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Cited by 40Health disparities and outcomesRetirement, Disability, and EmploymentSocial Policy and Reform Studies

Social security and mortality: The role of income support policies and population health in the United States

Open access
Arno, Peter S, House, James S, Viola, Deborah, Schechter, Clyde·2011·Journal of Public Health Policy
DOI 10.1057/jphp.2011.2PMC PMC3148579
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Abstract

Social Security is the most important and effective income support program ever introduced in the United States, alleviating the burden of poverty for millions of elderly Americans. We explored the possible role of Social Security in reducing mortality among the elderly. In support of this hypothesis, we found that declines in mortality among the elderly exceeded those among younger age groups following the initial implementation of Social Security in 1940, and also in the periods following marked improvements in Social Security benefits via legislation and indexing of benefits that occurred between the mid-1960s and the early 1970s. A better understanding of the link between Social Security and health status among the elderly would add a significant and missing dimension to the public discourse over the future of Social Security, and the potential role of income support programs in reducing health-related socioeconomic disparities and improving population health.

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Crossref · 10.1057/jphp.2011.2

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

9 of 25 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Higher SSI benefit levels reduced disability among beneficiaries aged 65 and older, robust across disability measures and Medicaid receipt.

    “They conclude that higher SSI benefit levels reduced disability in this group and their results remained robust regardless of the disability measure used (self-reported health condition or census Activities of Daily living (ADL) measure) and whether or not beneficiaries also received Medicaid (state programs to pay for medical care used by the indigent) payments for medical services.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [6] Herd, P., Schoeni, R.F. and House, J.S. (2008) Upstream solutions: Does the supplemental security income program reduce disability in the elderly? The Milbank Quarterly 86: 5–45. source

      The Results and Summary and Discussion link higher state SSI benefit maximums to lower disability among adults aged 65 and older, and report broadly similar findings using a census ADL measure. But the analysis did not estimate the effect specifically among SSI beneficiaries; it studied broader populations, including a low-income subgroup. The Medicaid analyses tested whether Medicaid participation or spending confounded the finding, not whether it held separately for beneficiaries who did and did not receive Medicaid. No page numbers are available in our copy. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Findingown data

    Era-to-era comparisons show that average absolute mortality declines occurred in all age groups.

    “The era-to-era comparisons clearly indicate that average absolute mortality declines (and the annual percent declines) were experienced within all age groups.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Mortality decline is linear over time.
    • The authors state this as an assumption: Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.
  • Findingown data

    Annual percent mortality declines within eras differed between younger and older age groups.

    “The annual percent declines within eras, however, are inconsistent across younger and older age groups.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Mortality decline is linear over time.
    • The authors state this as an assumption: Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.
  • Findingown data

    Average annual absolute mortality reductions were consistently larger in groups aged 65 and older than in younger groups, except for non-infectious disease mortality among those 75 and older in 1930-1939.

    “larger reductions in average annual absolute mortality rates are consistently observed in the groups aged 65 years and older compared with those younger than 65 years with the one exception of non-infectious disease mortality for those ≥75 in 1930–1939.”
    Quote in the paperNot a substantial claim
    • The authors state this as an assumption: Mortality decline is linear over time.
    • The authors state this as an assumption: Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.
  • Findingown data

    Non-infectious disease mortality fell throughout the first 80 years of the twentieth century.

    “Our most convincing test showed that non-infectious disease mortality declined throughout the first 80 years of the twentieth century.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Mortality decline is linear over time.
    • The authors state this as an assumption: Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.
  • Classified as probably not a substantial claim. 12
  • May combine two claims. 12
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Social Security has been credited with reducing poverty for millions of Americans, especially the elderly.

    “It has been credited with alleviating the burden of poverty for millions of Americans, particularly for the elderly.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [8] Englehardt, G.V. and Gruber, J. (2004) Social Security and the Evolution of Elderly Poverty. Working Paper 10466. Cambridge MA: National Bureau of Economic Research. source

      The Conclusion says the decline in elderly poverty is commonly credited to Social Security and that the authors’ analysis suggests Social Security growth can explain that decline. The paper supports the elderly-poverty point, but the cited passages do not establish that millions of Americans were helped or assess poverty reduction among Americans generally. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Classified as probably not a substantial claim.

    Premisecitation

    Low socioeconomic position, measured by poverty, income, wealth, education, or occupation, has repeatedly been linked to greater disease and death in the US and elsewhere.

    “Low socioeconomic position, measured variously in terms of poverty, income, wealth, education, or occupation, has been repeatedly linked to a greater burden of disease and death in the United States and other countries.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [1] Adler, N.E. and Rehkopf, D.H. (2008) U.S. disparities in health: Descriptions, causes, and mechanisms. Annual Review of Public Health 29: 235–252. source
    • cites [2] Marmot, M. and Wilkinson, R.G. (2006) Social Determinants of Health, 2nd edn. Oxford: UK Oxford University Press. source
    • cites [3] Lantz, P.M., House, J.S., Lepkowski, L.M., Williams, D.R., Mero, R.P. and Chen, J. (1998) Socioeconomic factors, health behaviors, and mortality. Journal of the American Medical Association 279: 1703–1708. source
    • cites [4] Pappas, G., Queen, S., Hadden, W. and Fisher, G. (1993) The increasing disparity in mortality between socioeconomic groups in the United States, 1960 and 1986. New England Journal of Medicine 329: 103–109. source

  • May combine two claims.

    Premisecitation

    Medicare grew and treatment and prevention of life-threatening chronic diseases, especially heart disease, improved from 1971 to 1985.

    “the period 1971 to 1985 saw the growth of Medicare and improvement in the treatment and prevention of life-threatening chronic diseases, especially heart disease.”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [35] Cutler, D. and Meara, E. (2004) Changes in the age distribution of mortality over the 20th century. In: D.A. Wise (ed.) Perspectives on the Economics of Aging. Chicago, IL: University of Chicago Press, pp. 333–366. source

      Section 9.4 (page not supplied) describes advances in treating and preventing heart disease and a sustained decline in cardiovascular mortality beginning in the mid-1960s. The paper also says Medicare likely improved elderly access to care, but the passages do not establish that Medicare grew specifically from 1971 to 1985. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
    • cites [40] Card, D., Dobkin, C. and Maestas, N. (2009) Does Medicare save lives? The Quarterly Journal of Economics 124 (2): 597–636. source

      Section III describes California hospital data from 1992–2002, and Section V.B reports changes in treatment at age 65, including for heart attacks. Neither addresses whether Medicare grew or treatment and prevention of chronic disease improved from 1971 to 1985; searches for those years and the claimed historical trend found no supporting passage. Page numbers were not available in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Antibiotic use for infectious disease emerged and grew in clinical medicine from 1940 to 1955.

    “Specifically the period from 1940 to 1955 was also one in which the use of antibiotics in the treatment of infectious disease emerged and grew in clinical medicine”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [35] Cutler, D. and Meara, E. (2004) Changes in the age distribution of mortality over the 20th century. In: D.A. Wise (ed.) Perspectives on the Economics of Aging. Chicago, IL: University of Chicago Press, pp. 333–366. source
      Experimental — accuracy not yet measured
    • cites [40] Card, D., Dobkin, C. and Maestas, N. (2009) Does Medicare save lives? The Quarterly Journal of Economics 124 (2): 597–636. source

      The Introduction and Section V.B discuss hospital admissions and treatment around Medicare eligibility at age 65, not the historical adoption of antibiotics. Searches for “1940 to 1955” and for antibiotic use in infectious disease found no passage addressing the claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Smoking decline and the civil rights movement had salutary population health effects beginning in the 1960s.

    “Similarly, both the decline in smoking rates and the civil rights movement have been shown to have had salutary impacts on population health beginning in the 1960s.”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [35] Cutler, D. and Meara, E. (2004) Changes in the age distribution of mortality over the 20th century. In: D.A. Wise (ed.) Perspectives on the Economics of Aging. Chicago, IL: University of Chicago Press, pp. 333–366. source

      Section 9.4 identifies reduced smoking after 1960 as an important behavioral change associated with better health. Section 9.5.3 reports evidence suggesting that the Civil Rights Act, together with Medicaid expansion, improved access to care and health outcomes for the poor. It does not establish a separate population-wide health effect of the civil rights movement; the paper also cautions that multiple factors affected racial differences in infant mortality. Page numbers were not available in our copy. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [41] Kaplan, G.A, Ranjit, N. and Burgard, S.A. (2008) Lifting gates, lengthening lives: Did civil rights policies improve the health of African American women in the 1960s and 1970s? In: R.F. Schoeni, J.S. House, G.A. Kaplan and H. Pollack (eds.) Making Americans Healthier. New York: Russell Sage Foundation, pp. 145–169.

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In China, falling pension wealth led households to cut education and health spending on children.

    “as ‘pension wealth declines, households reduce their expenditures on education and health for children’.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] Feng, J., He, L. and Sato, H. (2009) Public Pension and Household Saving: Evidence from China. Bank of Finland, Institute for Economies in Transition, BOTIT Discussion Papers, No 2009/02. source

  • May combine two claims.

    Findingown data

    For age groups under 65, mortality declines before and after 1940 were nearly identical, and their rates of decline were modest and not statistically different across periods.

    “This is in stark contrast to the groups younger than 65 years, whose mortality rate declines before and after 1940 remained virtually the same. Furthermore, the rates of mortality decline for these younger age groups were modest and not statistically different across the time periods.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Mortality decline is linear over time.
    • The authors state this as an assumption: Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.

  • May combine two claims.

    Findingown data

    Mortality declines were larger in 1970-1984 than in 1955-1969, and in 1940-1954 than in 1900-1939.

    “The magnitude of these declines is, however, greater for the 1970–1984 period compared to the 1955–1969 period, as well as the 1940–1954 period compared to the 1900–1939 period.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Mortality decline is linear over time.
    • The authors state this as an assumption: Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.

  • May combine two claims.

    Findingown data

    In both 65-and-older groups, mortality decelerated sharply in 1940-1954 and 1970-1984, with the steepest decline in the first half of each interval.

    “in both of the two age groups 65 years and older, there was a sharp deceleration of mortality in both the 1940–1954 and 1970–1984 eras, with sharpest rate of decline in the first half of both of these intervals.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Mortality decline is linear over time.
    • The authors state this as an assumption: Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.

  • May combine two claims.

    Findingown data

    Non-infectious disease mortality rates fell throughout the 1900s in both younger and older strata, but older groups' declines were almost always larger.

    “non-infectious disease mortality rates declined throughout the 1900s in both the young and elderly age strata, but the rates of decline for the elderly were in almost all instances higher than those for the younger age groups.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Mortality decline is linear over time.
    • The authors state this as an assumption: Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    SSI had a larger mortality impact than Social Security benefits, attributed to SSI going only to the poor and near-poor elderly.

    “They also found that SSI has an even larger impact on mortality than Social Security benefits, which they attributed to the fact that SSI goes exclusively to the poor and near-poor elderly.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Behrman, J.C., Sickles, R. and Taubman, P. (1998) Causes, Correlates and Consequences of Death among Older Adults: Some Methodological Approaches and Substantive Analyses. Boston, MA: Kluwer Academic Publishers, pp. 109–129. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Residual plots showed no autocorrelation.

    “Our residual plots show no signs of autocorrelation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    In the US, a plausible cause of smaller health disparities is that people 65 and older are the only group with a substantial welfare safety net, including Social Security since 1940 and Medicare since 1965.

    “Particularly in the United States, one plausible cause of reduced health disparities is that the population aged 65 years or older is the only one that has a substantial social welfare safety net – both income support via Social Security since 1940 and later universal health insurance via Medicare (the Federal program of health insurance for the elderly) since 1965.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Public pension income affects household consumption and may indirectly affect health outcomes.

    “In other words, the existence of public pension income affects household consumption and may have an indirect effect on health outcomes.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    The era differences largely held for absolute and annual percent mortality declines and support the hypotheses.

    “These patterns of differences between eras largely held for both absolute declines in mortality rates, as well as annual percent declines and support our hypotheses.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: Mortality decline is linear over time.
    • The authors state this as an assumption: Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.

  • The quote only partly states this claim.

    Interpretationcitation

    These findings affirm that income policies can improve health outcomes among the elderly.

    “These findings affirm that income policies have potential for improving health outcomes among the elderly.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The analyses could not separate beneficiaries by income level within each era.

    “We could not distinguish between income levels of beneficiaries within each era.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductnone given

    Unmeasured factors affected mortality among cohorts born in the late nineteenth century, especially in 1900-1930.

    “there are undeniably a host of unmeasured factors affecting mortality among the age cohorts born in the last half of the nineteenth century particularly affecting mortality in the 1900–1930 era.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    The health benefit of Social Security may be correlated with the share of total income the benefit represents.

    “It is likely that the beneficial impact of Social Security on health could be correlated with the proportion of total income the benefit represents.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The sharp cardiovascular disease mortality decline in the 1970s and 1980s was largest in younger groups and may explain their larger mortality declines in that era.

    “the dramatic decline in cardiovascular disease mortality in the 1970s and 1980s was most pronounced in the younger age groups and may account for larger mortality declines in these age groups during this era.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [38] CDC. (1999) Achievements in public health, 1900–1999: Decline in deaths from heart disease and stroke: United States, 1900–1999. MMWR 48: 649–656.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [39] National Center for Health Statistics. (1978) Chartbook for the conference on the decline in coronary heart disease mortality. U.S. Department of Health, Education, and Welfare. www.cdc.gov/nchs/data/misc/corltrtacc.pdf , accessed 12 December 2010. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Linear segmented regression is a partly controlled design using the pre-event trend as a control period and can use an unaffected comparison area or group.

    “According to Andersson et al, ‘Linear segmented regression analysis is a partly controlled design where the trend before the event of interest is used as a control period and can be controlled by the use of a comparison area or group that was not affected by the policy studied’.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] Andersson, K., Petzold, M.G., Sonesson, C., Lonnroth, K. and Carlsten, A. (2006) Do policy changes in the pharmaceutical reimbursement schedule affect drug expenditures? Interrupted time series analysis of cost, volume and cost per volume trends in Sweden 1986–2002. Health Policy 79 (2–3): 231–243. source

  • May combine two claims.

    Premisecitation

    In South Africa, expanded pension payments improved adults' self-reported health, increased children's height, and improved nutrition and sanitation in households pooling incomes.

    “In households where incomes were pooled with other earners, self-reported health (including psychological health) of adults was improved, children living in the households were taller, and overall nutrition and sanitation were improved.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Case, A. (2004) Does money protect health status? Evidence from South African pensions. In: D.A. Wise (ed.) Perspectives on the Economics of Aging. Chicago, IL: University of Chicago Press, pp. 287–312. source
22 of 22

  • The authors state this as an assumption.

    Mortality decline is linear over time.

    “Mortality decline is assumed to be linear over time.”

  • The authors state this as an assumption.

    Separate rates of decline may exist for each age group and all time trends are piecewise, log-linear.

    “We then modeled the logarithm of the all-cause and non-infectious disease mortality rates assuming that separate rates of decline might be found for each age group and all time trends were piecewise, log-linear.”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Figure 1 labels the oldest age group differently from the analyzed group

    Minor

    The results describe Figure 1's oldest group as ages 75-84, but the methods say the analyzed group includes everyone aged 75 or older, including those aged 85 or older.

1 of 1

Cites

Flagged first, then by citations

3 of the 45 references couldn’t be matched to a known paper.

Research works printed but not linked: 3

  1. Balan-Cohen, A. (2009) The effect of income on elderly mortality: Evidence from the Old Age Assistance Program in the United States. American Economic Association Conference Papers. http://www.aeaweb.org/assa/2009/author_papers.php?author_ID=6557 , accessed 1 January 2009.
  2. Handwerker, E.W. (2007) Empirical essays in the economics of aging. Unpublished doctoral dissertation, University of California, Berkeley.
  3. Kaplan, G.A, Ranjit, N. and Burgard, S.A. (2008) Lifting gates, lengthening lives: Did civil rights policies improve the health of African American women in the 1960s and 1970s? In: R.F. Schoeni, J.S. House, G.A. Kaplan and H. Pollack (eds.) Making Americans Healthier. New York: Russell Sage Foundation, pp. 145–169.

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Related

Authors
Arno, P. S., House, J. S., Viola, D., & Schechter, C.
Affiliations
  • New York Medical College (US)
  • University of Michigan (US)
  • Albert Einstein College of Medicine (US)
ORCID
Schechter, Clyde
Venue
Journal of Public Health Policy
Publisher
Springer Science and Business Media LLC
Published
2011-02-17
Volume
32
Issue
2
Pages
234-250
ISSN
  • 0197-5897 (ISSN-L)
  • 1745-655X
DOI
10.1057/jphp.2011.2
PMC
PMC3148579
OpenAlex
W2046289405
Cited by
40
References
45
Citations by year
2026: 1 · 2025: 7 · 2024: 1 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 1 · 2019: 3 · 2018: 4 · 2017: 1 · 2016: 1 · 2015: 1 · 2014: 2 · 2013: 1 · 2012: 1
FWCI
1.32
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of Public Health Policy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Robert Wood Johnson Foundation
  • National Institutes of Health (5p60md000514-09)
  • National Institute on Minority Health and Health Disparities (P60 MD-000514, P60MD000503)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD041028)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Demography › Retirement, Disability, and Employment
  • Social Sciences › Political Science and International Relations › Social Policy and Reform Studies
Keywords
social security, mortality, older adults, income support, population health, health disparities, social insurance
MeSH terms
Aged, Aged, 80 and over, Cause of Death, Health Policy, Humans, Income, Middle Aged, Mortality, Social Security, United States, United States Social Security Administration

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Claims read under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

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