title: Do U.S. states' socioeconomic and policy contexts shape adult disability?
abstract: Growing disparities in adult mortality across U.S. states point to the importance of assessing disparities in other domains of health. Here, we estimate state-level differences in disability, and draw on the WHO socio-ecological framework to assess the role of ecological factors in explaining these differences. Our study is based on data from 5.5 million adults aged 25-94 years in the 2010-2014 waves of the American Community Survey. Disability is defined as difficulty with mobility, independent living, self-care, vision, hearing, or cognition. We first provide estimates of age-standardized and age-specific disability prevalence by state. We then estimate multilevel models to assess how states' socioeconomic and policy contexts shape the probability of having a disability. Age-standardized disability prevalence differs markedly by state, from 12.9% in North Dakota and Minnesota to 23.5% in West Virginia. Disability was lower in states with stronger economic output, more income equality, longer histories of tax credits for low-income workers, and higher cigarette taxes (for middle-age women), net of individuals' socio-demographic characteristics. States' socioeconomic and policy contexts appear particularly important for older adults. Findings underscore the importance of socio-ecological influences on disability.
authors.affiliation: Department of Sociology and Aging Studies Institute, 314 Lyman Hall, Syracuse University, Syracuse, NY 13244, USA. Electronic address: jmontez@maxwell.syr.edu.
authors.forename: Jennifer Karas
authors.initials: JK
authors.lastname: Montez
authors.affiliation: Population Research Center, 1800 Main, University of Texas at Austin, Austin, TX 78705, USA. Electronic address: mhayward@prc.utexas.edu.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Hayward
authors.affiliation: Department of Public Administration and International Affairs, and Aging Studies Institute, 314 Lyman Hall, Syracuse University, Syracuse, NY 13244, USA. Electronic address: dawolf@maxwell.syr.edu.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Wolf
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011336:Probability; D011640:Public Policy / Q000639:trends*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013660:Taxes / Q000706:statistics & numerical data; D014481:United States
keywords: Disability; Health; Social determinants; States; United States