High costs of poverty for active life expectancy after mid-life: Half the life expectancy, double the disability

International research associates poverty with more disability and shorter life. Few U.S. studies address this topic, in part due to inadequate income data. We examined associations between income, disability, and life expectancy with a cohort ages 55+ (mean 67.4), followed 1992-2009 in 12 waves of the nationally representative U.S. Panel Study of Income Dynamics (n=2,165). The outcome was disability in activities of daily living, such as walking or dressing. We estimated monthly probabilities of disability transitions and death with multinomial logistic Markov models focusing on 30 levels of income adjusted for family characteristics, controlling for age, gender, ethnicity, education, and other factors. Measures were updated at each wave, including income inflation adjustment. Using the transition probabilities, we conducted microsimulations of large populations, each individual having a full record of monthly disability status from age 55 to death. Bootstrapping addressed survey design. There was a strong gradient associating income with both outcomes. Beginning at age 55, average remaining years lived and years with disability for the highest income White women were 31.6 and 5.8; analogous estimates for women with lowest incomes were 18.1 and 7.0. Thus, women with the least income lived 13.5 fewer years, 42% of the remaining life of those with highest income, with 111% more disability as a proportion of remaining life. Results for White men: 13.6 fewer years, 116% more disability. For African Americans: 12.6/100% for women, 13.0/108% for men. Findings quantify high costs of poverty in lost life and disability in the U.S.