September 07, 2023 | Press Release

Dramatic Disparities in the Health of America´s Older Population

Society is aging. What does this mean for health in old age, how is the quality of life evolving, and what are the disparities between different groups of people? Shubhankar Sharma, a researcher at the Max Planck Institute for Demographic Research and the University of St Andrews, and colleagues have published a study that examines gender, racial/ethnic, and educational differences in relation to both mild cognitive impairment or dementia and physical “activity limitations” in the United States. The researchers found that people who are Black, Latinx, and less educated, especially those falling into more than one category, are at a severe disadvantage. They are more likely than their peers to have both cognitive impairment and activity limitations.

The researchers found that people who are Black, Latinx, and less educated are at a severe disadvantage. © iStockphoto.com/smartboy10

For the study, the researchers analyzed data from the Health and Retirement Study (HRS) from 1998 to 2016. They looked at what proportion of adults experience co-impairment of both mild cognitive impairment or dementia and physical “activity limitations”, and when. Activity limitations meaning having difficulty dressing, walking, bathing, eating, and/or getting in or out of bed. "We looked at three key indicators: mean age of onset, lifetime risk, and expectancy. These were broken down by gender, race/ethnicity, educational attainment, and their interactions, for U.S. residents aged 50 to 100. We also looked at what percentage of these disparities are driven by inequalities in educational attainment," Shubhankar Sharma says.

Women are more likely to be affected

The study found that about 56 percent of women vs. only 41 percent of men experience both cognitive impairment and activity limitations after age 50. For men, however, the co-impairment occurs earlier, starting, on average, at the age of 74 while the average age of onset for women is 77. Women live after onset, on average, 3.4 years in co-impairment, compared to 1.9 years for men. This is also because women have a higher life expectancy than men.

Nine-year gap between Latinas and White men

Blacks, Latinx, and those with less than a high school diploma have a significantly higher risk of developing both of these disorders and living longer with this co-impairment. "We observe dramatic disparities in the older U.S. population, with Blacks with the lowest levels of education developing both conditions about two decades earlier than Whites with the highest levels of education. Foreign-born Latinas with the lowest levels of education live for about nine years longer with both of these health issues than White men with the highest levels of education. Education also plays a critical role, especially for Latinx: up to 75 percent of the disparities are attributable to the differences in educational attainment," Sharma said.

These findings can be used to improve support systems for these highly vulnerable groups, as well as the people who care for them. "Future research must investigate the disparities in having both cognitive impairment and activity limitations using advanced causal inference modeling. This can help explain how these disparities can be reduced by working to eliminate educational inequalities", explains Sharma.

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Original Publication

Shubhankar Sharma; Jo Mhairi Hale; Mikko Myrskylä; Hill Kulu: Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016 in Demography; DOI: https://doi.org/10.1215/00703370-10941414