Racial/ethnic differences in activities of daily living disability in older adults with arthritis: A longitudinal study

Objective To investigate racial/ethnic differences in disability onset among older Americans with arthritis. Factors amenable to clinical and public health intervention that may explain racial/ethnic differences in incident disability were examined. Methods We analyzed longitudinal data (1998–2004)...

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Bibliographic Details
Published in:Arthritis and rheumatism 2007-08, Vol.57 (6), p.1058-1066
Main Authors: Song, Jing, Chang, Huan J., Tirodkar, Manasi, Chang, Rowland W., Manheim, Larry M., Dunlop, Dorothy D.
Format: Article
Language:English
Subjects:
Activities of Daily Living
African Americans
Age Factors
Aged
Aged, 80 and over
Arthritis - complications
Arthritis - economics
Arthritis - ethnology
Arthritis - physiopathology
Biological and medical sciences
Disability
Disability Evaluation
Diseases of the osteoarticular system
European Continental Ancestry Group
Female
Health Services Accessibility
Hispanic
Hispanic Americans
Humans
Longitudinal
Longitudinal Studies
Male
Medical sciences
Medically Uninsured
Middle Aged
Miscellaneous. Osteoarticular involvement in other diseases
Odds Ratio
Risk Factors
United States
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Summary:Objective To investigate racial/ethnic differences in disability onset among older Americans with arthritis. Factors amenable to clinical and public health intervention that may explain racial/ethnic differences in incident disability were examined. Methods We analyzed longitudinal data (1998–2004) from a national representative sample of 5,818 non‐Hispanic whites, 1,001 African Americans, 228 Hispanics interviewed in Spanish (Hispanic/Spanish), and 210 Hispanics interviewed in English (Hispanic/English), with arthritis and age ≥51 years who did not have baseline disability. Disability in activities of daily living (ADL) was identified from report of inability, avoidance, or needing assistance to perform ≥1 ADL task. Results Over the period of 6 years, 28.0% of African Americans, 28.5% of Hispanic/Spanish, 19.1% of Hispanic/English, and 16.2% of whites developed disability. The demographic‐adjusted disability hazard ratios (AHR) were significantly greater among African Americans (AHR 1.94, 95% confidence interval [95% CI] 1.51–2.38) and Hispanic/Spanish (AHR 2.03, 95% CI 1.35–2.71), but not significantly increased for Hispanic/English (AHR 1.41, 95% CI 0.82–2.00) compared with whites. Differences in health factors (comorbid conditions, functional limitations, and behaviors) explained over half the excess risk among African Americans and Hispanic/Spanish. Medical access factors (education, income, wealth, and health insurance) were substantial mediators of racial/ethnic differences in all minority groups. Conclusion Racial/ethnic differences in the development of disability among older adults with arthritis were largely attenuated by health and medical access factors. Lack of health insurance was particularly problematic. At the clinical level, treatment of comorbid conditions, functional limitations, and promotion of physical activity and weight maintenance should be a priority to prevent the development of disability, especially in minority populations.
ISSN:0004-3591
0893-7524
1529-0131
1529-0123
DOI:10.1002/art.22906