Proceedings of a Workshop

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Digital Object Identifier: https://doi.org/10.17226/29100

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2025. Health and Disability Among Working-Age Adults: Trends, Disparities, and Implications for Employment and Federal Programs: Proceedings of a Workshop. Washington, DC: National Academies Press. https://doi.org/10.17226/29100.

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WORKSHOP PLANNING COMMITTEE

EMILY M. AGREE (Chair), Johns Hopkins University

HIRAM BELTRÁN-SÁNCHEZ, University of California, Los Angeles

TYSON H. BROWN, Duke University

COURTNEY C. COILE, Wellesley College

SCOTT D. LANDES, Syracuse University

NICOLE A. MAESTAS, Harvard University

JENNIFER KARAS MONTEZ, Syracuse University

Staff

CHRISTOPHER MACKIE, Study Director

ALEX HENDERSON, Senior Project Assistant (until November 2024)

ANTHONY S. MANN, Senior Program Associate (since November 2024)

MALAY K. MAJMUNDAR, Director, Committee on Population

COMMITTEE ON POPULATION

ANNE R. PEBLEY (Chair), Distinguished Professor Emerita of Community Health Sciences, University of California, Los Angeles

EMILY M. AGREE, Research Professor, Johns Hopkins University

ALLISON E. AIELLO, James S. Jackson Healthy Longevity Professor of Epidemiology, Columbia University

RANDALL Q. K. AKEE, Associate Professor of Public Policy, University of California, Los Angeles

DEBORAH BALK, Professor, Baruch College of the City University of New York

COURTNEY C. COILE, William R. Kenan, Jr., Professor of Economics, Wellesley College

SONALDE DESAI, Distinguished University Professor, University of Maryland

KATHARINE M. DONATO, Donald G. Herzberg Professor of International Migration, Georgetown University

TOD G. HAMILTON, Professor of Sociology, Princeton University

SEEMA JAYACHANDRAN, Professor of Economics and Public Affairs, Princeton University

KENNETH LANGA, Cyrus Sturgis Professor of Medicine, University of Michigan

TREVON D. LOGAN, Hazel C. Youngberg Distinguished Professor of Economics, The Ohio State University

JENNA NOBLES, Professor of Sociology, University of Wisconsin–Madison

FERNANDO RIOSMENA, Professor of Sociology and Demography, The University of Texas at San Antonio

DAVID T. TAKEUCHI, Associate Dean for Faculty Excellence, University of Washington

Staff

MALAY K. MAJMUNDAR, Director

Acknowledgments

This document summarizes the discussions and presentations at the Workshop on Health and Disability Among Working-Age Adults: Trends, Disparities, and Implications for Employment and Federal Programs. Held as a hybrid meeting in Washington, DC, on October 15–16, 2024, the workshop was convened by the Committee on Population of the National Academies of Sciences, Engineering, and Medicine (National Academies), and it was sponsored by the National Institute on Aging.

The National Academies’ Committee on Population expresses its sincere gratitude to the planning committee chair, Dr. Emily Agree of Johns Hopkins University, for her valuable contributions to the development and leadership of this workshop. The committee also wishes to thank the members of the planning committee who collaborated to ensure workshop content that included informative presentations and rich discussions. Likewise, we want to thank the speakers and moderators, who delivered this content and discussion in an exemplary manner. Finally, the workshop would not have been possible without the support and guidance of Dr. Kriti Jain and her team at the National Institute on Aging.

This proceedings has been prepared by the workshop rapporteur as a factual summary of what occurred at the workshop. The planning committee’s role entailed planning and convening the workshop and serving as moderators. The views contained in the proceedings are those of individual workshop participants and do not necessarily represent the views of all workshop participants, the planning committee, or the National Academies.

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Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

We also thank staff member Ruth Cooper for reading and providing helpful comments on this manuscript. Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by MARK HAYWARD, University of Texas. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.

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Contents

Acronyms and Abbreviations

1 Introduction

WORKSHOP THEMES

ORGANIZATION OF THE PROCEEDINGS

2 Defining, Conceptualizing, and Measuring Disability

OVERVIEW

KEY DATA ISSUES AND THE MEASUREMENT FRAMEWORK

MEASURING WORK CAPACITY

HISTORICAL TRENDS

ENSURING EQUITY IN DISABILITY MEASUREMENT

DISCUSSION

3 Period and Cohort Trends in Disabling Morbidity—Health and Medical Drivers

OVERVIEW

DISABILITY TRENDS AND TRAJECTORIES IN THE COVID-19 ERA

OVERVIEW OF DISABILITY, PHYSICAL FUNCTIONING, HEALTH AND THE ROLES OF OBESITY AND RELATED CARDIO-METABOLIC CONDITIONS

DISABILITY TRENDS AMONG ADULTS AGES 18–44; TRENDS IN PAIN AND OTHER OUTCOMES AND LINKS BETWEEN PAIN AND DISABILITY

DISCUSSION

4 Population Disparities

OVERVIEW

CONSEQUENCES OF INTERSECTING SOCIAL STATUSES ON TRENDS IN HEALTH AND WELLBEING ACROSS ADULTHOOD

STRUCTURAL ABLEISM: ITS RELATIONSHIP TO THE BROADER TOPIC OF POPULATION DISPARITIES

VARIABILITY IN DISABILITY RISK AMONG MIDLIFE WORKING-AGE LATINOS IN THE UNITED STATES

DISCUSSION

5 Contextual Factors: Policy Influences on Morbidity and Disability

OVERVIEW

THE ROLE OF COMMUNITY AND HOUSING ENVIRONMENTS FOR OPTIMIZING FUNCTION WITH AGING

STRUCTURAL BARRIERS TO PUBLIC DISABILITY AND HEALTH INSURANCE

THE INFLUENCE OF STATE POLICY CONTEXTS ON COGNITIVE FUNCTIONING AND IMPAIRMENT

6 Workforce and Workplace Trends in Disability and Disability Policy

OVERVIEW

SOCIAL SECURITY DISABILITY REFORM AND IMPLICATIONS FOR EMPLOYMENT

IMPACT OF THE PANDEMIC ON DISABILITY EMPLOYMENT TRENDS

HOW DO EMPLOYER DISABILITY PRACTICES AFFECT DISABILITY EMPLOYMENT OUTCOMES?

EMPLOYMENT EFFECTS OF THE AMERICANS WITH DISABILITIES ACT: A FRESH LOOK

7 Synthesis and Takeaways—Research Gaps, Data and Measurement Needs, and Policy Directions

DEFINITIONS AND MEASUREMENT

DATA SOURCES AND NEEDS

IMPACTS OF POLICIES

FUTURE RESEARCH

References

Appendix: Workshop Agenda

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Box, Figures, and Table

BOX

1-1 Statement of Task

FIGURES

2-1 Statistical rearrangement by Ursus Wehrli of a mosaic by Keith Haring

3-1 U.S. disability trends, measured in activities in daily living (ADL), ages 50–64, 2000–2020

3-2 Proportion of people (y-axis) reporting pain-producing conditions as the cause of their limitations

4-1 Risk of disability by disability type, gender, age, and nativity

5-1 Household income over adulthood by disability status, ages 20–62

5-2 Percentage of Medicaid and commercial insurance enrollees with insurance gap, by age, type of insurance, and health condition, Colorado, 2014–2018

5-3 Trends in state policy liberalism by U.S. state, 1932–2020

6-1 Number of Social Security Disability Insurance (SSDI) beneficiaries, exists, and new awards, 2001–2023

6-2 Percentage of employees with disability, by type of disability, 1984–2010

TABLE

3-1 Likelihood of Developing and Recovering from a Functional Limitation (FL)

Acronyms and Abbreviations