Trends and Disparities in the Number of Self-reported Healthy Older Adults in the United States, 2000 to 2014

Previous research has examined trends in the health of older adults who are frail or in otherwise poor health.¹ Collectively, this body of evidence points to encouraging improvements. It is well recognized, though, that health is a spectrum and examining only those in poor health neglects to consider how good health (the goal of public health and policy initiatives) is distributed in the general population. Use of disability trends alone to evaluate population health is analogous to making conclusions about the US economy based solely on the poverty rate. Because healthy older adults are a sizeable and growing segment of the US population,² it is important to better appraise the full spectrum of health among older adults. Examining the distribution of good health among older adults has implications for planning overall health care needs for older adults and understanding whether improvements are distributed across all socioeconomic groups.

Methods

We examined trends in the rate of healthy older adults (ie, those ≥65 years) from 2000 to 2014. To do so, we used nationally representative data from the Medical Expenditure Panel Survey to identify older adults who reported their general health to be either “excellent” or “very good” on 2 separate occasions in the same calendar year. We examined trends overall as well as separately by socioeconomic group (Table). To account for changes in age and sex composition over time, rates were adjusted for age and sex using the direct adjustment method (2010 US Census population was the reference distribution). This study used publicly available and deidentified data, and was granted an exemption from institutional board review by the University of Michigan Health Sciences and Behavioral Sciences Institutional Review Board. Complex survey design methods were used to make national estimates.

Table.

Change in the Age- and Sex-Adjusted Rate of Healthy Older Adults, 2014–2000(2014 Rate)^a

Characteristic	Change in Age- and Sex-Adjusted Rate 2014–2000 (2014 Rate), No. per 1000 Population
Sex
Male	38 (480)
Female	77 (490)
Race/ethnicity
Non-Hispanic white	91 (533)
Non-Hispanic black	−63 (303)
Hispanic	−54 (283)
Other	108 (423)
Educational level
High school or less	−10 (377)
Some college	62 (546)
Bachelor’s degree	42 (569)
Graduate degree	56 (630)
Family annual income categoryb
Poor or near poor	−45 (321)
Low family income	−16 (360)
Middle family income	37 (453)
High family income	113 (603)
Marital status
Married	87 (515)
Widowed/divorced/separated	48 (464)
Never married	−70 (382)
US census region
Northeast	35 (501)
Midwest	14 (494)
South	79 (455)
West	99 (520)

^aHealthy was defined as either “excellent” or “very good” self-reported health status twice during the calendar year.

^bFamily annual income measured as a percentage of the federal poverty line as poor or near poor (<125%), low family income (125%to <200%), middle family income (200% to <400%), and high family income (≥400%).

Results

The total number of healthy older adults in the United States increased from 14.0 million (42.4% of all older adults) in 2000 to 22.4 million (48.2% of all older adults) in 2014. The rate of healthy older adults increased from 426 per 1000 population in 2000 to 485 per 1000 population in 2014 (P < .001 for trend). The age-and sex-adjusted rate of healthy older adults differed significantly by race/ethnicity, level of educational attainment, and family annual income level (Table). Across the entire period, older non-Hispanic white individuals were more likely to report being healthy, and that rate increased over time, from 442 per 1000 population in 2000 to 533 per 1000 population in 2015 (Figure). Those with higher educational attainment had the greatest gains in the rate of healthy older adults; for instance, among those with a graduate or advanced degree, the rate increased by 56 per 1000 population from 2000 to 2014. Older adults in the highest level of family annual income exhibited the highest rate of reporting themselves to be healthy over the entire period and increased steadily from 490 per 1000 population in 2000 to 603 per 1000 population in 2014.

Figure. Age- and Sex-Adjusted Rate of Healthy Older Adults, 2000–2014.

The age- and sex-adjusted rate of healthy older adults by race/ethnicity (A), level of education (B), and level of family annual income (C). Family annual income measured as a percentage of the federal poverty line as poor or near poor (<125%), low family income (125% to <200%), middle family income (200% to <400%) and high family income (≥400%).

Discussion

The population of healthy older adults is on the rise in the United States, and this increase is not distributed uniformly across socioeconomic groups. Despite universal health insurance coverage under Medicare, older adults are not isolated from pervasive health disparities. While differences in the rate of healthy adults across these factors at any one point confirm known differences,^3–5 our new finding regarding widening gaps by race/ethnicity and socioeconomic status is concerning. This finding supports the notion of “2 different Americas” having formed.⁶ We also found that the distribution and trend in good health among Hispanic adults approximates that of non-Hispanic black adults, in contrast to the “Hispanic paradox” (ie, previous findings of health comparable to non-Hispanic white individuals despite lower socioeconomic status).

The aging US population, coupled with its growing diversity, marks a critical need to develop policies above and beyond those regarding access to health care in order to address these widening disparities in health.