March 1, 2022

When workers develop disabilities on the job, it often has some connection to where they live.

Musculoskeletal conditions like arthritis and tendinitis can happen anywhere but are especially prevalent in a swath surrounding the Kentucky-West Virginia border and running south to Alabama. Intellectual disabilities and mood disorders like autism and depression are common in Vermont, New Hampshire, Massachusetts, and Rhode Island.

The hot spots, described in new research, represent areas that fall in the top 10 percent of all the areas with awards for the specific condition in many of the years studied, 2005 through 2018.

New Hampshire is a dramatic example: all 10 designated areas of the state were identified as hot spots for awards based on mental disorders in all 14 years.

In addition to mental and musculoskeletal conditions, the researchers from Mathematica found a third major hot spot for circulatory and respiratory disorders like heart disease and asthma. These disorders are prevalent in an area that starts in Indiana and Illinois and flows down the Mississippi River to Mississippi.

The explanations for the hot spots are myriad and complex. Musculoskeletal disabilities constitute the largest single type of benefit award – a third of the U.S. total – and hot spots in the Southeast, where coal mining, agriculture and manufacturing are dominant, tend to have older, less educated populations and more veterans. …Learn More

Research

November 18, 2021

The federal minimum wage is $7.25 an hour and hasn’t budged since 2009. But many states and some municipalities have raised their minimum wages. Today, more than half of the state minimums exceed the federal minimum.

Now a new trend has emerged: 19 states have enacted or approved automatic yearly increases in their minimum wages to protect their residents from inflation. These adjustments just went into effect this year in Arizona, Colorado, Maine, and Washington D.C.

How might higher minimum wages affect applications for disability insurance? On the one hand, the higher pay could prevent some people with mild disabilities from resorting to the fallback option: applying for disability benefits. But if small employers lay people off to cut costs or feel they can’t afford to hire workers at the new higher minimum wage, applications could go up. Facing fewer job opportunities, more low-wage workers might apply for benefits from a program that currently covers some 16 million Americans.

A new study finds that a rising minimum wage does, indeed, increase disability applications to the U.S. Social Security Administration. But the researchers stress that this impact is minimal compared with the increase driven by an economic downturn that throws more people out of work.

In their analysis of nearly 3,000 counties from 2000 through 2015, a one-dollar increase in the minimum wage added some 80,000 more applications to the disability program and its companion, the Supplemental Security Income program for the poor, elderly, and adults with disabilities. That represents a 2 percent increase.

Contrast that to the impact of a rising unemployment rate, which was about three times larger. …Learn More

Behavior

November 2, 2021

Opioid painkillers are a double-edged sword for older workers. The medications allow them to keep working through their joint or back pain. But a slide into addiction would interfere with doing their jobs.

A new RAND study of workers over age 50 has identified some of the negative consequences of relying on opioids. Rather than promoting work, the researchers found that opioids can cause or exacerbate disabling health conditions, hindering users’ ability to work and making them increasingly dependent on federal disability benefits over time.

Bad results from opioid overuse may seem predictable, given that doctors prescribe them to people who are in worse physical condition in the first place. But older workers’ health is already in decline, just by virtue of their age, so it’s not always clear how, or to what extent, opioids are affecting them.

The researchers sorted this out using a 2009 survey of older Americans in the long-running Health and Retirement Study (HRS). They matched people who didn’t take the medications with similar people who did – similar in everything from their functional limitations and sociodemographics to their labor market histories. The HRS continued to interview both groups over the next decade, allowing the researchers to compare the opioids’ effects over a longer period than prior studies.

For example, although the opioid users and non-users were in similar health in 2008, things changed dramatically – and quickly – the researchers found. As early as 2012, the opioid users were significantly more likely to have developed a disabling condition that limited their work capacity.

Opioid use or abuse is linked to myriad health problems. Overuse can exacerbate autoimmune conditions such as rheumatoid arthritis. Users also have less healthy lifestyles and are prone to infectious diseases and mental illness, and opioids can impair lung function. …Learn More

Research

July 27, 2021

With the nation still in the midst of an opioid crisis, a new study provides the first estimate of opioid use among people who apply for disability.

One out of every four applicants used opioids in 2017 – below the peak in 2012 but still significantly more than in the general population, according to researchers at Mathematica and the U.S. Social Security Administration.

And the researchers may be underestimating the extent of opioid use. Their data come from Social Security’s disability application forms. The forms ask applicants to list their prescriptions, including opioids taken for musculoskeletal pain such as a bad back, as well as their non-prescription drug use, and the stigma around use and abuse may encourage underreporting.

To estimate opioid use required creating a database because none existed. The researchers mined the text fields in each disability application using machine learning to find information about opioid use and then entered the information into the database.

Some interesting demographic trends emerged from the study. Opioid use is most prevalent in middle age, at around 30 percent of disability applicants in their 40s and 50s. “This is notable,” the researchers said, because if Social Security grants their requests for benefits, they “may remain on the [disability rolls] for 25 years.”

In a breakdown by education levels, the biggest opioid users had attended college but didn’t get a degree. Women’s use exceeded men’s throughout the study’s 10-year period, mirroring the population as a whole. And a state-by-state breakdown shows that applicants’ opioid use fell across the nation during that time. But Alabama, Arkansas, Michigan, and Nevada still had particularly high rates in 2017. …Learn More

Research

September 10, 2020

The mix of disabilities for people receiving federal disability insurance has changed in important ways that often reflect trends in the health of the population as a whole.

Two disabling conditions that have become a growing share of Social Security’s benefit awards in recent decades are mood disorders and various musculoskeletal problems, which include arthritis and back pain.

First, consider mood disorders. They range from depression and bipolar disorder to irritability and seasonal affective disorder, and they can hamper someone’s ability to work. Mirroring the rising share of awards for mood disorders, their prevalence in the population has edged up from 54.6 percent of adults in 1997 to 56.2 percent in 2017, according to a study by Mathematica, a research organization.

Second, disability awards to people with musculoskeletal problems like arthritis and back pain have increased dramatically. These conditions are often aggravated by carrying excess weight, so the rise in cases aligns with the researchers’ estimate that the adult obesity rate has surged from about 20 percent to 31 percent. 

But a related finding about musculoskeletal conditions is more difficult to explain. Despite the growth in disability awards involving these conditions, the share of the population afflicted by them – about a third – hasn’t changed much, according to the study, which was conducted for the Retirement and Disability Research Consortium.

The researchers found one clue to this apparent contradiction in a separate analysis indicating that this population’s ability to work may be deteriorating over time. …Learn More

Research

August 11, 2020

The X-rays look very similar for two 60-year-old women with arthritic knees.

But the less-educated woman has more severe pain than the person who graduated college.

A new study of men and women finds that the degree of knee-joint deterioration visible in an X-ray isn’t the primary reason one person experiences more knee pain than someone else. Instead, the overwhelming reason is knee strain caused by obesity and the toll taken by physically demanding jobs – both of which are more common among less-educated workers.

The researchers focused on knee arthritis, because musculoskeletal pain is one of the leading causes of Social Security benefit payments to people who develop a disability and can no longer work.

Understanding what’s behind the pain differences is important, because the need for workers in certain jobs requiring physical strength – home health aides, janitors, and construction workers are examples – is expected to increase in the future.

Given this growing demand and predictions of a continued rise in obesity, the researchers conclude that “pain is expected to contribute to an increase” over time in the percentage of the population who will be impaired by their pain.

The people in the study fell into three educational groups: a high school degree or less; some college; or a four-year college degree. The researchers also had information about their occupations, as well as several data sources that gauge the severity of their knee pain, including the ability to do things like walking a quarter of a mile.

Knee arthritis worsens with age. However, a surge in reports of severe knee pain came about a decade earlier for people with no more than a high school degree than the surge for college graduates. …Learn More

April 30, 2020

Resourceful retirees usually weather the financial surprises that come their way. But a handful of unexpected health events can really hurt.

The death of a spouse is at the top of the list. Net worth drops by more than $30,000 over a couple of years as retirees pay for the extraordinary medical and other expenses surrounding a spouse’s death.

Two serious health conditions also deplete retirees’ assets: strokes and lung disease, which strike about one in five older Americans during their lifetimes, according to a National Bureau of Economic Research study funded by the U.S. Social Security Administration that tracked changes in the finances of people 65 and over.

Despite the presence of Medicare, a first-time stroke reduces a retired household’s average wealth by more than $25,000 – or 6 percent – and lung disease reduces it by about $29,000.

Net worth in this study includes financial assets and home equity minus debts.

These estimates of the cost of various events provide new information about a few of the many unknowns that go into retirement planning. Workers who may think they are saving enough to cover their routine retirement expenses don’t necessarily factor in medical and related costs that are difficult or impossible to predict.

Taken together, single and married retirees will use anywhere from 3 percent to 14 percent of their wealth to pay these unpredictable expenses. But wealthy retirees, who can afford first-rate care, spend much more than the average, while poor people, who have Medicaid to supplement their Medicare, spend very little. …Learn More