The Dynamic contribution of chronic conditions to temporal trends in disability among U.S. adults

Shih-Fan Lin, DrPH , Audrey N. Beck, Ph.D., Brian K. Finch, Ph.D.
Disability and Health Journal, Vol. 9, Issue 2, p332–340


Although evidence has shown that U.S. late-life disability has been declining, studies have also suggested that there has been an increase in chronic diseases between 1984 and 2007.


To further illuminate these potentially contradictory trends, we explicate how the contribution of chronic conditions changes across four common types of disability (ADL, IADL, mobility disability, and functional limitations) by age (A), period (P), and birth cohorts (C) among adults aged 20 and above.


Our data came from seven cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES). We utilize a cross-classified random effect model (CCREM) to simultaneously estimate age, period, and cohort trends for each disability. Each chronic condition was sequentially then simultaneously added to our base models (sociodemographics only). Reductions in predicted probability from the base model were then calculated for each chronic condition by each temporal dimension (A/P/C) to assess the contribution of each chronic condition.


There was increasing age-based contribution of chronic conditions to all disabilities. The period-based contribution remained quite stagnant across years while cohort-based contributions showed a continual decline for recent cohorts. Arthritis showed the greatest contribution to disability of all types which was followed by obesity. Cancer was the least important contributor to disabilities.


Although chronic conditions are becoming less disabling across recent cohorts, other competing risk factors might suggest prevailing causes of disability.