The accumulation of population data produces benefits that accrue both to individuals and society. Fertility and immigration rates provide an indication that population growth is moving in a positive direction. The volume of high school graduates each year enables higher education administrators to develop student enrollment projections. The size of the overall workforce makes it possible to assess the amount of tax revenues that can be generated and the extent to which they suffice to pay for health and social benefits of individuals who are not employed. Life expectancy data make it possible to determine how many and what kinds of clinicians will be needed to meet population health care needs.
The United States has an impressive record of producing valuable data, but there continues to be opportunities for making improvement in the health realm. For example, according to a paper in the October 2023 issue of the journal Demography, despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, researchers studied the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. Patterns were examined by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50–100. Moreover, the analysis included looking at what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment.
Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men have an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are from racial and ethnic minority groups, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. As much as 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment.
Life expectancy at older ages has increased in the United States, contributing to the expansion of the older population. Adults aged 65 and older constituted 17% (56 million individuals) of the total U.S. population in 2020, but are expected to represent 22% (81 million individuals) of the population by 2040. Population aging poses a challenge because cognitive function and the ability to carry out basic activities of daily living decline as adults age, often preventing independent living. The most disadvantaged subpopulations, which are likely to be the least economically resourced, bear the greatest burden of co-impairment. Hence, policy implications include not just interventions on proximate determinants of health, such as promoting positive health contexts (e.g., increasing social connectedness), but also providing support for these vulnerable groups (e.g., expanding coverage of health and long-term care insurance).