Health status of older US workers and nonworkers, National Health Interview Survey, 1997-2011.

This is the final version of the article. Available from the publisher via the DOI in this record.INTRODUCTION: Many US workers are increasingly delaying retirement from work, which may be leading to an increase in chronic disease at the workplace. We examined the association of older adults' health status with their employment/occupation and other characteristics. METHODS: National Health Interview Survey data from 1997 through 2011 were pooled for adults aged 65 or older (n = 83,338; mean age, 74.6 y). Multivariable logistic regression modeling was used to estimate the association of socioeconomic factors and health behaviors with 4 health status measures: 1) self-rated health (fair/poor vs good/very good/excellent); 2) multimorbidity (≤1 vs ≥2 chronic conditions); 3) multiple functional limitations (≤1 vs ≥2); and 4) Health and Activities Limitation Index (HALex) (below vs above 20th percentile). Analyses were stratified by sex and age (young-old vs old-old) where interactions with occupation were significant. RESULTS: Employed older adults had better health outcomes than unemployed older adults. Physically demanding occupations had the lowest risk of poor health outcomes, suggesting a stronger healthy worker effect: service workers were at lowest risk of multiple functional limitations (odds ratio [OR], 0.82; 95% confidence interval [CI], 0.71-0.95); and blue-collar workers were at lowest risk of multimorbidity (OR, 0.84; 95% CI, 0.74-0.97) and multiple functional limitation (OR, 0.84; 95% CI, 0.72-0.98). Hispanics were more likely than non-Hispanic whites to report fair/poor health (OR, 1.62; 95% CI, 1.52-1.73) and lowest HALex quintile (OR, 1.21; 95% CI, 1.13-1.30); however, they were less likely to report multimorbidity (OR, 0.78; 95% CI, 0.73-0.83) or multiple functional limitations (OR, 0.82; 95% CI, 0.77-0.88). CONCLUSION: A strong association exists between employment and health status in older adults beyond what can be explained by socioeconomic factors (eg, education, income) or health behaviors (eg, smoking). Disability accommodations in the workplace could encourage employment among older adults with limitations.Funding sources included the National Institute for Occupational Safety and Health (grant no. R01OH03915), the National Institute on Aging (grant no. F30AG040886), and the European Regional Development Fund and European Social Fund to the European Centre for Environment and Human Health (University of Exeter Medical School)

Health Selection vs. Causation in the Income Gradient: What Can We Learn from Graphical Trends?

Income produces health, and sickness negatively affects earnings. These two factors likely explain the income gradient in health, but each has very different policy implications. In this paper, I examine graphical trends in mortality risk between low-income and higher-income people by age and gender. These trends suggest that forward causality (income affecting health) is more important than reverse causality (health affecting income) in the income-health gradient. However, there is some evidence to suggest that reverse causality plays an important role for younger men

The Social Costs of Childhood Lead Exposure in the Post–Lead Regulation Era

Objective: To estimate the benefits that might be realized if all children in the United States had a blood lead level of less than 1 μg/dL. Design: Data were obtained from published and electronic sources. A Markov model was used to project lifetime earnings, reduced crime costs, improvements in health, and reduced welfare costs using 2 scenarios: (1) maintaining the status quo and (2) reducing the blood lead level of all children to less than 1 μg/dL. Participants: The cohort of US children between birth and age 6 years in 2008, with economic and health outcomes projected for 65 years. Interventions: Increased primary prevention efforts aimed at reducing lead exposure among children and pregnant women. Main Outcome Measures: Societal costs and quality-adjusted life years (QALYs) gained. Results: Reducing blood lead levels to less than 1 μg/dL among all US children between birth and age 6 years would reduce crime and increase on-time high school graduation rates later in life. The net societal benefits arising from these improvements in high school graduation rates and reductions in crime would amount to $50 000 (SD,$14 000) per child annually at a discount rate of 3%. This would result in overall savings of approximately $1.2 trillion (SD,$341 billion) and produce an additional 4.8 million QALYs (SD, 2 million QALYs) for US society as a whole. Conclusion: More aggressive programs aimed at reducing childhood lead exposure may produce large social benefits

Redistribution and Health

In their evocative thought experiment, Woolf et al. demonstrate that reducing racial disparities might result in greater gains in life expectancy than investments in medical technology.1 In calculating reductions in mortality attributable to medical technology, the authors conservatively assumed that medical technology was responsible for 100% of the observed reduction in mortality over the study period. Unfortunately, there is a catch to this assumption that renders it less conservative. Over the 1991–2000 study frame the authors used, increases in the Gini coefficient occurred.2 This suggests that socioeconomic disparities for the overall population (not just African Americans) worsened. If disparities are causing declines in health, they will hide a portion of the observed gains in life expectancy owing to medical technology

Healthier and Wealthier: Decreasing Health Care Costs by Increasing Educational Attainment

In the past, states spent more on K–12 education than on any other budget item. However, in recent years, rising medical costs have changed this pattern; in 2003, health care expenses surpassed education as the largest item in states’ budgets. In fiscal year 2006, Medicaid alone is estimated to account for approximately 22 percent of total state spending, while all health care costs will account for about 32 percent of states’ expenditures (National Governors Association & National Association of State Budget Officers, 2006). These costs keep going up, and absent some drastic change, there is every indication that they will continue to outpace most states’ economic growth (Pew Research Center, 2006)

The body politic: the relationship between stigma and obesity-associated disease

Background: It is commonly believed that the pathophysiology of obesity arises from adiposity. In this paper, I forward a complementary explanation; this pathophysiology arises not from adiposity alone, but also from the psychological stress induced by the social stigma associated with being obese. Methods: In this study, I pursue novel lines of evidence to explore the possibility that obesity associated stigma produces obesity-associated medical conditions. I also entertain alternative hypotheses that might explain the observed relationships. Results: I forward four lines of evidence supporting the hypothesis that psychological stress plays a role in the adiposity-health association. First, body mass index (BMI) is a strong predictor of serological biomarkers of stress. Second, obesity and stress are linked to the same diseases. Third, body norms appear to be strong determinants of morbidity and mortality among obese persons; obese whites and women – the two groups most affected by weight-related stigma in surveys – disproportionately suffer from excess mortality. Finally, statistical models suggest that the desire to lose weight is an important driver of weight-related morbidity when BMI is held constant. Conclusion: Obese persons experience a high degree of stress, and this stress plausibly explains a portion of the BMI-health association. Thus, the obesity epidemic may, in part, be driven by social constructs surrounding body image norms

Consequences in Health Status and Costs

People with more education typically live longer and healthier lives. High school graduates, for example, live about six to nine years longer than high school dropouts. They also are less likely to suffer from illness or disability in a variety of forms. In this chapter I seek to measure these benefits in dollar terms. I focus on the association between educational attainment and (1) reductions in morbidity and mortality and (2) reductions in government spending on health care. I examine these effects using a large, comprehensive health data set, the Medical Expenditure Panel Survey, covering the non-institutionalized civilian population in the United States. On the basis of conservative assumptions, I conclude that each additional high school graduate represents a health-related gain to the government of at least $39,000 in discounted lifetime medical expenditures. Monetized gains in health and longevity amount to an additional$183,000. I also discuss the limitations of this analysis

The Social Costs Of Lead Poisonings

The lead poisoning of children in Flint, Michigan, discussed by David Rosner (May 2016), has created a new awareness of a public health crisis that has never left us because the investment needed to remove lead from pipes in high-risk areas was never made. But what is the cost of inaction

Education and Health

High school graduates live 6–9 years longer than high school dropouts. Those with less education are more likely to die prematurely of cardiovascular disease, cancer, infectious disease, diabetes, lung disease, and injury than those with more education. There is good evidence that the education–health relationship is causal, but the underlying mechanisms have not all been adequately tied together. The health risk factors that are more prevalent among those with lower educational attainment drawing on the public health, economics, endocrinology, sociology, neurosciences, and other literatures are explored