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Previous Volume 329:110-116 July 8, 1993 Number 2 Next

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ABSTRACT

Background and Methods Persons of low socioeconomic status are known to have reduced life expectancy. In a study of the relation of socioeconomic status to disability-free or active life expectancy among older persons, we analyzed prospectively gathered data on 2219 blacks and 1838 whites who were 65 years of age or older in the Piedmont region of North Carolina. We defined disability as the inability to perform independently one or more basic functional activities such as walking, bathing, dressing, eating, and using the toilet. For subgroups defined by sex, race, and education, statistical models were used to estimate, for persons at each year of age, the probability of transition from not being disabled or being disabled at base line to not being disabled, being disabled, or having died one year later. These transition probabilities were then entered into increment-decrement life tables to generate estimates of total, active, and disabled life expectancy (with total life expectancy equal to active life expectancy plus disabled life expectancy).

Results Sixty-five-year-old black men had a lower total life expectancy (11.4 years) and active life expectancy (10 years) than white men (total life expectancy, 12.6 years; active life expectancy, 11.2 years), although the differences were reduced after we controlled for education. The estimates for 65-year-old black women (total life expectancy, 18.7 years; active life expectancy, 15.9 years) were similar to those for white women. Black men and women 75 years old and older had higher values for total life expectancy and active life expectancy than whites, and the differences were larger after stratification for education. Education had a substantially stronger relation to total life expectancy and active life expectancy than did race. At the age of 65, those with 12 or more years of education had an active life expectancy that was 2.4 to 3.9 years longer than the values for those with less education in all the four subgroups defined by sex and race. Overall, the subgroups with longer total life expectancy and active life expectancy also lived more years with a disability.

Conclusions Among older blacks and whites, the level of education, a measure of socioeconomic status, has a greater effect than race on total life expectancy and active life expectancy.

Source Information

From the Epidemiology, Demography, and Biometry Program, National Institute on Aging, Bethesda, Md. (J.M.G.); the Department of Sociology, Duke University (K.C.L.), and the Department of Psychiatry (D.B.) and the Center for the Study of Aging and Human Development (G.G.F.), Duke University Medical Center, Raleigh, N.C.; Boston University School of Medicine, Boston (L.G.B.); and Abt Associates, Cambridge, Mass. (L.G.B.).

Address reprint requests to Dr. Guralnik at the National Institute on Aging, 7201 Wisconsin Ave., Rm. 3C-309, Bethesda, MD 20892.

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• Nelson, K., Brown, M. E., Lurie, N. (1998). Hunger in an Adult Patient Population. JAMA 279: 1211-1214 [Abstract] [Full Text]  
• Campion, E. W. (1998). Aging Better. NEJM 338: 1064-1066 [Full Text]  
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• Palmore, E. B., Burchett, B. M. (1997). Predictors of Disability in the Final Year of Life. J Aging Health 9: 283-297 [Abstract]  
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• LIU, X., LIANG, J., TU, E. J.-C., WHITELAW, N. (1997). Modeling Multidimensional Transitions in Health Care. Sociological Methods Research 25: 284-317 [Abstract]  
• Marmot, M G, Shipley, M. J (1996). Do socioeconomic differences in mortality persist after retirement? 25 Year follow up of civil servants from the first Whitehall study. BMJ 313: 1177-1180 [Abstract] [Full Text]  
• Gupta, R, Gupta, V P, Ahluwalia, N S (1994). Educational status, coronary heart disease, and coronary risk factor prevalence in a rural population of India. BMJ 309: 1332-1336 [Abstract] [Full Text]  
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