Linda J. Waite Editor Aging, Health, and Public Policy Demographic and Economic Perspectives A Supplement to Vol. 30, 2004 POPULATION AND DEVELOPMENT REVIEW Population and Development Review seeks to advance knowledge of the interrelationships between population and socioeconomic development and provides a forum for discussion of related issues of public policy. EDITOR Paul Demeny MANAGING EDITOR Ethel P. Churchill EDITORIAL COMMITTEE Paul Demeny, Chair Geoffrey McNicoll Ethel P. Churchill Michael P. Todaro Susan Greenhalgh EDITORIAL STAFF Robert Heidel, Production Editor Y. Christina Tse, Production/Design Sura Rosenthal / Mike Vosika, Production ADVISORY BOARD John C. Caldwell Akin L. Mabogunje David Coleman Carmen A. Miró Richard A. Easterlin Samuel H. Preston S. Ryan Johansson Vaclav Smil Ronald D. Lee Signed articles are the responsibility of the authors. Views expressed in the Review do not necessarily reflect the views of the Population Council or its publisher, Blackwell Publishing. Direct manuscripts, comments on articles, and correspondence to: Population and Development Review Population Council One Dag Hammarskjold Plaza New York, New York 10017 USA Electronic submissions are encouraged and should be sent to [email protected] Support from the United Nations Population Fund is gratefully acknowledged. Volumes are available on microfilm from UMI, 300 North Zeeb Road, Ann Arbor, Michigan 48106. The website for Population and Development Review is www.blackwellpublishing.com/pdr. Subscribers have access to the electronic edition of the journal, which is published simultaneously with the printed issue. The full contents of volumes 1–28 (1975–2002) are available through participating libraries from JSTOR at www.jstor.org/journals/00987921.html Population and Development Review (ISSN 0098-7921) is published quarterly on behalf of the Population Council, One Dag Hammarskjold Plaza, New York, NY 10017, USA by Blackwell Publishing, with offices at 350 Main Street, Malden, MA 02148, USA, and P.O. Box 1354, 9600 Garsington Road, Oxford OX4 2DQ, UK. Telephone 800-835-6770 or 781-388-8206, or fax 781-388-8232 (US office) or telephone +44-1865-778315 or fax +44-1865-471775 (UK office). E-mail: [email protected]; on the Web: www.blackwellpublishing.com/cservices. PDR 30 supp ifc/sp 1 1/26/05, 9:35 AM AGING, HEALTH, AND PUBLIC POLICY: DEMOGRAPHIC AND ECONOMIC PERSPECTIVES PDR 30 Supp FM/sp 1 1/26/05, 1:29 PM PDR 30 Supp FM/sp 2 1/26/05, 1:29 PM AGING, HEALTH, AND PUBLIC POLICY: DEMOGRAPHIC AND ECONOMIC PERSPECTIVES Linda J. Waite Editor POPULATION AND DEVELOPMENT REVIEW A Supplement to Volume 30, 2004 POPULATION COUNCIL New York PDR 30 Supp FM/sp 3 1/26/05, 1:29 PM ©2005 by The Population Council, Inc. All rights reserved. Library of Congress Cataloging-in-Publication Data Aging, health, and public policy: demographic and economic perspectives / Linda J. Waite, editor. p. cm. “Population and development review, a supplement to volume 30, 2004.” Includes bibliographical references. ISBN 0-87834-112-9 (pbk. : alk. paper) 1. Age distribution (Demography)--Economic aspects. 2. Older people--Health and hygiene. 3. Older people--Economic conditions. 4. Older people--Social conditions. 5. Older people--Government policy--Economic aspects. 6. Old age assistance--Forecasting. I. Waite, Linda J. II. Population and development review. HB1531.A35 2004 305.26—dc22 2004062826 ISSN 0098-7921 ISBN 0-87834-112-9 Printed in the United States of America. PDR 30 Supp FM/sp 4 1/26/05, 1:29 PM CONTENTS Acknowledgments vii INTRODUCTION The Demographic Faces of the Elderly 3 LINDA J. WAITE I. HISTORY, BIOLOGY, AND DISEASE Changes in the Process of Aging during the Twentieth Century: Findings and Procedures of the Early Indicators Project 19 ROBERT WILLIAM FOGEL The Biodemography of Aging 48 JAMES W. VAUPEL From Alzheimer’s Disease to a Demography of Chronic Disease: The Development of Demographic Synthesis for Fitting Multistate Models 63 DOUGLAS EWBANK II. HEALTH AND SOCIOECONOMIC STATUS Integrating Biology into the Study of Health Disparities 89 EILEEN M. CRIMMINS TERESA E. SEEMAN Unraveling the SES–Health Connection 108 JAMES P. SMITH Socioeconomic Status and Coronary Heart Disease: A Psychobiological Perspective 133 ANDREW STEPTOE MICHAEL MARMOT PDR 30 Supp FM/sp 5 1/26/05, 1:29 PM III. AGING, WORK, AND PUBLIC POLICY Quantifying Our Ignorance: Stochastic Forecasts of Population and Public Budgets 153 RONALD LEE Social Security Provisions and the Labor Force Participation of Older Workers 176 DAVID A. WISE IV. DATA AND STATISTICS Survey Design and Methodology in the Health and Retirement Study and the Wisconsin Longitudinal Study 209 ROBERT M. HAUSER ROBERT J. WILLIS EPILOGUE Research on Population Aging at NIA: Retrospect and Prospect 239 RICHARD SUZMAN AUTHORS 265 PDR 30 Supp FM/sp 6 1/26/05, 1:29 PM ACKNOWLEDGMENTS The RAND Summer Institute on the Demography, Economics, and Epidemiol- ogy of Aging annually brings together research scientists from the centers on population aging supported by the US National Institute on Aging. The tenth anniversary Summer Institute, held at Santa Monica, California, 11–12 July 2003, provided an occasion for highlighting some recent achievements of ag- ing research in the social sciences undertaken in these centers. This volume is largely based on the papers presented at this conference. The authors and the editor express their gratitude to Bob Schoeni and Lora Myers of the Michigan Center on the Demography of Aging, and Dana Goldman and Dawn Matsui at RAND for their role in organizing the meeting. We also thank the Michigan Center for logistic support and Bob Schoeni for encouragement and advice during the production of this supplement. Financial support for both the conference and the volume came from the Office of Behavioral and Social Research, National Institute on Aging. We wish to acknowledge in particular the instrumental role of Richard Suzman, Asso- ciate Director of the Office. Without Richard’s vision, persistence, and willing- ness to support new directions and new ideas, the demography and econom- ics of aging would not be the vibrant, productive, exciting research arena that it has become. Of course, Richard’s vision would have come to little without the support of Richard Hodes, Director of the National Institute on Aging, and, ultimately, the support of the US National Institutes of Health. This publication was also supported by contributions from: —Center for the Demography and Economics of Aging at the University of California at Berkeley —Center on the Demography and Economics of Aging at the University of Chicago —Population Aging Center at the University of Colorado —Center for Demographic Studies at Duke University —Center on the Demography of Aging at the University of Michigan —Center for Aging and Health Research, NBER —Population Aging Research Center at the University of Pennsylvania —Center for the Study of Aging at RAND —Center on the Demography and Economics of Health and Aging at Stanford University —Center on Biodemography and Population Health at USC-UCLA —Center for Demography of Health and Aging at the University of Wis- consin-Madison We also thank the editorial staff of Population and Development Review for their assistance in producing this volume. L.J.W. vii PDR 30 Supp FM/sp 7 1/26/05, 1:29 PM PDR 30 Supp FM/sp 8 1/26/05, 1:29 PM INTRODUCTION PDR 30 supp Waite/au/EPC/sp 1 1/26/05, 9:45 AM PDR 30 supp Waite/au/EPC/sp 2 1/26/05, 9:45 AM The Demographic Faces of the Elderly LINDA J. WAITE Much of the world is aging rapidly. Both the number and proportion of people aged 65 years and older are increasing, although at different rates in different parts of the world. The number of older adults has risen more than threefold since 1950, from approximately 130 million to 419 million in 2000, with the elderly share of the population increasing from 4 percent to 7 per- cent during that period. In the United States, those aged 65 and older cur- rently make up about 13 percent of the population. The US Census Bureau (2004) projects that in 25 years this proportion will exceed 20 percent. Over the next 50 years the United States will undergo a profound transforma- tion, becoming a mature nation in which one citizen in five is 65 or older. (Now, one person in eight is that old.) The dramatic increases to come in the older population will exert powerful pressures on health care delivery systems, on programs such as Social Security, Medicare, Medicaid, and Supplemental Security Income that provide financial support, and on social institutions such as the family that provide instrumental, financial, and emo- tional support for the elderly. As part of the same process, the older population itself will age, with large increases in the number of people who are 85 and older. In 2004, these oldest-old Americans accounted for just over 1 percent of the popula- tion (US Census Bureau 2004), but they exert a disproportionate effect on both their families and the health care system. These oldest-old men and— more frequently—women are much more likely than the young-old to live in nursing homes, to have substantial disabilities, and to have restricted fi- nancial resources. Both the American population and the population of the world are adding oldest-old members at a much faster rate than any other age group. This means that the numbers of very old people will increase and the pro- portion of the population that is very old will rise. The Census Bureau (2004) projects that the US population aged 85 and older will double from about 4.3 million today to about 7.3 million in 2020, then double again to 15 3 PDR 30 supp Waite/au/EPC/sp 3 1/26/05, 9:45 AM 4 T HE DEMOGRAPHIC FACES OF THE ELDERLY million by 2040, as members of the very large baby boom cohorts born af- ter World War II reach these ages.