Care Counts: Inequality in Life Expectancy with Unmet Care Needs at Older Ages

• In Event: Sociology of Population Section Roundtables
  In Refereed Roundtable (60 minute): Table 8. Aging and Population Change

Abstract

Healthy life expectancy (HLE) is widely used to assess population health and social inequalities, yet it does not capture whether functional limitations are experienced with adequate support. From a life course perspective, later-life health inequalities reflect not only differential exposure to disease and disability, but also unequal access to resources that buffer dependence once care needs emerge. This study conceptualizes unmet care needs as an important dimension of later-life health inequality, capturing how differences in resources shape the management of disabilities at older ages. Using longitudinal data from the National Health and Aging Trends Study (NHATS), 2011–2023, and Bayesian multistate life table models, we estimate life expectancy at age 65 across states defined by no care needs, met care needs, and unmet care needs. We examine disparities by education, race/ethnicity, and gender to assess how intersecting dimensions of inequality shape exposure to unsupported dependence in later life. We find that women, individuals with less than a high school education, and racial/ethnic minorities not only spend more years with care needs, but also a substantially greater share of their remaining lives with unmet care needs. By expanding the state space of life expectancy calculations to include care adequacy, this study highlights how cumulative disadvantage extends beyond morbidity and mortality into the management of later-life disabilities. These findings contribute to research on health inequalities by identifying unmet care needs as a critical site where structural inequalities are reproduced in older adulthood. Policies and programs that target social groups with greater exposure to unmet care needs may represent an important pathway for disrupting health inequalities in aging populations.

Authors

• Yongxin Shang, Yale University

• Emma Zang, Yale University