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Determinants of Morbidity and Disability Trends in the United States, 1958-77

Kenneth C. Land and Marilyn M. McMillen
Social Indicators Research
Vol. 9, No. 3 (Sep., 1981), pp. 313-345
Published by: Springer
Stable URL: http://www.jstor.org/stable/27520979
Page Count: 33
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Determinants of Morbidity and Disability Trends in the United States, 1958-77
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Abstract

Macrodynamic structural-equation models are presented that show how changes in annual levels of aggregate indexes of several morbidity and disability conditions for the United States over the years 1958 to 1977 affect each other and are affected by other aggregate demographic and socioeconomic changes. After reviewing the record of annual changes in these indexes based on data from the National Health Interview Survey, patterns of temporal covariation in the time series are discussed and some tentative structural-equation models are constructed to account for their behavior. Statistically, the analyses reveal considerable variation in levels of year-to-year variance explained for these indexes - from 35 percent explained for days of school loss to 97 percent for all acute conditions. Substantive findings imply that a decreasing proportion of preschool children in the population contributes to a decline in the incidence of infective and parasitic diseases, and an increasing proportion of the population at the older ages results in increases in the prevalence of chronic conditions, days of bed disability, and days of restricted activity. Further, increases in economic prosperity lead to an increase in the incidence of injuries and a decrease in the incidence of viral conditions, while higher levels of unemployment produce more injuries and restricted activity days. These inferences corroborate, for the most part, results of prior studies that have been restricted to cross-sectional analyses. In addition, however, they provide a basis for making explicit quantitative projections of future levels of morbidity and disability in the American population on the basis of exogenous demographic and socioeconomic conditions.

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