title: Unemployment, disability and life expectancy in the United States: A life course study.
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Public Health Sciences, Public Policy, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA.
authors.forename: James N
authors.initials: JN
authors.lastname: Laditka
authors.affiliation: Department of Public Health Sciences, Public Policy, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA. Electronic address: sladitka@uncc.edu.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Laditka
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007182:Income; D008017:Life Expectancy / Q000208:ethnology; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D016019:Survival Analysis; D014478:Unemployment; D014481:United States; D044465:White People
keywords: Active life expectancy; African Americans; Disability; Health disparities; Unemployment