NB20-11: The Interaction of Health, Genetics, and Occupational Demands in DI Determinations

Evaluations of Social Security Disability Insurance (DI) applications are based not only on poor health, but in most cases, consider the vocational factors of age, education and work experience to determine whether individuals can work. DI determinations based on these factors have grown threefold since 1985 (Michaud et al., 2018). Yet little is known about the relationship between DI activity and the ability to meet occupational requirements (Rutledge et al., 2019). Moreover, there is strong evidence that morbidity and mortality are distributed unequally across occupations (Marmot et al., 1991), perhaps because differential work environments may exacerbate disability but also because individual-level underlying health is unlikely to be randomly distributed across occupations (Mackenbach et al., 2017).
Together, these phenomena result in complex relationships of DI determinants with both the independent and joint effects of health and occupational demands. Disentangling the contributions of these forces is challenging, because selection into occupations by health is often unobserved and because data on occupational demands for employment histories is limited. We propose to triangulate between these factors by using a rich set of data linkages from the Health and Retirement Study. Our project aims are as follows: First, we ask whether there exist differences in DI application, receipt, and denial as a function of the occupational demands of applicant’s employment history. Secondly, we examine whether these differences can be explained by selection into occupational class by health, using both observed health and genetic data to capture unobserved health.