Does an aging American workforce mean more time lost due to chronic conditions such as arthritis, cancer, chronic pulmonary disease, coronary artery disease, diabetes, depression, hypertension, and low back pain?
It is no secret that the American population as a whole is getting older, which also means that it is generally more susceptible to chronic health conditions and longer periods of disease and illness. An estimated 133 million Americans suffer from at least one chronic health condition, with almost 80% of American adults aged 50 or older reported to have at least one. The existence of such a large population of chronic health sufferers will of necessity have an adverse impact on work productivity, as these conditions will often require an absence from work, and many studies have looked at the costs associated with ill health and work disability. However, very little research exists examining more specifically the relationship between age and the length of non-work disability across the different types of chronic conditions that are most common today in the American population.
In “Comparing the Relationship Between Age and Length of Disability Across Common Chronic Conditions,” published in the Journal of Occupational and Environmental Medicine , authors Arif Jetha, PhD, Elyssa Besen, PhD, and Peter M. Smith, PhD, examine the relationship between between age and length of disability across eight common chronic conditions: arthritis, cancer, chronic pulmonary disease, coronary artery disease, diabetes, depression, hypertension, and low back pain. Their goal was to discover whether there is a positive relationship between age and length of disability with regard to these conditions and, if so, whether there is any noticeable variation in that relationship across these different conditions.
For their analysis, the authors studied data from a large disability insurer in the U.S. and limited their scope to short- and long-term disability claims between 2008 and 2012 involving health conditions unrelated to work. Thus, the study focused on persons suffering from chronic conditions not caused by their jobs who took time away from work because of these health conditions and received disability benefit payments to help compensate for lost salary during the period they were not at work.
From a starting pool of almost 70,000 claims, almost 30,000 claims were excluded to address various methodological concerns. For example, the study was limited to claims with a minimum of 14 days of disability and no more than 14 days between the report that time off was needed and the commencement of wage replacement benefits. In addition, the study excluded all claimants who were under the age of 25, due to their “unique transitional life phase” and lack of many claims related to chronic conditions, as well as persons who were 65 years of age or older, who rely primarily on Social Security for disability wage replacement. Persons who filed more than one claim in a single calendar year were also excluded, which by itself eliminated almost 19,000 claims.
After these reductions were made, the resulting pool of claimants was only 41% male and 48% married. Almost 93% were full-time workers and 73% had an annual income of $50,000 or less. Almost 59% of the claimants worked in sedentary or light physical jobs, compared to only 13% in jobs with heavy physical demands. The claims in the data pool came from many different employers and industries across different states, although some industries were not represented in the database, including agriculture, forestry and fishing, and public administration.
The authors found that there was a “significant relationship” between age and length of disability for all eight chronic health conditions they examined, with little difference between male and female claimants in this regard. The data showed the following ranges in length of disability for the eight conditions:
• For arthritis, the predicted length of disability increased from 70 days for those claimants age 25 to approximately 86 days for those at age 65, with a mean length across all age groups of 76 days.• For depression, the predicted length increased from about 56 days at age 25 to 72 days for those at age 65, with a mean length of 63 days.• For diabetes, the predicted length ran from approximately 46 days at age 25 up to about 64 days at age 65, with a mean of 51 days.• For low back pain, the predicted length ran from 51 days at age 25 to 66 days for those at age 65, with a mean length of 58 days.• For hypertension, the predicted length ran from 55 days at age 25 down to 39 days at age 50 and then up to 48 days at age 65, with a mean of 41 days.• For cancer, the predicted length ran from 52 days at age 25 up to 85 days at age 65, with a mean of 65 days.• For coronary artery disease, the predicted length ran from about 49 days at age 25 down to about 44 days at age 40 and then up to about 60 days at age 65, with a mean of 48 days.• For chronic pulmonary disease, the predicted length ran from 37 days at age 25 to about 62 days at age 65, with a mean of 47 days.
As this data showed, there was a positive correlation between age and length of disability across all eight chronic conditions, although the positive correlation for two of the chronic conditions, hypertension and coronary artery disease, did not manifest until the claimants were in their 40s. Only hypertension had a predicted length of disability that was shorter at age 65 than at age 25.
The lengths of disability varied widely, with a mean of only 41 days for those with hypertension up to a mean of 76 days for those suffering from arthritis. In fact, arthritis sufferers had a longer predicted length of disability across all age groups by a noticeable margin, which is consistent with other research showing that arthritis is “the most significant cause of work disability in industrialized countries.” Only cancer claimants in their 60s approached similar predicted disability lengths. Depression, at 63 days, was the only other condition with a mean length of disability above 60 days. Hypertension, coronary artery disease, and chronic pulmonary disease had the lowest mean length of disability, with means in the low- to mid-40s.
Limitations of Study
The data used in this study, and the information provided about the individual claimants, had its limitations. For example, as the authors note, “Details on condition severity (e.g., levels of pain, fatigue, and disease activity), previous chronic disease diagnosis, presence of comorbidities, and work context characteristics (e.g., company size, social support, job demands, or availability of accommodations) were unavailable.” In addition, they assumed for purposes of this study that an end to disability benefits equaled a return to work, which is not necessarily true.
Importance of Study
Despite these limitations, however, this research suggests that Americans suffering from many common chronic health conditions tend to have longer periods of disability as they age. Given the advancing age of the American population, the increasing numbers of Americans suffering from chronic health conditions, and the fact that this population is working longer before retirement, this type of research focusing on specific chronic health conditions may help inform policy planners addressing broader issues of health policy and return-to-work strategies.
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