Racial, ethnic, nativity, and educational disparities in cognitive impairment and activity limitations in the United States, 1998-2016

Shubhankar Sharma*, Jo Mhairi Hale, Mikko Myrskylä, Hill Kulu

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

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.

Original languageEnglish
Article number10941414
Pages (from-to)1441-1468
Number of pages28
JournalDemography
Volume60
Issue number5
Early online date28 Aug 2023
DOIs
Publication statusPublished - 1 Oct 2023

Keywords

  • Health disparities
  • Cognitive impairment
  • ADLs
  • Social stratification

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