@article {12168, title = {Differential trends in disability among rich and poor adults in the US and England from 2002 to 2016.}, journal = {The Journals of Gerontology, Series B }, volume = {77}, year = {2022}, pages = {S189-S198}, abstract = {

OBJECTIVE: Disability in the US has not improved in recent decades. Comparing temporal trends in disability prevalence across different income groups, both within and between the US and England, would inform public policy aimed at reducing disparities in disability.

METHODS: Using the Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA), we estimated annual percent change from 2002 to 2016 in disability among community dwelling adults (197,021 person-years of observations). Disability was defined based on self-report of limitations with five instrumental activities of daily living (IADLs) and six activities of daily living (ADLs). We examined the trends by age and income quintile and adjusted for individual-level sociodemographic status and survey design.

RESULTS: The adjusted annual percent change (AAPC) in disability prevalence declined significantly in both countries for ages 75 and older during 2002--2016. For ages 55-64 and 65-74, disability prevalence was unchanged in the US but declined in England. Both countries experienced a widening gap in disability between low- and high-income adults among the younger age groups. For example, for those ages 55-64 in each country, there was no significant improvement in disability for the low-income group but a significant improvement for the high-income group (AAPC=-3.60 95\% CI [-6.57,-0.63] for the US; AAPC=-6.06 95\% CI [-8.77,-3.35] for England).

DISCUSSION: Improvements in disability were more widespread in England than in the US between 2002 and 2016. In both countries, the disparity in disability between low- and high-income adults widened for middle-aged adults. Policies targeted at preventing disability among low-income adults should be a priority in both countries.

}, keywords = {ADL limitation, Disability trend, ELSA, health disparity, IADL limitation}, issn = {1758-5368}, doi = {10.1093/geronb/gbac029}, author = {Choi, Hwa Jung and Robert F. Schoeni and Andrew Steptoe and Cho, Tsai-Chin and Kenneth M. Langa} } @article {11221, title = {Disability Incidence Rates for Men and Women in 23 Countries: Evidence on Health Effects of Gender Inequality.}, journal = {The Journals of Gerontology, Series A }, volume = {76}, year = {2021}, pages = {328-338}, abstract = {

BACKGROUND: Inequality in gender varies across social contexts, which may influence the health of both men and women. Based on theories of gender as a social system, we examine whether systematic gender inequality at the macro level influences health of men and women.

METHODS: Using harmonized panel data from the Gateway to Global Aging Data in 23 high and middle income countries (N=168,873), we estimate disability prevalence and incidence for men and women ages 55 to 89 (2000-2016). Within each country or geographic region, we also investigate gender differences in age gradients of the probability of disability onset. We, then, pool data from all countries and test the hypothesis that gender inequality increases the probability of disability onset.

RESULTS: We found substantial cross-country variation in disability incidence rates, and this variation is greater for women than for men. Among ages 65-69, disability incidence rates ranged from 0.4 to 5.0 for men and from 0.5 to 9.4 for women. Our within-country analysis showed significant gender differences in age gradients of the probability of disability onset in the U.S., Korea, Southern Europe, Mexico, and China, but not in Northern, Central, and Eastern Europe, England and Israel. Testing hypothesized effects of gender inequality, we find that gender inequality is significantly associated with the probability of disability onset for women, but not for men.

CONCLUSIONS: Macro-level societal gender inequality is significantly associated with the probability of disability onset for women. Reducing and eliminating gender inequality is crucial to achieving good health for women.

}, keywords = {Activities of Daily Living, CHARLS, Cross-Country, ELSA, health disparity, KLoSA, Longitudinal analysis, MHAS, SHARE}, issn = {1758-535X}, doi = {10.1093/gerona/glaa288}, author = {Jinkook Lee and Erik Meijer and Drystan F. Phillips and Hu, Peifeng} } @article {10514, title = {Association between telomere length and neighborhood characteristics by race and region in US midlife and older adults}, journal = {Health and Place}, volume = {62}, year = {2020}, abstract = {Disadvantaged neighborhoods are correlated with worse health outcomes, particularly among US Blacks. However, less is known about the link between neighborhood characteristics and biomarkers of cellular age, such as telomere length (TL), which may be implicated in racial health inequities. Moreover, this relationship may vary across US region given patterns of racial segregation across the US. Therefore, this study analyzed 2008 Health and Retirement Study data on 3,869 US-born white and Black adults >50 years old to examine race differences in the relationship between salivary TL and (1) neighborhood safety, cleanliness, and social cohesion and (2) interactions between neighborhood characteristics and US region. Neighborhood characteristics were not associated with TL in whites. However, significant associations were found among Blacks with variation by region. Blacks living in less clean neighborhoods in the Northeast (b = -0.03, SE = 0.01, p < 0.05), Midwest (b = -0.04, SE = 0.01, p < 0.01), and South (b = -0.05, SE = 0.01, p < 0.01) as well as those reporting less neighborhood safety and social cohesion in the Midwest (b = -0.03, SE = 0.02, p < 0.05 and b = -0.03, SE = 0.01, p < 0.05) and South (b = -0.03, SE = 0.01, p < 0.05 for both characteristics) had shorter TL than Blacks in the West. Therefore, exposure to neighborhood level historical discrimination and neglect may be detrimental to TL in Blacks. Future research should further examine how neighborhoods contribute to aging disparities. {\textcopyright} 2019 Elsevier Ltd}, keywords = {Adult, Aged, Aging, Article, Black person, Caucasian, controlled study, Health Disparities, health disparity, human, neglect, neighborhood, Neighborhood characteristics, race, race difference, Retirement, Telomere length}, isbn = {13538292 (ISSN)}, doi = {10.1016/j.healthplace.2019.102272}, url = {https://www.sciencedirect.com/science/article/pii/S1353829219303752}, author = {Amy D Thierry} } @article {10913, title = {Inter-Cohort Variations in the Education-Health Gradient: Socio-Historical Changes in Early-Life Selection Mechanisms in the U.S.}, journal = {J Gerontol B Psychol Sci Soc Sci}, year = {2020}, abstract = {

OBJECTIVES: Most prior studies on cohort-specific changes in the education gradient relative to health treat the distribution of education within a particular cohort as a "starting place" for understanding later life health disparities. This premise has obfuscated the role that socio-historical changes in early-life selection mechanisms play in the widening of education-based inequalities in functional limitations across birth cohorts.

METHOD: Drawing from the Health and Retirement Survey (1992-2016; n=20,920), this study employs inverse probability weight (IPW) to account for early-life selection mechanisms that are likely to impact both educational attainment and functional limitations. IPW adjusted generalized linear mixed effects models were used to estimate the total effect of education on functional limitations across birth cohorts (born 1924-1959).

RESULTS: A significant linear decline in the negative effects of childhood socioeconomic disadvantage on education (β =0.005, p<0.01) over birth year was documented. By contrast, the same variable{\textquoteright}s negative effect on functional health increased significantly (β =0.006, p<0.001) across cohorts. Adjustment for childhood socioeconomic status did yield narrower education-based inequalities in functional limitations, but the difference between IPW adjusted and unadjusted results was not statistically significant. The pattern of significant widening of education-based inequalities (β =-0.05, p<0.001) in functional limitations across birth cohorts was maintained.

DISCUSSION: This study underscores the role that socio-historical changes in early-life selection mechanisms play in modifying patterns of education-based inequalities in health across cohorts.

}, keywords = {Childhood, Educational Status, health disparity, Older adult, Socioeconomic factors}, issn = {1758-5368}, doi = {10.1093/geronb/gbaa100}, author = {Bhatta, Tirth R} } @article {Gianattasio2019891, title = {Racial disparities and temporal trends in dementia misdiagnosis risk in the United States}, journal = {Alzheimer{\textquoteright}s and Dementia: Translational Research and Clinical Interventions}, volume = {5}, year = {2019}, pages = {891-898}, abstract = {Introduction: Systematic disparities in misdiagnosis of dementia across racial/ethnic groups have implications for health disparities. We compared the risk of dementia under- and overdiagnosis in clinical settings across racial/ethnic groups from 2000 to 2010. Methods: We linked fee-for-service Medicare claims to participants aged >=70 from the nationally representative Health and Retirement Study. We classified dementia status using an algorithm with similar sensitivity and specificity across racial/ethnic groups and assigned clinical dementia diagnosis status using ICD-9-CM codes from Medicare claims. Multinomial logit models were used to estimate relative risks of clinical under- and overdiagnosis between groups and over time. Results: Non-Hispanic blacks had roughly double the risk of underdiagnosis as non-Hispanic whites. While primary analyses suggested a shrinking disparity over time, this was not robust to sensitivity analyses or adjustment for covariates. Risk of overdiagnosis increased over time in both groups. Discussion: Our results suggest that efforts to reduce racial disparities in underdiagnosis are warranted. {\textcopyright} 2019 The Authors}, keywords = {Aged, algorithm, ancestry group, Article, Black person, Caucasian, Dementia, diagnostic error, ethnic group, Female, health disparity, human, ICD-9-CM, major clinical study, Male, Medicare, priority journal, Retirement, risk factor, sensitivity analysis, Sensitivity and Specificity, United States}, issn = {23528737}, doi = {10.1016/j.trci.2019.11.008}, author = {Kan Z Gianattasio and Prather, C. and M. Maria Glymour and Ciarleglio, A. and Melinda C Power} }