves external and internal charges/complaints of discrimination or harassment, recommends corrective action, if appropriate. Prepares position statement and response package for external agency charges.
Facilitate various trainings such as Leadership Academy and other compliance or developmental related trainings. Confers with HR Directors and Sr. Managers to determine training and development needs and assisting in the development of long-range programs accordingly.
Works with Talent Acquisition and Compensation Department in developing job documentation criteria for new and evolving positions.
Assists in the development and facilitation of programs to promote positive employee relations. Provides guidance to management and team members on issues, complaints, or concerns, educating supervisors to routinely audit workplace environment. Keep management informed regarding current issues, regulations, etc.
Analyze data that may include turnover reporting headcount summaries, exit interview data, internal/external market data and makes recommendations to management based upon analysis.
Provides assistance on leave administration and coordination.
May assist in managing the labor relations and contract administration responsibilities including facilitating a partnership with the union bargaining committee, sitting at the table for labor contract negotiations, and administering 2nd and 3rd step grievances (at union facilities).
Performs other related duties as required or requested.
Position Requirements:
Education equivalent to college degree in Human Resources, or the equivalent in related work experience demonstrating sound knowledge of human resources policies and procedures. PHR certification a plus.
Seven or more years of Human Resources Generalist/Management experience required, or the equivalent in related work experience, demonstrating a sound knowledge of state, local and federal labor laws and regulations. Employee Relations experience a must.
Prior experience in working with multiple work locations and union experience a plus, demonstrating the ability to handle sensitive, confidential information on a regular basis.
Demonstrated ability facilitating various trainings.
Demonstrates good knowledge of Microsoft Office including Word, Excel, and PowerPoint.
Demonstrates familiarity with SAP SuccessFactors, ADP HRIS/Payroll system or other HRIS Systems a plus.
Demonstrates the ability to provide technical and work direction to lower level Human Resource Representatives/Generalists.
Fluently bilungual in written and spoken Spanish is a must.
Job Detailstop
|Orlando, FL, 32899, United States
|Human Resources
|Experience Years
|7 yrs
|Pref Degree
Location Maptop
Contact Informationtop
|Contact Name
|How to apply
|Employer provided a link where your application will be accepted. Click on the link below and follow instructions.
|Click Here (apply to job)
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text:
Lord Robert Grosvenor, 1st Baron Ebury1801 - 1893
Name Lord Robert Grosvenor, 1st Baron Ebury Title Lord Suffix 1st Baron Ebury Born 24 Apr 1801 Milbank house, Westminster, London Gender Male Died 18 Nov 1893 Grosvenor Square, London Person ID I5282 Fidgen Last Modified 6 Jun 2014
Father Robert Grosvenor, 1st Marquess Westminster, b. 22 Mar 1767, Eaton Hall, Cheshire , d. 17 Feb 1845, Eaton Hall, Cheshire Mother Eleanor Egerton, b. 19 Jul 1770, Egerton, Kent , d. 29 Nov 1846, Westminster, London Family ID F1996 Group Sheet
Photos Caricature of Lord Ebury Lord Ebury


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Champs-Élysées shooter did not appear to be radicalised - police
Issued on: Modified:
The suspect in a gun attack on the Champs-Élysées that left a policeman dead was long known to the police but had shown "no sign" of radicalisation, Paris Prosecutor François Molins said on Friday.
Molins said that investigators were still working to determine if the man had acted in concert with others.
"Investigations will now focus on determining [whether he had] the benefit of possible accomplices," Molins told the press conference.
He added that the suspect, 39-year-old Karim C., had not been on France's official Fiche S watch list of those being monitored by security services.
The shooter opened fire with an automatic weapon on a police van on the famous Champs-Élysées avenue at around 9pm Paris time on Thursday.
After killing a police officer and injuring his two colleagues just a few hundred metres from the Arc de Triomphe, the gunman was shot dead while trying to flee on foot, according to the police.
A note found near the suspect's body had handwritten messages expressing support for the Islamic State group, Molins said. A statement published by its propaganda agency Amaq also said the attacker was "one of the Islamic State's fighters".
Soon after, police launched a raid on the suspect's home in a middle-class neighbourhood in a suburb east of Paris.
Karim C. had previously served nearly 14 years in prison on three counts of attempted murder, including of police officers, as well as for lesser offences.
"Police unions say there is a problem because the assailant was convicted several times – saying he wanted to attack the police – but was released anyway," he explained.
Neighbours react
Karim Cheurfi, 39, was described as an oddball by his neighbours in the multi-ethnic suburb of Chelles east of Paris, about a 30-minute train ride from the centre of the City of Light.
"Everyone knew him here," said one resident in the quiet area where Cheurfi lived with his mother. "It was someone who had lost all reason, who was psychologically very damaged," said the resident, asking not to be named.
Another local man, Salim, described him as "nuts" and someone never seen at the local mosque, while fellow resident Abdel said Cheurfi had been influenced by his repeated experiences in prison.
"He hated the police and France," 23-year-old Abdel said, yet he found it hard to believe he was linked to the Islamic State group, which claimed the attack a few hours after the shooting on Thursday evening.
Salim, who said he knew Cheurfi's cousin, said the gunman "could hardly use a remote controller for the television. Go on the internet and contact esh (Islamic State)? I can't see it."
After shooting a policeman dead with an automatic weapon and injuring two others on Thursday night, Cheurfi was killed in return fire. A hand-written note praising IS was found near his body.
Plots thwarted
French authorities claim they have thwarted on average one plot every month since December 2015 when a wave of Islamist-inspired violence began.
In January 2015, gunmen targeted the Charlie Hebdo satirical magazine and a Jewish supermarket, which was followed by atrocities around Paris including at the Bataclan concert hall in November of the same year.
In July 2016, a self-radicalised extremist drove a truck through crowds watching fireworks in the southern city of Nice, killing 86.


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Netflix is introducing a long-awaited feature that will make it easier for the Internet video service to track and analyze the viewing habits of people sharing the same $8-per-month account.
The tool coming out Thursday can splinter a single Netflix account into up to five different profiles at no additional charge. The Los Gatos, California, company is hoping its 37.6 million worldwide subscribers will use the profiles feature because it will help Netflix's recommendation system gain a better understanding of the different tastes of viewers using the same account.
The feature initially will only be available on Netflix's own website and several other viewing outlets, including the iPad, iPhone, Apple TV, PlayStation 3, Xbox 360, Apple TV and some smart TV models. It may take up to two weeks before the profiles choice pops up in these options. Profiles should be available on the Wii console before the end of August and on Android devices before the end of the year. Netflix subscribers who use Netflix on Roku's set-top box probably won't be able to use profiles on that device until early next year.
Until now, deciphering the preferences in large households could be tricky because Netflix's system couldn't distinguish between when a 50-year-old dad was watching its Internet video service and when his 10-year-old girl might be viewing under the same account.
"If the kids have been watching a lot of 'Shaun the Sheep,' that doesn't particularly help us help you find the next gritty drama to watch after they have gone to bed," said Neil Hunt, Netflix's chief product officer.
Read more at: Phys.org