# Implications of residential location in midlife disability and cognitive functioning among the poor vs. rich: within the US and cross-country comparisons

> **NIH NIH R01** · UNIVERSITY OF MICHIGAN AT ANN ARBOR · 2024 · $598,079

## Abstract

PROJECT SUMMARY/ABSTRACT
Despite that the US spends much more on healthcare than other high-income countries, the health and
life expectancy of US working-age adults has declined, losing ground further to their peers in other
countries. Identifying those most at risk for worsening health and determining the key factors
contributing to the widening health disparities in the US population is critically important and timely. The
overarching goal of this project is to clarify the multi-level factors in determining US midlife health,
focusing on disability and cognitive functioning outcomes.
We will first focus on within-US comparison determining the role of place-specific contextual factors in
disability and cognitive functioning among working-age adults in the US. We will use a quasi-
experimental approach to enhance detecting marginal effects attributable to place-level vs. individual-
level factors; we compare adults with similar individual-level characteristics and resources but living in
areas with different place-level contexts. We will examine contextual factors of multi-level geographic
units such as tract-level social vulnerability and built environment, county-level social programs and
resources, and state-level social protection and healthcare policy. We will also capitalize on life-history
data that provide residential histories over the entire life course to help understate the level of exposure
and differential effect by life stage.
We will then identify factors contributing to the relative position of US midlife disability and cognitive
functioning compared to other high-income European countries. We will use harmonized survey data
from the Health and Retirement Study (HRS), English Longitudinal Study of Ageing (ELSA), and Survey
of Health, Ageing and Retirement in Europe (SHARE). We will assess the extent to which national-level
economic inequality, healthcare system, and social protection policies affected the relative position of
the US among low- vs. high-SES adults. We will then examine the extent to which local-area factors
contribute to the difference in the outcomes across countries by leveraging and extending the study
team’s novel procedure to harmonize local-area contextual data across countries and link the
contextual data to each survey.
This study will contribute to clarifying socioeconomic, physical, and institutional factors for geographic
variation in midlife health by intersecting multi-level contextual factors with individual-level
socioeconomic characteristics. The project will also advance data for the comparative assessment in
cross-country health disparity by generating the local-area data harmonized across high-income
countries, which will be released in full compliance with confidential data protection policies.
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## Key facts

- **NIH application ID:** 10752694
- **Project number:** 5R01AG080491-02
- **Recipient organization:** UNIVERSITY OF MICHIGAN AT ANN ARBOR
- **Principal Investigator:** HwaJung Choi
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $598,079
- **Award type:** 5
- **Project period:** 2022-12-15 → 2027-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10752694

## Citation

> US National Institutes of Health, RePORTER application 10752694, Implications of residential location in midlife disability and cognitive functioning among the poor vs. rich: within the US and cross-country comparisons (5R01AG080491-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10752694. Licensed CC0.

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