Racial/Ethnic Differences in the Development of Disability Among Older Adults

Abstract

Objective-This study investigates differences in developing activities of daily living (ADL) disability among non-Hispanic Whites, African Americans, Hispanics interviewed in Spanish (Hispanic/Spanish), and Hispanics interviewed in English (Hispanic/English) Methods-Six-year risk for disability development is estimated from 8161 participants age 65 or older free of baseline disability in a population-based sample. Mediating factors amenable to clinical and public health intervention on racial/ethnic difference are evaluated.Results-The risk for developing disability among Hispanic/English was similar to Whites (hazard ratio [HR] = 0.99, 95% confidence interval [CI]: 0.6, 1.4), but substantially elevated for African Americans (HR=1.6, 95%CI: 1.3, 1.9) and Hispanic/Spanish (HR=1.8, 95%CI: 1.4, 2.1). Adjustment for demographics, health, and socioeconomic status reduced a large portion of those disparities (African American adjusted HR=1.1, Hispanic/Spanish adjusted HR=1.2).Conclusion-Excess risks for developing disability among older African Americans and Hispanic/ Spanish compared to Whites are largely attenuated by health and socioeconomic differences. Language and culture specific programs to increase physical activity and promote weight maintenance may prove to be efficient strategies to both reduce national ADL disability rates in the future and reduce racial/ethnic disparities in disability. INSTITUTIONAL REVIEW BOARD APPROVAL. This study received exemption from Human Subjects Review by the Northwestern University Institutional Review Board for these analyses of public data. Disability among older adults is a major health issue that is tied to high personal and economic costs. The number of Americans age 65 or older with chronic disability exceeds 7 million people. 1 Maintaining the quality of life for older adults by delaying disability may be as important as prolonging life. 2, 3 Medical spending among older adults is related more strongly to the presence of disability than remaining life expectancy. 4,5 Long-term care expenditures for older persons are projected to reach $161 billion by 2010, of which two-thirds is paid by government programs. 6 The composition of the U.S. population is changing. In 2000, 18% of people in the U.S. spoke a language at home other than English, up from 11% in 1980. 7 The fastest growing part of the U.S. population over 65 is among minority groups, particularly African American and Hispanic. 8 As numbers of older minorities increase, well documented public health concerns grow regarding racial/ethnic disparities in health outcomes. 9 While disability trends have declined among older Americans, racial/ethnic disparities persist. 1, 10-13 Literature on racial/ ethnic disparities in disability largely evaluate African American experiences; national studies investigating disability among Hispanics are limited 1,12,14,15 Despite the common practice of conducting interviews in languages other than English to allows respondent to participate in their primary language, few nat...

Self-Reported Sleep in Older African Americans and White Americans

“…Like sleep complaints, disability is common in older adults, with approximately 35%-50% of older adults having some difficulties with activities of daily living. Consistent with previous studies, 34,35 there was an increased burden of disability among African Americans. Further, sleep was a predictor of disability in our study.…”

Socioeconomic and Ethnic Differences in Disease Burden and Disparities in Physical Function in Older Adults

“…Contrary to studies that report ethnic disparities in disability, [4][5][6][7][8][9] we found that risks of functional limitations were generally similar between non-Hispanic Blacks, Mexican Americans, and non-Hispanic Whites after adjustment for demographic characteristics-including education level and poverty index-and disease burden. Similar findings were recently reported by Song et al using data from the Health and Retirement Study.…”

“…Musculoskeletal conditions, chronic neurological and cardiopulmonary disorders, sensory and cognitive deficits, anemia, sarcopenia, and chronic pain may lead to functional limitations and disability. Many of the chronic health conditions that can affect physical functioning are more common among ethnic minorities and economically disadvantaged groups, 5,6,[9][10][11][12] raising the question of whether a greater burden of disease can primarily explain the higher prevalence of functional limitations and disability in these groups. Previous studies of socioeconomic and ethnic disparities in functional limitations reported unadjusted data or data adjusted only for differences in demographic characteristics.…”

“…10,11,[23][24][25][26][27] Few studies have examined the role of differences in comorbid conditions, obesity, or smoking or simultaneously examined a range of indicators of disease burden. 6,9,28 We sought to determine whether socioeconomic and ethnic differences in functional limitations among noninstitutionalized older adults in the United States remain after adjusting for measures of disease burden.…”

The association between skin color/race and health indicators in elderly Brazilians: a study based on the Brazilian National Household Sample Survey (2008)

“…In some studies, the explanatory role of color/race in the functional decline of elderly is controversial. In the United States, race explains functional decline in the elderly, even after adjusting for socioeconomic variables 29,38 . However, in England and Brazil this association has still not been observed 6,9,16 .…”