Racial, ethnic, nativity, and educational disparities in cognitive impairment and activity limitations in the United States, 1998-2016
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Despite extensive research on cognitive impairment and limitations in basic activities of daily living, no study has investigated the burden of their co-occurrence (co-impairment). Using the Health and Retirement Study data and incidence-based multistate models, we study the population burden of co-impairment using three key indicators: mean age at onset, lifetime risk, and health expectancy. We examine patterns by gender, race, ethnicity, nativity, education, and their interactions for U.S. residents aged 50-100. Furthermore, we analyze what fractions of racial, ethnic, and nativity disparities in co-impairment are attributable to inequalities in educational attainment. Results reveal that an estimated 56% of women and 41% of men aged 50 will experience co-impairment in their remaining life expectancy. Men experience an earlier onset of co-impairment than women (74 vs. 77 years), and women live longer in co-impairment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substantially higher lifetime risk of co-impairment, earlier co-impairment onset, and longer life in co-impairment than their counterparts. Up to 75% of racial, ethnic, and nativity disparity is attributable to inequality in educational attainment. This study provides novel insights into the burden of co-impairment and offers evidence of dramatic disparities in the older U.S. population.
Sharma , S , Hale , J M , Myrskylä , M & Kulu , H 2023 , ' Racial, ethnic, nativity, and educational disparities in cognitive impairment and activity limitations in the United States, 1998-2016 ' , Demography , vol. Advance publication , 10941414 . https://doi.org/10.1215/00703370-10941414
Copyright © 2023 The Authors. This is an open access article distributed under the terms of a Creative Commons license (CC BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/.
DescriptionFunding: Shubhankar Sharma gratefully acknowledges funding from the Max Planck Institute for Demographic Research, the University of St Andrews, and the resources made available by the International Max Planck Research School for Population, Health and Data Science doctoral program. Shubhankar Sharma’s and Hill Kulu’s research was part of the MigrantLife project, which received funding from the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (grant agreement 834103). Mikko Myrskylä was supported by the Strategic Research Council’s FLUX Consortium (decision numbers 345130 and 345131); the National Institute on Aging (R01AG075208); grants to the Max Planck–University of Helsinki Center from the Max Planck Society, Jane and Aatos Erkko Foundation, Faculty of Social Sciences at the University of Helsinki, and Cities of Helsinki, Vantaa, and Espoo; and the European Union (ERC Synergy, BIOSFER, 101071773).
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