The Growth in the Social Security Disability Rolls: A Fiscal Crisis Unfolding

Autor, David H.; Duggan, Mark

doi:10.1257/jep.20.3.71

Cited by 315 publications

(53 citation statements)

References 15 publications

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“…(61) In 1983 musculoskeletal disorders were the fourth leading diagnostic group in disability awards; in 2003, they were the leading diagnostic group. (62). While the musculoskeletal disease classification includes conditions other than back pain, this national trend is consistent with our data on Medicare recipients under 62 years of age with chronic LBP.…”

Section: Discussionmentioning

confidence: 99%

The Rising Prevalence of Chronic Low Back Pain

Freburger¹,

Holmes²,

Agans³

et al. 2009

Arch Intern Med

1,254

876

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Background National or state-level estimates on trends in the prevalence of chronic low back pain (LBP) are lacking. The objective of this study was to determine whether the prevalence of chronic LBP, and the demographic, health-related, and care-seeking characteristics of individuals with the condition have changed over the past 14 years. Methods A cross-sectional, telephone survey of a representative sample of North Carolina (NC) households was conducted in 1992 and repeated in 2006. 4,437 households were contacted in 1992 and 5,357 households were contacted in 2006 to identify noninstitutionalized, adults 21 years and older with chronic, impairing (pain>3 months that limits daily activities). These individuals were interviewed in more detail about their health and care-seeking. Results The prevalence of chronic, impairing LBP rose significantly over the 14 year interval, from 3.9% (95% CI:3.4–4.4) in 1992 to 10.2% (95% CI:9.3–11.0) in 2006. Increases were seen for all adult age strata, in males and females, and in white and black races. Symptom severity and general health were similar for both years. The proportion of individuals who sought care from a health care provider in the past year increased from 73.1% (95% CI:65.2–79.8) to 84.0% (95% CI:80.8–86.8), while mean number of visits to all providers were similar (19.5 vs 19.4). Conclusions The prevalence of chronic, impairing LBP has risen significantly in NC, with continuing high levels of disability and care utilization. A substantial portion of the rise in LBP care costs over the past two decades may be related to this rising prevalence..

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Section: Discussionmentioning

confidence: 99%

The Rising Prevalence of Chronic Low Back Pain

Freburger¹,

Holmes²,

Agans³

et al. 2009

Arch Intern Med

1,254

876

View full text Add to dashboard Cite

show abstract

“…And, while all providers and states are subject to the same federal criteria for disability qualification, interpretation of and adherence to these criteria may not be uniform over space or time. 3 Thus, the disabled population we study may be less homogeneous in terms of function and illness than the unifying benefits program suggests.…”

Section: Limitationsmentioning

confidence: 93%

“…1 Growing numbers of Americans are applying for and receiving Social Security Disability Insurance (SSDI). 2,3 This SSDI program expansion includes a rapid rise in eligibility due to musculoskeletal conditions, often treated with prescription analgesics. In 2011, musculoskeletal conditions such as back pain, were the most common SSDI-qualifying diagnoses, accounting for 33.8% of program participants (up from 20% in 1996).…”

Section: Introductionmentioning

confidence: 99%

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Prescription Opioid Use Among Disabled Medicare Beneficiaries

et al. 2014

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Background Prescription opioid use and overdose deaths are increasing in the U.S. Among under-age-65, disabled Medicare beneficiaries, the rise in musculoskeletal conditions as qualifying diagnoses suggests opioid analgesic use may be common and increasing, raising safety concerns. Methods From a 40% random-sample Medicare denominator, we identified fee-for-service beneficiaries under-age-65 and created annual enrollment cohorts 2007-2011 (6.4 million person-years). We obtained adjusted, annual opioid use measures: any use, chronic use (≥6 prescriptions), intensity of use (daily morphine equivalent dose (MED)), opioid prescribers per user. Geographic variation was studied across Hospital Referral Regions (HRRs). Results Most measures peaked in 2010. The adjusted proportion with any opioid use was 43.9% in 2007, 44.7% in 2010 and 43.7% in 2011. The proportion with chronic use rose from 21.4% in 2007 to 23.1%, in 2011. Among chronic users: mean MED peaked at 81.3 mg in 2010, declining to 77.4 mg in 2011; in 2011, 19.8% received ≥ 100 mg MED; 10.4% received ≥200 mg. In 2011 HRR-level measures varied broadly (5th to 95th percentile): any use: 33.0% to 58.6%, chronic use: 14.0% to 36.6%; among chronic users, mean MED ranged from 45 mg to 125 mg; mean annual opioid prescribers from 2.4 to 3.7. Conclusions Among these beneficiaries, opioid use was common. While intensity stabilized, the population using opioids chronically grew. Variation shows a lack of standardized approach and reveals regions with mean MED at levels associated with overdose risk. Future work should assess outcomes, chronic use predictors and policies balancing pain control and safety.

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“…1 Figure 1 shows that the share of the working-age population receiving SSDI has more than doubled since 1990; as of the end of 2012, 8.8 million adult Americans received SSDI benefits. The rapid growth has prompted concerns about SSDI’s fiscal sustainability (e.g., Autor and Duggan 2006). …”

Section: Introductionmentioning

confidence: 99%

Unemployment Insurance and Disability Insurance in the Great Recession

Mueller

Rothstein

Wachter

2016

Journal of Labor Economics

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Social Security Disability Insurance (SSDI) awards rise during recessions. If marginal applicants are able to work but unable to find jobs, countercyclical Unemployment Insurance (UI) benefit extensions may reduce SSDI uptake. Exploiting UI extensions in the Great Recession as a source of variation, we find no indication that expiration of UI benefits causes SSDI applications and can rule out effects of meaningful magnitude. A supplementary analysis finds little overlap between the two programs’ recipient populations: only 28% of SSDI awardees had any labor force attachment in the prior calendar year, and of those, only 4% received UI.

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The Growth in the Social Security Disability Rolls: A Fiscal Crisis Unfolding

Cited by 315 publications

References 15 publications

The Rising Prevalence of Chronic Low Back Pain

The Rising Prevalence of Chronic Low Back Pain

Prescription Opioid Use Among Disabled Medicare Beneficiaries

Unemployment Insurance and Disability Insurance in the Great Recession

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