Suicide Rates and Risks Across U.S. Industries: A 29-Year Population-Based Survey.

OBJECTIVE: Suicide rates in the working-age U.S. population have increased by over 40% in the last two decades. Although suicide may be linked with characteristics of workplaces and their industries, few studies have reported industry-level suicide rates. No study has reported suicide rates by industry using nationally representative data. This study estimates suicide risks across industries in the U.S. working population. METHODS: Industry-level estimates of suicide risks require substantial data; we combined 29 years of U.S. suicide data using the National Health Interview Survey (NHIS)-Mortality Linked data from 1986 through 2014, with mortality follow-up through 2015. We conducted survey-weighted Poisson regression analyses to estimate suicide mortality rates and rate ratios across all populations and stratified by gender. All analyses were adjusted first for age, and then for age, employment status, marital status, race/ethnicity, and rurality/urbanicity (demographic-adjusted). Rate ratios compared results for workers in each industry to those for all industries, accounting for the NHIS survey design. RESULTS: A total of 1,943 suicide deaths were recorded. Age-adjusted suicide rates per 100,000 were highest in the furniture, lumber, and wood industry group (29.3), the fabricated metal industry (26.3), and mining (25.8). Demographic-adjusted rates were higher among men than women in most industries. Demographic-adjusted rate ratios were significantly elevated in the furniture, lumber, and wood industries (Rate Ratio, RR = 1.60, 95% confidence interval, CI = 1.18-2.18); chemicals and allied products (RR = 1.49, 95%CI = 1.04-2.13); and construction (RR = 1.21, 95% CI = 1.03-1.41). CONCLUSION: Several industries had significantly high suicide rates. Suicide prevention efforts may be particularly useful for workers in those industries.

Psychological distress is more common in some occupations and increases with job tenure: a thirty-seven year panel study in the United States.

BACKGROUND: Workers in certain occupations may have elevated risks of psychological distress. However, research is limited. For example, researchers often measure distress that may have existed before occupational exposures. We studied occupations and the development of psychological distress using national data from the United States. METHODS: We reviewed relevant research to identify occupations with low and high risks of mental health problems. We confirmed those individual low and high risk occupations using 1981-2017 data from the Panel Study of Income Dynamics (n = 24,789). We measured new cases of distress using the Screening Scale for Psychological Distress (Kessler K6) and compared distress in the low and high risk groups, adjusted for factors associated with occupational selection and non-occupational distress risks. A subset of participants described their jobs (n = 1,484), including factors such as job demands, social support, and control over work. We examined associations of those factors with psychological distress. RESULTS: Workers in high risk occupations had 20% higher adjusted odds of developing distress than those in low risk occupations (odds ratio, OR 1.20, 95% confidence interval, CI 1.13-1.28). Distress increased with time in a high risk occupation: ≥5 years OR 1.38 (CI 1.18-1.62), ≥ 10 years OR 1.46 (CI 1.07-1.99), and ≥ 15 years OR 1.77 (CI 1.08-2.90; p-trend = 0.0145). The most common positive participant descriptions of their jobs indicated social support (34%), sense of accomplishment (17%), and control over work (15%). Participants reporting such descriptions were significantly less likely to have a high risk occupation (OR 0.66, CI 0.46-0.94, p = 0.0195). The most common negative descriptions were excessive job demands (43%), low social support (27%), and lack of control (14%). Participants reporting such descriptions were significantly more likely to have a high risk occupation (OR 1.49, CI 1.03-2.14, p = 0.0331). CONCLUSION: Certain occupations may have high risks of psychological distress, which may be due to characteristics of the occupations rather than employee characteristics, or in addition to them. Results were consistent with theoretical models of psychosocial work environments. Providers of health care and social services should ask patients or clients about work-related distress.

"Eventually I'm gonna need people": Social capital among college students with developmental disability.

BACKGROUND AND AIMS: About 18% of college students have disabilities. Social capital, resources we can tap from relationships, may be particularly valuable for students with disabilities. Yet, disabilities often limit the individual's ability to develop or use social capital. We studied how college students with developmental disabilities understand, develop, and use social capital. METHODS AND PROCEDURES: We conducted in-depth semi-structured Zoom interviews with 10 women with developmental disabilities enrolled at a public university in the southeastern United States early in 2021. We examined the qualitative data with thematic analysis. OUTCOMES AND RESULTS: Participants averaged age 20; 70% reported attention deficit disorder or attention deficit hyperactivity disorder; 90% reported multiple diagnoses. Most participants described COVID-19 pandemic-related isolation and stress, which magnified both the need for relationships and awareness of that need, prompting participants to become proactive in forming and maintaining relationships despite anxiety about them. Themes were: foundational relationships, reciprocity, expanding horizons, a need for new relationships, focus on the future and relationship barriers. CONCLUSIONS AND IMPLICATIONS: Results highlight the importance of social relationships and the resources they provide to students with disabilities, particularly in stressful times. Colleges can help students by connecting them with others and providing strategies for building and maintaining social capital. WHAT THIS PAPER ADDS: College students with developmental disabilities often face challenges developing and maintaining social capital, resources derived from relationships with other people. These resources are key to success in school and after graduation, as students continue into adulthood. We studied how students with developmental disabilities build social capital. The students described their relationships with others and the types of support they contributed to and received from those relationships. We also extended previous research by examining pandemic-related effects, interviewing participants nearly one year into the COVID-19 pandemic. We provide recommendations for further research and ways colleges and universities can encourage social capital development among all students.

Identifying developmental disability in national surveys: Addressing the knowledge gap with special education histories.

BACKGROUND: In the United States nearly 20% of children ages 12-17 have developmental disorders. Some attain population-based developmental milestones after a delay, or increase functioning through special education, medication, technology, or therapy. Others have severe lasting impairments. An indicator identifying those groups in surveys of adults could help shape policies to improve lives. HYPOTHESES: We hypothesized that survey histories of special education could indicate functional status levels. METHODS: Data were from the nationally representative Panel Study of Income Dynamics (1997-2017, n = 2745). With measures of diagnoses, behaviors, functional status, service use, and adult outcomes, we tested three special education groups as indicators of: (1) no impairment (no special education), (2) disorders, developmental diagnoses that adversely affect educational performance, but with development after a period of delay or only moderate disability, indicated by transfer from special education; and (3) severe lasting disability, the diagnoses combined with life-long needs for supports or services, with limitations in areas including self-care, mobility, and capacity for independent living, indicated by special education in the individual's final year of school. RESULTS: Across the special education groups, from no impairment to severe lasting disability, there were trends of: increasing severe and lasting disability (respectively 4.8%, 35.6%, 76.4%); increasing special services use (13.5%, 43.1%, 83.7%); increasing severe emotional disorders (2.3%, 11.3%, 17.9%); lower percentages attaining at least an associate's degree by age 25 (42.1%, 20.7%, and 8.9%); and more chronic diseases. CONCLUSIONS: Special education histories provide a useful indicator of developmental disability impairment levels in adults.

Suicide mortality rates in farm-related occupations and the agriculture industry in the United States.

BACKGROUND: Studies suggest that agricultural workers and rural residents may have an elevated suicide risk. However, suicide is relatively rare, and rural and farming populations have significantly declined, limiting their representation in national surveys. Many studies have inadequate samples for meaningful analysis. METHODS: We pooled 29 years of data from the Mortality-Linked National Health Interview Survey, 1986-2014, then measured suicide mortality in groups including agriculture workers, and variation in suicide across rural and urban areas. Exposure variables indicated whether participants worked in a farm-related occupation or industry, or lived in a rural area. We used survey-weighted Poisson regression to estimate suicide mortality rates and rate ratios. RESULTS: Age-adjusted suicide mortality rate per 100,000 was: 22.3 for farmers and farm managers; 21.6 for farmworkers; 28.7 in farming, forestry, and fishing; 15.3 across all other occupations; 16.1 among rural residents. Among farmworkers, age-adjusted rates were 28.3 in rural areas, 17.1 in urban areas (not significantly different). The age-adjusted suicide mortality rate ratio (RR) comparing workers in the agriculture, forestry, and fishery industries to those in all other industries was 1.34 (95% confidence interval, [CI]: 1.05-1.72) (not statistically significant after further adjustment for demographic characteristics). Age-adjusted results were consistent with a higher suicide risk for workers in forestry and fishing than in all other occupations (RR: 1.88, 95% CI: 0.79-4.46). CONCLUSION: Workers in agriculture, forestry, and fishing may have an elevated suicide risk. National surveys should consider oversampling of rural residents, who have increased morbidity and mortality risks.

Disability in Childhood, Special Education Histories, and Lifetime Health Outcomes in the United States.

Objectives: We evaluated special education as an indicator of childhood disability and used that indicator to estimate lifetime dependency and life expectancy. Methods: Data: Panel Study of Income Dynamics and Health and Retirement Study (n = 20,563). Dependency: Nursing home care or equivalent. Analysis: We first analyzed special education as an indicator of childhood disability; multinomial logistic Markov models and microsimulation then compared populations with and without childhood disability. Results: Special education history was a valid indicator of childhood disability. For example, with parents who did not complete high school, 3.8% with no special education history were dependent at least 5 years of adult life; that result with special education was 15.2%. Life expectancy from age 20 was 58.3 years without special education, 46.0 years with special education (both p < .05). Discussion: Special education history can indicate childhood disability. People with that history had significantly a more dependency than others and significantly shorter lives.

Mental health risks of parents of children with developmental disabilities: A nationally representative study in the United States.

BACKGROUND: Caring for a child with a developmental disability may affect parents' mental health. There are few longitudinal or nationally representative studies, none on new mental health problems. Studies have few young children, and few adult children. OBJECTIVE/HYPOTHESES: We hypothesized that parents of children with developmental disability would be more likely to develop mental health problems than other parents. METHODS: We used the Panel Study of Income Dynamics (PSID, 1997-2017) and its Child Development Supplements, defining developmental disability by diagnoses such as autism spectrum disorder or intellectual disability, and requiring additional evidence of lasting impairment. We linked children's and parents' data spanning 20 years, including 44,264 mental health measurements for 4024 parents of 7030 children. Discrete-time hazard analysis controlled for child and parent characteristics. RESULTS: About 9.4% of children had developmental disability. Parents of children with developmental disability were more likely to develop mental health problems than other parents. The odds of developing anxiety or depression were higher when an adult child with developmental disability lived independently, nearly 3 times higher for mothers (OR 2.89, CI 2.33-3.59) and more than twice as large for fathers (OR 2.35, CI 1.70-3.26). Compared to fathers whose children did not have developmental disability and challenging behaviors, the odds of psychological distress were over 7 times larger (odds ratio, OR 7.18, 95% confidence interval, CI, 5.37-9.61) for those whose children had developmental disability and challenging behaviors. CONCLUSIONS: Parents of children with developmental disability may benefit from increased emotional support, respite, and interventions addressing challenging behaviors.

Work-related asthma in the USA: nationally representative estimates with extended follow-up.

OBJECTIVE: We studied the associations of working in occupations with high asthma trigger exposures with the prevalence and incidence of asthma, and with ever reporting an asthma diagnosis throughout working life. METHODS: We used the nationally representative Panel Study of Income Dynamics (1968-2015; n=13 957; 205 498 person-years), with annual reports of occupation and asthma diagnoses across 48 years. We compared asthma outcomes in occupations likely to have asthma trigger exposures with those in occupations with limited trigger exposures. We estimated the prevalence ratios and the incidence risk ratios using log-binomial regression adjusted for age, sex, race/ethnicity, education, and current and past atopy and smoking, and accounting for the survey design and sampling weights. We calculated the attributable risk fractions and population attributable risks, and used multinomial logistic Markov models and microsimulation to estimate the percentage of people ever diagnosed with asthma during working life. RESULTS: The adjusted prevalence ratio comparing high-risk occupations with low-risk was 4.1 (95% CI 3.5 to 4.8); the adjusted risk ratio was 2.6 (CI 1.8 to 3.9). The attributable risk was 16.7% (CI 8.5 to 23.6); the population attributable risk was 11.3% (CI 5.0 to 17.2). In microsimulations, 14.9% (CI 13.4 to 16.3) with low trigger exposure risk reported asthma at least once, ages 18-65, compared with 23.9% (CI 22.3 to 26.0) with high exposure risk. CONCLUSION: Adults were more than twice as likely to report a new asthma diagnosis if their occupation involved asthma triggers. Work exposures to asthma triggers may cause or aggravate about 11% of all adult asthma and increase the risk of work-life asthma by 60%.

Severe developmental disability and the transition to adulthood.

BACKGROUND: Developmental disabilities are serious and long-lasting. There are few studies of developmental disability in the transition to adulthood, when the programs that provided support in childhood may no longer be available. OBJECTIVE: We studied associations of long-lasting developmental disabilities with health, behaviors, and well-being in adulthood. METHODS: We used the Panel Study of Income Dynamics (1968-2017), its Child Development Supplement (CDS, 1997, 2002, 2007), and its Transition into Adulthood Supplement (TAS, every-other year, 2005-2017) (n = 2702) following a national sample from childhood through age 28, defining serious developmental disabilities using diagnoses and reports from parents, teachers, schools, children, and young adults. We tested differences in proportions using Chi-square tests, estimated differences in least squares means, and used logistic regression to compare results for those with and without developmental disabilities. We adjusted results for age, sex, race, immigrant status, family income, region, metropolitan statistical area, educational attainment, and employment status, accounting for sampling weights and survey design. RESULTS: At ages 18-21, 8.2% had serious developmental disability (95% confidence interval, CI 6.6-9.8). They were more likely to report: no high school graduation (19.3% vs. 4.3%), being assaulted physically (32.1% vs. 20.4%) or sexually (14.4% vs. 6.6%), serious criminal arrests (25.7% vs. 13.2%), smoking (30.8% vs. 12.8%), sedentariness (5.8% vs. 1.1%), obesity (39.2% vs. 23.4%), diabetes (9.1% vs. 2.1%), and work disability (18.7% vs. 4.3%) (all p < 0.01) compared to peers without developmental disability. CONCLUSIONS: Results indicate opportunities to promote education, self-direction, safety, and well-being for people transitioning to adulthood with serious developmental disabilities.

Is having any prenatal care associated with lower infant mortality in West Africa? Evidence from the Demographic and Health Surveys.

Although developing countries may find it difficult to provide adequate prenatal care, it is likely that they can provide at least some. We examined associations of prenatal care with infant mortality in West Africa. We used data from the Demographic and Health Surveys (n = 57,322) and proportional hazards regression models to estimate the risk of infant mortality. Having any prenatal care was associated with lower infant mortality risk in all but the poorest wealth quintile, with 56% lower risk in the wealthiest quintile (95% confidence interval [CI] 0.28-0.69). Even limited prenatal care may significantly reduce infant mortality in developing countries.

An Enduring Health Risk of Childhood Adversity: Earlier, More Severe, and Longer Lasting Work Disability in Adult Life.

Objectives: Childhood adversity has been linked with adult health problems. We hypothesized that childhood adversity would also be associated with work limitations due to physical or nervous health problems, known as work disability. Method: With data from the Panel Study of Income Dynamics (PSID) (1968-2013; n = 6,045; 82,374 transitions; 129,107 person-years) and the 2014 PSID Childhood Retrospective Circumstances Study, we estimated work disability transition probabilities with multinomial logistic Markov models. Four or more adversities defined a high level. Microsimulations quantified adult work disability patterns for African American and non-Hispanic white women and men, accounting for age, education, race, sex, diabetes, heart disease, obesity, and sedentary behavior. Results: Childhood adversity was significantly associated with work disability. Of African American women with high adversity, 10.2% had moderate work disability at age 30 versus 4.1% with no reported adversities; comparable results for severe work disability were 5.6% versus 1.9% (both p < .01). Comparable results for whites were 11.3% versus 4.7%, and 3.5% versus 1.1% (p < .01). The association of childhood adversity with work disability remained significant after adjusting for diabetes, heart disease, obesity, and sedentary behavior (p < .05). Conclusions: Childhood adversity may increase work disability throughout adult life.

Work disability in the United States, 1968-2015: Prevalence, duration, recovery, and trends.

The United States workforce is aging. At the same time more people have chronic conditions, for longer periods. Given these trends the importance of work disability, physical or nervous problems that limit a person's type or amount of work, is increasing. No research has examined transitions among multiple levels of work disability, recovery from work disability, or trends. Limited research has focused on work disability among African Americans and Hispanics, or separately for women and men. We examined these areas using data from 30,563 adults in the 1968-2015 Panel Study of Income Dynamics. We estimated annual probabilities of work disability, recovery, and death with multinomial logistic Markov models. Microsimulations accounting for age and education estimated outcomes for African American, Hispanic, and non-Hispanic white women and men. Results from these nationally representative data suggested that the majority of Americans experience work disability during working life. Most spells ended with recovery or reduced severity. Among women, African Americans and Hispanics had less moderate and severe work disability than whites. Among men, African Americans became severely work disabled more often than whites, recovered from severe spells more often and had shorter severe spells, yet had more severe work disability at age 65. Hispanic men were more likely to report at least one spell of severe work disability than whites; they also had substantially more recovery from severe work disability, and a lower percentage of working years with work disability. Among African Americans and Hispanics, men were considerably more likely than women to have severe work disability at age 65. Work disability declined significantly across the study period for all groups. Although work disability has declined over several decades, it remains common. Results suggest that the majority of work disability spells end with recovery, underscoring the importance of rehabilitation and workplace accommodation.

Lifetime Disadvantages after Childhood Adversity: Health Problems Limiting Work and Shorter Life.

We examine how childhood adversity relates to work disability and life expectancy, using 1999-2015 data from the Panel Study of Income Dynamics. We estimate the probabilities of work disability and death, adjusting for age, sex, race/ethnicity, and education in a nationally representative sample of African American, Hispanic, and white women and men. We find that people in all these groups who experienced high adversity childhoods (individuals with four or more of six adversity indicators) had significantly more work disability and shorter lives than those who experienced no adversity. These findings provide evidence that childhood adversity is associated with substantial disability, and a reduction in life expectancy of at least a decade. Childhood adversity was generally associated with more lost years of life for men than for women, and more disability for women than for men. The results are robust, even when controlling for diabetes, heart disease, depression, obesity, and sedentary behavior.

Adverse Childhood Circumstances and Functional Status Throughout Adult Life.

OBJECTIVE: We studied the association of childhood adversity with adult functional status. METHOD: With data from the Panel Study of Income Dynamics and the 2014 Childhood Retrospective Circumstances Study (1992-2013; N = 6,705; 62,885 person-years), we estimated functional status transition probabilities associated with childhood adversity, with multinomial logistic Markov models adjusted for age, sex, race/ethnicity, and education. Microsimulation then estimated functional status outcomes throughout adulthood for African American, Hispanic, and non-Hispanic White women and men. RESULTS: Adversity was significantly associated with functional status. Of White women without adversities, 2.3% had difficulty doing activities of daily living at age 30, compared with 8.2% with high adversity; comparable results were 3.7% and 8.7% for African Americans, 0.9% and 11.5% for Hispanics (all p < .01). Patterns were similar at other ages, for men, and when adjusted for midlife health conditions and health behavior. DISCUSSION: Childhood adversity may substantially increase functional impairment throughout adult life.

Moxie matters: associations of future orientation with active life expectancy.

OBJECTIVE: Being oriented toward the future has been associated with better future health. We studied associations of future orientation with life expectancy and the percentage of life with disability. METHOD: We used the Panel Study of Income Dynamics (n = 5249). Participants' average age in 1968 was 33.0. Six questions repeatedly measured future orientation, 1968-1976. Seven waves (1999-2011, 33,331 person-years) measured disability in activities of daily living for the same individuals, whose average age in 1999 was 64.0. We estimated monthly probabilities of disability and death with multinomial logistic Markov models adjusted for age, sex, race/ethnicity, childhood health, and education. Using the probabilities, we created large populations with microsimulation, measuring disability in each month for each individual, age 55 through death. RESULTS: Life expectancy from age 55 for white men with high future orientation was age 77.6 (95% confidence interval 75.5-79.0), 6.9% (4.9-7.2) of those years with disability; results with low future orientation were 73.6 (72.2-75.4) and 9.6% (7.7-10.7). Comparable results for African American men were 74.8 (72.9-75.3), 8.1 (5.6-9.3), 71.0 (69.6-72.8), and 11.3 (9.1-11.7). For women, there were no significant differences associated with levels of future orientation for life expectancy. For white women with high future orientation 9.1% of remaining life from age 55 was disabled (6.3-9.9), compared to 12.4% (10.2-13.2) with low future orientation. Disability results for African American women were similar but statistically significant only at age 80 and over. CONCLUSION: High future orientation during early to middle adult ages may be associated with better health in older age.

Associations of government health expenditures, the supply of health care professionals, and country literacy with prenatal care use in ten West African countries.

Social and health care context may influence prenatal care use. We studied associations of government health expenditures, supply of health care professionals, and country literacy rates with prenatal care use in ten West African countries, controlling for individual factors. We used data from Demographic and Health Surveys (n = 58,512) and random effect logistic regression models to estimate the likelihood of having any prenatal care and adequate prenatal care. Each percentage increase in the literacy rate was associated with 4% higher odds of having adequate prenatal care (p = .029). Higher literacy rates among women may help to promote adequate prenatal care.

Associations of Household Wealth and Individual Literacy with Prenatal Care in Ten West African Countries.

Objective To examine associations of household wealth and individual literacy with prenatal care in West Africa. Methods Data on women with recent births in Benin, Burkina Faso, Ghana, Guinea, Liberia, Mali, Nigeria, Niger, Senegal and Sierra Leone were obtained from 2006 to 2010 Demographic and Health Surveys (n = 58,512). Separate logistic regressions estimated associations of literacy and wealth quintiles with prenatal care, controlling for age, parity, marital status, rural/urban residence, religion, multiple births, pregnancy wantedness, and the woman's involvement in decision-making at home. Any prenatal care was defined by ≥1 prenatal care visit. Adequate prenatal care was defined as at least four prenatal care visits beginning in the first trimester, at least one with a skilled provider. Results Seventy-eight percent of women had any prenatal care; 23 % had adequate care. Women who were not literate had lower odds of having any prenatal care (odds ratio, OR 0.29; 95 % confidence interval, CI 0.26-0.33) and lower odds of adequate care (OR 0.73, CI 0.68-0.78). Women in the poorest wealth quintile were substantially less likely to have any prenatal care than women in the wealthiest quintile (OR 0.24, CI 0.11-0.18), and less likely to have adequate care (OR 0.31, CI 0.27-0.35). Conclusions for Practice A substantial percentage of women in West Africa have no prenatal care. Few have adequate care. Illiteracy and poverty are important risk factors for having little or no prenatal care. Increasing education for girls, promoting culturally appropriate messages about prenatal care, and building trust in providers may increase prenatal care.

Unemployment, disability and life expectancy in the United States: A life course study.

BACKGROUND: Unemployment may be associated with health through factors including stress, depression, unhealthy behaviors, reduced health care, and loss of social networks. Little is known about associations of total lifetime unemployment with disability and life expectancy. HYPOTHESIS: People with high unemployment (≥the median) will live shorter lives with more disability than those with less unemployment. METHODS: Data were nationally representative of African Americans and non-Hispanic whites, from the Panel Study of Income Dynamics (37 waves 1968-2011, n = 7,970, mean work years = 24.7). Seven waves (1999-2011, 58,268 person-years) measured disability in activities of daily living. We estimated monthly probabilities of disability and death associated with unemployment using multinomial logistic Markov models adjusted for age, sex, race/ethnicity, education, health status at baseline and throughout work life, and social support. We used the probabilities to create large populations with microsimulation, each individual having known monthly disability status, age 40 to death. We analyzed the populations to measure outcomes. RESULTS: Respectively for African American and white women and African American and white men, life expectancies (with 95% confidence intervals) from age 40 with low unemployment were ages: 77.1 (75.0-78.3), 80.6 (78.4-81.4), 71.4 (69.6-72.5), and 76.9 (74.9-77.9). Corresponding high unemployment results were: 73.7 (71.7-75.0), 77.5 (75.1-78.0), 68.4 (66.8-69.0), and 73.7 (71.5-74.3). The percentage of life disabled from age 40 was greater with high unemployment for the same groups, by 23.9%, 21.0%, 21.3%, and 21.1% (all p < 0.01). CONCLUSIONS: High lifetime unemployment may be associated with a larger proportion of later life with disability and lower life expectancy.

Associations of multiple chronic health conditions with active life expectancy in the United States.

PURPOSE: To estimate associations of eight common health conditions with life expectancy (LE) and disabled life expectancy (DLE), the percentage of life disabled in an activity of daily living. METHODS: Data from the Panel Study of Income Dynamics represented Americans ages 55+ (1999-2011, n = 2118, mean baseline age 63.3, 19 447 person-years). We estimated probabilities of death and disability with multinomial logistic Markov models adjusted for age, sex, race/ethnicity and education. We used the probabilities to create large populations with microsimulations, each individual having a known monthly disability status, age 55 through death. We calculated LE and DLE for the populations, repeating each microsimulation 100 times for confidence intervals. RESULTS: Nearly half (48.8%) of the participants had two or more conditions, 24.7% had three or more, 11.5% had four or more. Having any one condition significantly reduced LE. For example, white women lived to age 87.3 (95% confidence interval 86.5-88.1) with no conditions, 75.8 (70.9-80.7) with heart disease. Multiple conditions did not further reduce LE but often increased DLE, which for white women was 12.2% (11.1-13.2) with no conditions, 39.1% (28.3-49.8) with heart disease and 47.0% (46.9-47.1) with heart disease, diabetes and hypertension. CONCLUSION: The increasing prevalence of multiple chronic conditions may substantially increase disability. Implications for Rehabilitation The growing number of individuals with multiple chronic conditions will greatly increase the prevalence of disability in later life. It is important for rehabilitation science, practice and policy to address this emerging epidemiological transition. Rehabilitation is especially important for people with pre-diabetes, developing heart disease or early stages of other cardiovascular-related diseases as avoiding the development of multiple chronic diseases through increased activity may greatly reduce disability and mortality.

Associations of Educational Attainment With Disability and Life Expectancy by Race and Gender in the United States.

OBJECTIVE: This study provides estimates of associations of education with life expectancy and the percentage of remaining life from age 40 with disability. METHOD: We used the Panel Study of Income Dynamics, 1999-2011 ( n = 8,763; 94,246 person-years), measuring five education levels. We estimated probabilities of disability and death with multinomial logistic Markov models, and used microsimulations beginning at age 40, controlling for gender, race/ethnicity, age, and disability. RESULTS: With college education, African American and White women, and African American and White men, respectively, lived 46.6%, 44.0%, 55.2%, and 50.4% more years from age 40 than those educated at less than the ninth grade ( p < .001). Corresponding percentages of life with disability were lower with high education, by 37.9%, 38.9%, 41.0%, and 39.9% ( p < .001). There was little evidence of outcome differences between African Americans and Whites within education levels. DISCUSSION: Low education is associated with shorter lives with much more disability.