Americans

1
Americans Changing Lives Study

• Principal Investigators
• James S. House, Ph.D.
• Paula M. Lantz, Ph.D.

2
History

• Original Team at U-M
• James House
• James Lepkowski, Ron Kessler, Regula Herzog et
  al.
• Funded by NIA (NIH) and Robert Wood Johnson
  Foundation

3
Purpose

• To increase understanding of how individual,
  household and contextual socioeconomic and
  psychosocial factors combine to create health and
  health disparities across the adult life course.
• Driven by societal goals
• Reducing social inequalities in health
• Postponing morbidity and functional limitations
  into closing years of the life span (compression
  of morbidity)

4
ACL Study Design

• Longitudinal cohort study
• Stratified multistage area probability sample
• Age 25 and older (non-institutionalized)
• Contiguous U.S.
• Over-sampled 21 people 60 and Blacks
• Representative of July, 1986 U.S. population by
  sex, age and region

5
ACL Wave 1

• 1986
• Face-to-face interviews (86 minutes)
• N3,617
• Response rate 70 households
• 68 individuals

6
ACL Wave 2

• 1989
• Face-to-face interviews
• N2,867
• Response rate 83 of survivors

7
ACL Wave 3

• 1994
• Telephone Interviews
• N2,562
• Response rate 83 of survivors

8
ACL Wave 4

• 2001-2002
• Telephone Interviews
• N1,787
• Response rate 77 of survivors

9
Health Outcomes Variables

• Mortality
• Self-rated health (5 category)
• Functional impairment (physical)
• Chronic Conditions
• Cognitive impairment
• Depressive symptoms

10
ACL Mortality

• Annual searches using National Death Index
• Probable matches are certified with death
  certificates from states
• Cause of death coded from death certificates
  (ICD-9 and ICD-10)
• Death by Wave 4 1,184 respondents
• 32.7 of weighted sample
• 21.4 of unweighted sample

11
Self-Rated Health

• Wave 1
• Excellent/Very good 64.2
• Good 20.6
• Fair/Poor 15.2

12
Functional Impairment

• No limitation 84.7 (weighted)
• Difficult/unable to do heavy
• work around house (Low) 6.8
• Difficult/unable to climb stairs
• or walk a few blocks (Moderate) 5.3
• Confined to bed or chair (Severe) 3.2

13
Chronic Conditions

• Life Threatening and Debilitating
• 0 46.6 (weighted)
• 1 26.0
• 2 14.5
• 3 7.7
• 4 5.4

14
Socioeconomic Position

• Income R and spouse
• Education Wave 1 only
• Wealth
• Work status
• Occupation
• Sociodemographics

15
ACL Baseline
Variable Weighted
Male Female 47.1 52.9
White Other 83.5 16.5
Education 0-11 years 12-15 years 16 years 25.6 54.7 14.7
Income lt10,000 10,000 29,999 30,000 19.2 40.5 40.3
16
Health Risk Behaviors

• Cigarette smoking
• Alcohol use
• Body Mass Index
• Physical Activity

17
ACL Baseline
Variable Weighted
Smoking Current Former Never 30.4 27.5 42.1
Alcohol None Moderate High 41.2 54.5 4.3
BMI Underweight Normal Overweight Obese 2.3 49.0 34.3 14.4
18
Psychosocial Risk Factors

• Social integration (informal and formal)
• Life Satisfaction
• Social Relationships and Supports
• Marital Relationships and Events
• Personality Traits
• Productive Activities
• Paid/Unpaid Work

19
Psychosocial Risk Factors

• Stress job, financial, marital, parental
• Negative Life Events
• Religion and World Views
• Perceptions of Discrimination
• Physical/Social Environment
• Residential History

20
Contextual Variables

• Non-public at this point
• Addresses at all 4 waves geocoded and linked to
• 60 census tract variables for Census before and
  after wave
• Environmental Protection Agency Toxic Release
  Inventory (TRI) geocoded data of polluting and
  hazardous waste business es and sites

21
Articles by ACL Investigators

• Burgard SA. Brand JE. House JS. Toward a better
  estimation of the effect of job loss on health.
  Journal of Health Social Behavior.
  48(4)369-84, 2007
• Herd P. Goesling B. House JS. Socioeconomic
  position and health the differential effects of
  education versus income on the onset versus
  progression of health problems. Journal of Health
  Social Behavior. 48(3)223-38, 2007
• Robert SA. Ruel E. Racial segregation and health
  disparities between Black and White older adults.
  Journals of Gerontology Series B-Psychological
  Sciences Social Sciences. 61(4)S203-11, 2006

22
Articles by ACL Investigators

• Lantz PM. House JS. Mero RP. Williams DR. Stress,
  life events, and socioeconomic disparities in
  health. Journal of Health Social Behavior.
  46(3)274-88, 2005
• House JS. Lantz PM. Herd P. Continuity and change
  in the social stratification of aging and health
  over the life course. Journals of Gerontology
  Series B-Psychological Sciences Social
  Sciences. 60 Spec No 215-26, 2005
• Everson-Rose SA. House JS. Mero RP. Depressive
  symptoms and mortality risk in a national sample
  confounding effects of health status.
  Psychosomatic Medicine. 66(6)823-30, 2004

23
Other ACL Articles

• Shultz KS. Wang M. The influence of specific
  physical health conditions on retirement
  decisions. International Journal of Aging
  Human Development. 65(2)149-61, 2007
• Schnittker J. Look (closely) at all the lonely
  people age and the social psychology of social
  support. Journal of Aging Health.
  19(4)659-82, 2007
• Hinterlong JE. Race disparities in health among
  older adults examining the role of productive
  engagement. Health Social Work. 31(4)275-88,
  2006 Nov.

24
Other ACL Articles

• Burr JA. Choi NG. Mutchler JE. Caro FG.
  Caregiving and volunteering are private and
  public helping behaviors linked? Journals of
  Gerontology Series B-Psychological Sciences
  Social Sciences. 60(5)S247-56, 2005
• Collins AL. Smyer MA. The resilience of
  self-esteem in late adulthood. Journal of Aging
  Health. 17(4)471-89, 2005
• McKee SA. Maciejewski PK. Falba T. Mazure CM. Sex
  differences in the effects of stressful life
  events on changes in smoking status. Addiction.
  98(6)847-55, 2003

25
Relative Risk of Adjusted Mortality by Income,
U.S. Adults, 1986-2002
26
Relative Risk of Adjusted Mortality by Income,
U.S. Adults, 1986-2002
27
Compression of Morbidity Evidence from ACL