title: First in line: prioritizing receipt of Social Security disability benefits based on likelihood of death during adjudication.
abstract: BACKGROUND
  Given the complexity of the adjudication process and volume of applications to Social Security Administration's (SSA) disability programs, many individuals with serious medical conditions die while awaiting an application decision. Limitations of traditional survival methods called for a new empirical approach to identify conditions resulting in rapid mortality.
  
  
  OBJECTIVE
  To identify health conditions associated with significantly higher mortality than a key reference group among applicants for SSA disability programs.
  
  
  METHODS
  We identified mortality patterns and generated a survival surface for a reference group using conditions already designated for expedited processing. We identified conditions associated with significantly higher mortality than the reference group and prioritized them by the expected likelihood of death during the adjudication process.
  
  
  METHODS
  Administrative records of 29 million Social Security disability applicants, who applied for benefits from 1996 to 2007, were analyzed.
  
  
  METHODS
  We computed survival spells from time of onset of disability to death, and from date of application to death. Survival data were organized by entry cohort.
  
  
  RESULTS
  In our sample, we observed that approximately 42,000 applicants died before a decision was made on their disability claims. We identified 24 conditions with survival profiles comparable with the reference group. Applicants with these conditions were not likely to survive adjudication.
  
  
  CONCLUSIONS
  Our approach facilitates ongoing revision of the conditions SSA designates for expedited awards and has applicability to other programs where survival profiles are a consideration.
authors.affiliation: *Epidemiology and Biostatistics Section, Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, Bethesda, MD †Institute on Disability, University of New Hampshire, Durham, NH.
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Rasch
authors.forename: Minh
authors.initials: M
authors.lastname: Huynh
authors.forename: Pei-Shu
authors.initials: PS
authors.lastname: Ho
authors.forename: Aaron
authors.initials: A
authors.lastname: Heuser
authors.forename: Andrew
authors.initials: A
authors.lastname: Houtenville
authors.forename: Leighton
authors.initials: L
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D004608:Eligibility Determination / Q000458:organization & administration; D005260:Female; D006292:Health Priorities / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D012943:Social Security / Q000458:organization & administration*; D016019:Survival Analysis; D013997:Time Factors; D014481:United States; D019131:United States Social Security Administration / Q000458:organization & administration; D014850:Waiting Lists / Q000401:mortality; D055815:Young Adult