Do U.S. States’ Socioeconomic and Policy Contexts Shape Differences in Adult Disability?
MetadataShow full item record
In recent decades, the United States has experienced a sharp fall in its international ranking in life expectancy. Thanks to several recent studies, it is now known that part of this fall is due to large, and growing, differences in life expectancy across U.S. states. Less is known, however, about states’ differences in other health outcomes. For instance, while we know that women outlive men across states in the U.S., it is not known whether women experience better or worse health outcomes than men across states. In addition, it is not known if any state differences in health outcomes are due to states’ population characteristics (e.g., residents’ race/ethnic or educational composition) or due to the states’ economy and policies. The authors address these issues by exploring adult disability in the U.S. Specifically, they ask: (1) Does adult disability vary across U.S. states? (2) Are there differences by gender and age? (3) If differences exist, do states’ socioeconomic and policy contexts explain the variability? Using nationally-representative data from the American Community Survey that includes over 5.5 million U.S.- born adults 25-94 years of age, the authors apply the World Health Organization’s (WHO) socio-ecological framework to determine if differences in disability exist across states and, if so, what are possible explanations for those differences. The WHO framework posits that structural determinants—defined as socioeconomic and policy contexts that create stratified systems of economic resources across gender, race/ethnicity, and education level—differentially expose individuals to health risks and health resources. Therefore, in addition to analyzing individual characteristics (gender, age, race/ethnicity, and education level), the authors examine the following state-level factors: economic output (how economically healthy is the state), income inequality (do more or fewer people share in a state’s prosperity), years with the state supplemental Earned Income Tax Credit (a social policy that benefits lower-income workers), cigarette taxes per pack (a public health policy known to positively impact health), and Medicaid program score (a measure of access to health care for lowincome and disabled residents).