A Joint Model for Disability, Self-Rated Health, and Mortality Among Medicare Beneficiaries—Differences by Chronic Disease and Race/Ethnicity

Abstract

Objectives Quantifying interdependence in multiple patient-centered outcomes is important for understanding health declines among older adults. Methods Medicare-linked National Health and Aging Trends Study data (2011–2015) were used to estimate a joint longitudinal logistic regression model of disability in activities of daily living (ADL), fair/poor self-rated health (SRH), and mortality. We calculated personalized concurrent risk (PCR) and typical concurrent risk (TCR) using regression coefficients. Results For fair/poor SRH, highest odds were associated with COPD. For mortality, highest odds were associated with dementia, hip fracture, and kidney disease. Dementia and hip fracture were associated with highest odds of ADL disability. Hispanic respondents had highest odds of ADL disability. Hispanic and NH Black respondents had higher odds of fair/poor SRH, ADL disability, and mortality. PCRs/TCRs demonstrated wide variability for respondents with similar sociodemographic-multimorbidity profiles. Discussion These findings highlight the variability of personalized risk in examining interdependent outcomes among older adults.