Background

The Office of the Chief Actuary (OCACT) maintains a

file of records for persons awarded disability benefits

under either the title II program (Social Security) or

the title XVI program (Supplemental Security

Income) because of an impairment associated with

HIV infection. The file is used to measure the current

impact and to forecast the future impact of the HIV

disease on these two programs which the Social Security Administration (SSA) administers, and to gauge

the role played by SSA programs in meeting the

income needs of the population disabled because of

HIV.

The file contains information on dates of benefit entitlement and of death; State and county of residence;

year of birth, sex, and race; and educational attainment, most recent occupation, and (for title II) career

average earnings. Publication of analyses of data in

the file has been limited to internal memoranda.

The SSA HIV population, limited as it is to persons

with disabling conditions precluding substantial

gainful employment which are expected to last at

least one year or result in death, is much smaller and

more disabled than the HIV population tracked in the

Centers for Disease Control and Prevention surveillance system. However, a comparison of the SSA HIV

population to a population of persons who died from

HIV illness could be useful for assessing the coverage

and quality of the SSA database, and the extent to

which SSA program benefits reached persons before

their death from HIV.

Death certificates for the 1993 National Mortality

Followback Survey of the National Center for Health

Statistics were recently successfully matched to

Social Security Administration records, the match

rate exceeding 98 percent. Although the sample consists in total of only 23 thousand deaths in 1993 at

ages 15 and above, HIV was one of several causes of

death which were oversampled, so that 2,704 certificates with HIV as the cause of death were included—

representing some 37 thousand deaths attributed to

HIV illness in 1993. This subset of certificates was

matched to the SSA HIV database and SSA program

master files to address these questions:

1. For what percent of decedents in 1993 with HIV illness listed on the certificate as the cause of death is

there a record in the SSA HIV database? Why are the

others missed? What differences are there in the

characteristics of those entitled to program benefits

and those not entitled?

2. How complete is the death information in the SSA

database? Generally we expect death information to

be essentially complete for program beneficiaries.

3. How consistent is the information on person characteristics in the two databases? We expect high consistency with respect to demographic variables, but

less with respect to socioeconomic variables.

Results

There is a record in the OCACT HIV database for

about 70 percent of the 37 thousand adults dying

from HIV illness in 1993. Death information in the

OCACT HIV file is virtually complete for these persons.

For matched cases, agreement on demographic information was quite good. For example, the files were

consistent with respect to both State of residence and

race (black/other than black) 97 percent of the time.

Socioeconomic indicators are often missing on the

benefit application record, on the death certificate, or

on both; in fact, data on occupation is missing on at

least one of a pair of matched records most of the

time. With respect to educational attainment, which

is present most of the time on both records of a

matched pair, agreement is not very high: with educational attainment broadly categorized as (a) not a

high school graduate, (b) high school graduate but no

college, (c) one to three years of college, and (d) four or

more years of college, agreement is just 64 percent.

As for the 30 percent of adults dying from HIV illness

in 1993 for whom a matching record was not found in

ACTUARIAL NOTE

Number 140

January 1999

A MATCHED-RECORDS STUDY OF AIDS DEATHS IN 1993:

SSA ADMINISTRATIVE RECORDS AND DEATH CERTIFICATES

by Bertram M. Kestenbaum, A.S.A. and Chris Chaplain, A.S.A.

SOCIAL SECURITY ADMINISTRATION

Office of the Chief Actuary
2

our special database, for about one-third of these

decedents there is, however, a record of award of program benefits in the program master files. In some of

these master records—including a significant number

of records of award of old-age, rather than disability,

benefits—the type of impairment is not identified,

but in most the impairment is identified as other

than HIV. Different causes of disablement and death

do not, of course, always indicate inconsistent coding,

because some persons may die of an impairment

other than the one responsible for their disablement. 

Of the 21 percent of persons dying from HIV illness in

1993 who were not awarded program benefits before

their death, 17 percent did not apply, presumably

because of their inability to meet program eligibility

criteria, and 4 percent applied and were denied. Title

II benefits are available only to persons with substantial and current work experience, and title XVI eligibility is restricted to persons with family assets and

income below certain thresholds. Additionally, both

programs require that an applicant be unable to

work, and title II further imposes a 5-month waiting

period on the start of benefit payments from the time

the applicant is unable to work. Furthermore, some

noncitizens are ineligible for title XVI benefits, and

both programs do not make payments to certain

incarcerated persons.

Title II disability beneficiaries first become eligible

for Medicare in their 25th month of entitlement. This

makes the decision to stop work to claim title II benefits a difficult one for persons with employer-provided

health coverage.

The table below presents distributions of several

characteristics of persons dying in 1993 from HIV illness, classified by whether they were awarded title II

benefits, title XVI benefits only, or no program benefits. The effects of eligibility criteria on program benefit recipiency is evident from the lower panels of the

table. About 3,300 of the 7,600 nonrecipients worked

in jobs covered by the Social Security program in

1993, the year of their death, and some more may

have worked in non-covered jobs. Also, about 3,300

nonrecipients were not insured for title II disability

benefits when 1993 began. Because few nonrecipients

were both working in 1993 and not insured then for

title II benefits, these two circumstances explain

most of the program benefit nonrecipiency.

Persons of the highest socioeconomic status, in terms

of education and occupation, were the most likely to

be nonrecipients: compared to an overall nonrecipiency rate of 21 percent, the rate is 26 percent for college graduates and 25 percent for managers/

professionals. This differential is primarily because

persons of this status are more likely to continue

working until near death, and partly because their

levels of resources and income preclude eligibility for

title XVI benefits. 

Finally, we note that a significant number of persons

with records in the OCACT HIV file—about 4 thousand—died in 1993 of a cause other than HIV illness

according to the death certificate. In most of these

cases, however, the certificate cause of death was similar in nature to HIV illness.
3

1 Persons who did not receive title II benefits despite being insured typically had not satisfied the 5-month waiting period requirement.

Note: Detail may not add to totals because of rounding.

Selected Characteristics of Persons Dying of HIV Illness in 1993, by Program Benefit Recipiency

(Based on records from the National Mortality Followback Survey matched to SSA administrative records)

Title II or

both titles Title XVI only No program benefits Total

Total 20,720 8,376 7,595 36,691

Sex and age

Female 15-24 70 70 50 190

25-34 510 760 330 1,600

35-44 510 990 420 1,920

45-54 160 320 200 680

55-64 60 50 20 130

65 and over 40 20 40 100

Total female 1,350 2,210 1,060 4,620

Male 15-24 120 160 90 370

25-34 6,120 1,881 1,612 9,613

35-44 8,714 2,798 2,555 14,067

45-54 2,842 944 1,723 5,509

55-64 1,145 335 525 2,005

65 and over 429 49 29 507

Total male 19,370 6,166 6,535 32,071

Educational attainment

4 or more years of college 4,075 514 1,643 6,232

1 to 3 years of college 6,042 944 1,226 8,212

High school graduate—no college 6,954 3,221 2,521 12,696

Not a high school graduate 2,533 2,336 1,251 6,120

Unknown 1,116 1,361 954 3,431

Usual occupation

Technical Sales/Administrative Support 4,634 836 996 6,466

Managerial/Professional Specialty 3,697 713 1,507 5,918

Service Occupations 3,035 1,261 794 5,090

Operator/Fabricator/Laborer 1,945 1,161 602 3,708

Precision Production/Craft/Repair 1,425 507 501 2,434

Farming/Forestry/Fishing 311 158 69 538

Military 282 0 88 370

Other 149 296 79 525

Unknown 5,242 3,442 2,957 11,641

Last year employed in a job covered by the Social Security program

Before 1979 206 763 588 1,557

1979-1983 137 818 415 1,370

1984-1988 1,694 2,267 768 4,729

1989 1,456 777 394 2,627

1990 2,160 1,108 299 3,566

1991 4,522 939 598 6,059

1992 5,615 855 1,007 7,477

1993 4,930 509 3,299 8,738

Never worked in covered job 0 339 228 567

Disability insured status at beginning of 1993

Insured 20,720 587 1 4,251 25,559

Not insured 0 7,789 3,343 11,132