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Black–White Disparity in Disability: The Role of Medical Conditions

Authors

  • Heather E. Whitson MD, MHS,

    1. From the *Duke Aging Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatrics Research Education and Clinical Center and §Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • S. Nicole Hastings MD, MHS,

    1. From the *Duke Aging Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatrics Research Education and Clinical Center and §Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Lawrence R. Landerman PhD,

    1. From the *Duke Aging Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatrics Research Education and Clinical Center and §Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Gerda G. Fillenbaum PhD,

    1. From the *Duke Aging Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatrics Research Education and Clinical Center and §Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Harvey J. Cohen MD,

    1. From the *Duke Aging Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatrics Research Education and Clinical Center and §Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Kimberly S. Johnson MD, MHS

    1. From the *Duke Aging Center and Department of Medicine, Duke University Medical Center, Durham, North Carolina; and Geriatrics Research Education and Clinical Center and §Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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  • Some findings presented at the Gerontological Society of America conference, New Orleans, Louisiana, November 2010.

Address correspondence to Heather E. Whitson, DUMC 3003, Durham, NC 27710. E-mail: heather.whitson@duke.edu

Abstract

OBJECTIVES: To describe the independent contributions of selected medical conditions to the disparity between black and white people in disability rates, controlling for demographic and socioeconomic factors.

DESIGN: Cross-sectional analysis of a community-based cohort.

SETTING: Urban and rural counties of central North Carolina.

PARTICIPANTS: Two thousand nine hundred sixty-six adults aged 68 and older participating in the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE).

MEASUREMENTS: Self-reported data on sociodemographic characteristics and medical conditions, Short Portable Mental Status Questionnaire, activities of daily living (ADLs).

RESULTS: Fifty-five percent of the cohort was black. Blacks were more likely than whites to report disability (odds ratio=1.39, 95% confidence interval= 1.15–1.68). Controlling for age, sex, marital status, and socioeconomic status, blacks were more likely to be obese and have diabetes mellitus, and less likely to report vision problems, fractures, and heart attacks. The higher prevalence of obesity and diabetes mellitus in blacks, after adjustment for sociodemographic factors, accounted for more than 30% of the black–white difference in disability. Conversely, the black–white disability gap would be approximately 45% wider if whites had a lower prevalence of fractures and vision impairment, similar to their black peers.

CONCLUSION: Higher rates of obesity and diabetes mellitus in older black Americans account for a large amount of the racial disparity in disability, even after controlling for socioeconomic differences. Culturally appropriate interventions that lower the prevalence or the functional consequences of obesity and diabetes mellitus in blacks could substantially decrease this racial health disparity.

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