MPIDR Working Paper
Disparities in the population burden of joint cognitive and physical impairment in the US, 1998-2016
MPIDR Working Paper WP-2022-001, 48 pages.
Rostock, Max Planck Institute for Demographic Research (January 2022)
Although cognitive and physical impairments often co-occur in older individuals, they are typically studied as separate outcomes. Using the Health and Retirement Study (1998-2016) and multistate models, we quantify the population burden of their co-occurrence (joint impairment) using two key indicators- lifetime risk and expectancy, by gender, race/ethnicity/nativity, education and their interactions for Americans aged 50 and over. Furthermore, we analyze what fraction of the racial/ethnic inequalities in joint impairment is attributable to inequalities in educational attainment. Results reveal that 58% of women and 42% of men aged 50 are predicted to experience joint impairment in their remaining life expectancy. Women also live longer in joint impairment than men (3.4 vs 1.9 years). Foreign-born Latinas have 83% lifetime risk compared with Whites’ 52% and three times more jointly impaired years. Lower educated men experience 32 percentage points higher lifetime risk and three times more joint impairment years than higher educated men. The lowest educated Blacks and Latinx carry the greatest joint impairment burden. This study emphasizes the importance of considering cognitive and physical impairment simultaneously in assessing older-age disability. The finding that up to 74% of the racial/ethnic disparities are attributable to inequalities in educational attainment can inform policy.