PRB

(June 2010) Disability in older Americans affects the entire population of the United States because of its impact on the level of health care spending, especially spending on long-term care. Disability also influences productivity: Individuals contribute to the U.S. economy longer if they are able to remain healthy and free of limitations that might affect their ability to work.¹ Reducing disability among disadvantaged groups would result in more equal health outcomes and substantial savings in long-term care costs.

Trends

Between 1982 and 2002, the prevalence of any disability among the elderly decreased about 32 percent, or an average of 1.4 percent per year. However, this improvement did not apply to all measures of disability or benefit all socioeconomic and demographic groups equally.² People of lower socioeconomic status did not benefit as much from declining disability rates, and there were actually increases in disability for some groups.³

An analysis based on National Health Interview Survey data from 1982 to 2002 showed that in 1982, the proportion of people 70 years or older who had a disability was substantially higher for socioeconomically disadvantaged populations, minorities, the unmarried, and women than for people with higher levels of education and income, non-Hispanic whites, those who were married, and men. The disability gaps by marital status, income, and education groups grew even wider over the 20 years of the study period; the disparity by gender remained constant; and the disparity by race and ethnicity narrowed. The gap in disability rates between the unmarried and married was less than 11 percentage points in the early years of the study but had increased to 13 percentage points two decades later. For the lowest income quartile, the disability rate was 8 percentage points higher than that for the highest income quartile in the early 1980s. This divergence further increased to around 11 percentage points over the next 20 years. Educational disparities were even more substantial. In the early part of the study period, people with zero to eight years of schooling had disability rates about 10 percentage points higher than did people with 16 or more years of education. Twenty years later, the gap between the low and the high education groups increased to 15 percentage points.⁴ The analysis also revealed that the difference between the disability rates of minorities and non-Hispanic whites declined over the 20-year period, from a 10 percentage point difference to about a 5-point gap in 2002. The disparities by gender were fairly constant—around 8 percentage points.

Another report based on the National Long-Term Care Survey found that obese and overweight persons were much more likely to experience an increase in disability over time. This was most notable among minorities, where the epidemic of obesity is disproportionately prevalent.⁵ Forty-five percent of black adults and about 37 percent of Hispanics were considered obese in the beginning of the 2000s, compared with 30 percent of the white population.⁶ The trend puts these minorities at a higher risk for disability, particularly if the onset of obesity comes at an earlier age and is therefore present for a longer period. The report concluded that overall disability rates were increasing in the early 2000s, when compared with levels during the 1990s.⁷

Disability Differences in the Black and Non-Hispanic White Populations

A recent study compared elderly non-Hispanic white and black elderly populations and found that elderly blacks experienced the onset of disability earlier than whites and at a higher overall rate.⁸ Disparities between the two groups were especially evident in people between ages 70 and 79 and declined somewhat in older age groups. Over a two-year period, the study examined functional decline, which was defined as increased dependence in more activities such as bathing, moving, dressing, eating, and using the toilet. The authors concluded that the prevalence of decline in these activities of daily living (ADLs) was greater for black study participants between the ages of 70 and 79 than for whites of the same age. However, in the above-80 age group, the risk was about the same for both races.

Socioeconomic status, the presence of chronic diseases, and general health status had the most significant impact on the prevalence of disability in the elderly population. In the beginning of the two-year study mentioned above, blacks had higher rates of smoking, diabetes, and hypertension, which are some of the most significant complex causes of disability among the elderly. Blacks were also socioeconomically disadvantaged in higher proportions than whites as indicated by educational attainment, net worth, and household income, all of which also greatly contributed to higher disability rates.

Disability Differences in Asian/Pacific Islander and Non-Hispanic White Populations

Asian Americans and Pacific Islanders in the United States are an understudied but important demographic group, as their population is projected to grow about two-and-a-half times between 2000 and 2025. Compared with the white non-Hispanic population, Asian American/Pacific Islanders 55 and older had lower disability prevalence rates in all four measures of disability: functional and ADL limitations, cognitive problems, and blindness/deafness.⁹ However, vulnerable subgroups are hidden in these collective group figures. Hawaiian/Pacific Islanders and Vietnamese had higher disability rates in all four categories than the Asian group as a whole. Both Hawaiian/Pacific Islanders and Vietnamese experienced higher rates of cognitive problems than whites, while Hawaiian/Pacific Islanders also had higher rates of functional and ADL limitations. One explanation for this is that Hawaiian/Pacific Islanders have a disproportionately high prevalence of type 2 diabetes and are at an elevated risk for obesity. These two factors significantly increase the prevalence of old-age disability. On the other hand, for Vietnamese—many of whom entered the United States as refugees—environmental and economic conditions during the early part of their lives may negatively influence their health outcomes.

Educational attainment and immigration status affect health outcomes within the older Asian populations: Asians with higher socioeconomic status and those born outside the United States were healthier than Asian Americans born in the United States. The latter trend may be attributed to immigrant self-selection, high immigrant health standards (for groups other than refugees) of the U.S. government, and healthier eating habits among Asians in their native countries.¹⁰ Additionally, Asians as a group are relatively recent immigrants and they have not fully assimilated into the American lifestyle. Acculturation increases the risk of disability and chronic diseases and, as immigrant groups spend more time in the United States, their health advantages erode.¹¹

Barriers to Assistance

Less-advantaged groups often live in poorer physical conditions, have less access to homes with assistive features (accessible bathrooms, railings), and tend to have fewer resources available to pay for health aides or assistive technology.¹² In fact, the proportion of persons using some form of assistance by race and socioeconomic status was relatively constant between 1992 and 2001; however, the types of help differed by group. A study based on data from the Medicare Current Beneficiary Survey found that the independent use of assistive technology was more prevalent among those with 13 or more years of education. Minorities were more likely than others to have someone help them with an activity.¹³ In addition to decreasing racial and socioeconomic disparities in the prevalence of disability among older Americans, increasing access to paid care and assistive technology might reduce the potential negative impact of population aging on labor productivity.

Kata Fustos is a communications intern at the Population Reference Bureau.

References

1. Teresa E. Seeman et al., “Disability Trends Among Older Americans: National Health and Nutrition Examination Surveys, 1988-1994 and 1999-2004,” American Journal of Public Health 100, no. 1 (2010): 100-107.
2. Robert F. Schoeni, Vicki A. Freedman, and Linda G. Martin, Socioeconomic and Demographic Disparities in Trends in Old-Age Disability, ed. David M. Cutler and David A. Wise (Chicago: University of Chicago Press, 2008).
3. Schoeni, Freedman, and Martin, “Socioeconomic and Demographic Disparities in Trends in Old-Age Disability.”
4. Schoeni, Freedman, and Martin, “Socioeconomic and Demographic Disparities in Trends in Old-Age Disability.”
5. Seeman et al., “Disability Trends Among Older Americans.”
6. Cynthia L. Ogden et al., “Prevalence of Overweight and Obesity in the United States, 1999-2004,” Journal of the American Medical Association 295, no. 13 (2006): 1549-55.
7. Seeman et al., “Disability Trends Among Older Americans.”
8. Sandra Y. Moody-Ayers et al., “Black-White Disparities in Functional Decline in Older Persons: The Role of Cognitive Function,” The Journals of Gerontology 60A, no. 7 (2005): 933-39.
9. Esme Fuller-Thomson, Sarah Brennenstuhl, and Marion Hurd, “Comparison of Disability Rates Among Older Adults in Aggregated and Separate Asian American/Pacific Islander Subpopulations,” American Journal of Public Health, accessed at: http://ajph.aphapublications.org/cgi/doi/10.2105/AJPH.2009.176784, on May 25, 2010.
10. Fuller, Brennenstuhl, and Hurd, “Comparison of Disability Rates Among Older Adults in Aggregated and Separate Asian American/Pacific Islander Subpopulations.”
11. Gopal K. Singh and Barry A. Miller, “Health, Life Expectancy, and Mortality Patterns Among Immigrant Populations in the United States,” Canadian Journal of Public Health 95, no. 3 (2004): I14-21.
12. Schoeni, Freedman, and Martin, “Socioeconomic and Demographic Disparities in Trends in Old-Age Disability.”
13. Vicki A. Freedman et al., Trends in Assistance With Daily Activities, ed. David M. Cutler and David A. Wise (Chicago: University of Chicago Press, 2008): 432.