Work disability: A central measure of public health, a health disparity affecting African Americans

Being able to work is important for economic security and health. When retired or not employed, being able to do work that is needed in the home or community is similarly important. We studied work disability among 7,055 Americans ages 20 108, followed up to 41 years. We used the Panel Study of Income Dynamics (1968-2009), which in 37 waves asked adults at all ages if “a physical or nervous condition” prohibited work. We estimated monthly probabilities of transitions to and from disability, and to death, with multinomial logistic Markov models, adjusting for age, gender, income, education, wealth, childhood circumstances, and other confounders. Random effects adjusted for multiple observations for individuals. The disability probabilities were used to conduct microsimulations, creating large populations (1 million), providing a monthly record of work disability from age 20 to death for each individual. Bootstrapping addressed survey design. African Americans were more likely to become work disabled than non-Hispanic Whites (odds ratio 1.64) and to die non-disabled (1.49) or disabled (1.26), and less likely to recover from disability (0.83), all p<0.0001. Active life expectancy results underscored the disparity: Given survival to age 20, average total years lived and disabled were 83.0/23.7 for African American women, 87.4/18.4 for White women, 75.0/17.1 for African American men, 80.7/13.5 for White men. Thus, disabled life as a proportion of total life comparing African Americans to Whites was 37.7% greater for women, 39.7% for men. Findings highlight the life-course health impacts of a disparity affecting African Americans in work disability.