Skip to main content

Advertisement

SpringerLink
Log in

Socioeconomic Status Disparities in Cognitive and Physical Functional Impairment among Older Adults: Comparison of Asians with other Major Racial/Ethnic Groups

  • Original Article
  • Published:
Journal of Urban Health Aims and scope Submit manuscript

Abstract

This study investigated to what extent socioeconomic status (SES) disparity associates with cognitive and physical impairment within older Asian Americans in comparison with other races/ethnicities. Data were from the National Health and Nutrition Examination Survey 2011–2018 that included 3,297 White, 1,755 Black, 1,708 Hispanic, and 730 Asian Americans aged ≥ 60. Physical functioning was measured by activities of daily living (ADL) or instrumental activities of daily living (IADL). Memory and language fluency were evaluated using the Alzheimer's Disease Word List Memory Task and Animal Fluency Tests, respectively. Multivariate logistic regressions were conducted to investigate the association between SES and physical and cognitive impairment within racial/ethnic groups, and seemingly unrelated regressions compared coefficients across subgroups. Asians with ≤ high school education had the highest prevalence of age- and sex-adjusted memory impairment among all races/ethnicities, while no difference was observed for those with > high school education. ADL/IADL disability odds did not differ between Asians and Whites, but Asians were more likely to exhibit impaired verbal fluency. Education disparity for ADL disability (OR, 3.40; 95% CI, 2.20–5.25) and memory impairment (OR, 11.57; 95% CI, 6.59–20.31) were largest among Asians compared to Whites, Blacks, and Hispanics. Income disparity for function impairment showed no significant difference across racial/ethnic groups (all P > 0.05). Asians experienced the highest burden of physical functioning and memory impairment due to education disparity. Efforts should focus on strengthening research infrastructure and creating targeted programs and services to improve cognitive and physical health for racially/ethnically underrepresented older adults with lower education attainment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

The National Health and Nutrition Examination Survey (NHANES) datasets are publicly available at the National Center for Health Statistics of Centers of Diseases Control and Prevention. Researchers may obtain the datasets after sending a data user agreement to the NHANES team (https://www.cdc.gov/nchs/nhanes/index.htm).

References

  1. Mobility is Most Common Disability Among Older Americans, Census Bureau Reports. United States Census Bureau. https://www.census.gov/newsroom/archives/2014-pr/cb14-218.html#:~:text=Nearly%2040%20percent%20of%20people,difficulty%20in%20walking%20or%20climbing. Accessed 20 Mar 2023.

  2. Manly JJ, Jones RN, Langa KM, et al. Estimating the prevalence of dementia and mild cognitive impairment in the US: the 2016 health and retirement study harmonized cognitive assessment protocol project. JAMA Neurol. 2022;79(12):1242–9. https://doi.org/10.1001/jamaneurol.2022.3543.

    Article  PubMed  Google Scholar 

  3. Williams DR, Mohammed SA, Leavell J, Collins C. Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities. Ann N Y Acad Sci. 2010;1186:69–101. https://doi.org/10.1111/j.1749-6632.2009.05339.x.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Samper-Ternent R, Kuo YF, Ray LA, Ottenbacher KJ, Markides KS, Al SS. Prevalence of health conditions and predictors of mortality in oldest old Mexican Americans and non-Hispanic whites. J Am Med Dir Assoc. 2012;13(3):254–9. https://doi.org/10.1016/j.jamda.2010.07.010.

    Article  PubMed  Google Scholar 

  5. Potter GG, Plassman BL, Burke JR, et al. Cognitive performance and informant reports in the diagnosis of cognitive impairment and dementia in African Americans and whites. Alzheimers Dement. 2009;5(6):445–53. https://doi.org/10.1016/j.jalz.2009.04.1234.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Ng JH, Bierman AS, Elliott MN, Wilson RL, Xia C, Scholle SH. Beyond black and white: race/ethnicity and health status among older adults. Am J Manag Care. 2015;20(3):239–48.

    Google Scholar 

  7. Melvin J, Hummer R, Elo I, Mehta N. Age patterns of racial/ethnic/nativity differences in disability and physical functioning in the United States. Demogr Res. 2014;31(17):497–510. https://doi.org/10.4054/DemRes.2014.31.17.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Mayeda ER, Glymour MM, Quesenberry CP, Whitmer RA. Inequalities in dementia incidence between six racial and ethnic groups over 14 years. Alzheimer’s and Dementia. 2016;12(3):216–24. https://doi.org/10.1016/j.jalz.2015.12.007.

    Article  PubMed  Google Scholar 

  9. Cheng C. Are Asian American employees a model minority or just a minority. J Appl Behav Sci. 1997;33(3):277–90.

    Article  Google Scholar 

  10. Monte LM, Shin HB. 20.6 Million People in the U.S. Identify as Asian, native Hawaiian or Pacific Islander. United States Census Bureau. https://www.census.gov/library/stories/2022/05/aanhpi-population-diverse-geographically-dispersed.html. Accessed 19 Mar 2023.

  11. Harris B. Racial Inequality in the United States. U.S. Department of the Treasury. https://home.treasury.gov/news/featured-stories/racial-inequality-in-the-united-states. Accessed 18 Mar 2023

  12. Kochhar R, Cilluffo A. Income Inequality in the U.S. Is Rising Most Rapidly Among Asians. Pew Research Center. https://www.pewresearch.org/social-trends/2018/07/12/income-inequality-in-the-u-s-is-rising-most-rapidly-among-asians/. Accessed  19 Mar 2023.

  13. 2020 Profile of Asian Americans Age 65 and Older. Services USDoHaH. https://acl.gov/sites/default/files/Profile%20of%20OA/AsianProfileReport2021.pdf. Accessed  18 Mar 2023.

  14. Liu H, Hu T. Impact of socioeconomic status and health risk on fall inequality among older adults. Health Soc Care Community. 2022;30(6):e4961–74. https://doi.org/10.1111/hsc.13908.

    Article  PubMed  Google Scholar 

  15. Asian Americans and Pacific Islanders in the United States Aged 65 Years and Older: Population, Nativity, and Language. Vol. 1. https://www.napca.org/wp-content/uploads/2017/10/65-population-report-FINAL.pdf. Accessed 23 Mar 2023.

  16. Chan K, Marsack-Topolewski C. Ethnic and neighborhood differences in poverty and disability among older Asian Americans in New York City. Soc Work Public Health. 2022;37(3):258–73. https://doi.org/10.1080/19371918.2021.2000916.

    Article  PubMed  Google Scholar 

  17. Sorkin DH, Nguyen H, Ngo-Metzger Q. Assessing the mental health needs and barriers to care among a diverse sample of Asian American older adults. J Gen Intern Med. 2011;26(6):595–602. https://doi.org/10.1007/s11606-010-1612-6.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Tsoy E, Kiekhofer RE, Guterman EL, et al. Assessment of racial/ethnic disparities in timeliness and comprehensiveness of dementia diagnosis in California. JAMA Neurol. 2021;78(6):657–65. https://doi.org/10.1001/jamaneurol.2021.0399.

    Article  PubMed  Google Scholar 

  19. Wu B, Qi X. Addressing health disparities among older asian American populations: research, data, and policy. Public Policy Aging Rep. 2022;32(3):105–11. https://doi.org/10.1093/ppar/prac015.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zipf G, Chiappa M, Porter KS, Ostchega Y, Lewis BG, Dostal J. National health and nutrition examination survey: plan and operations, 1999–2010. Vital Health Stat 1. 2013;56:1–37.

    Google Scholar 

  21. Paulose-Ram R, Burt V, Broitman L, Ahluwalia N. Overview of Asian American data collection, release, and analysis: national health and nutrition examination survey 2011–2018. Am J Public Health. 2017;107(6):916–21. https://doi.org/10.2105/AJPH.2017.303815.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 2018 Poverty Guidelines. Office of the Assistant Secretary For Planning and Evaluation. https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines/prior-hhs-poverty-guidelines-federal-register-references/2018-poverty-guidelines. Accessed 23 Mar 2023.

  23. Data from: national Health and Nutrition Examination Survey 2022.

  24. Bailey RL, Jun S, Murphy L, et al. High folic acid or folate combined with low vitamin B-12 status: potential but inconsistent association with cognitive function in a nationally representative cross-sectional sample of US older adults participating in the NHANES. Am J Clin Nutr. 2020;112(6):1547–57. https://doi.org/10.1093/ajcn/nqaa239.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Kuo HK, Leveille SG, Yu YH, Milberg WP. Cognitive function, habitual gait speed, and late-life disability in the National Health and Nutrition Examination Survey (NHANES) 1999–2002. Gerontology. 2007;53(2):102–10. https://doi.org/10.1159/000096792.

    Article  PubMed  Google Scholar 

  26. Srivastava VK, Giles DEA. Seemingly Unrelated Regression Equations Models: Estimation and Inference. 1st ed. Boca Raton: CRC Press; 1987.

  27. Hayes-Larson E, Ikesu R, Fong J, et al. Association of education with dementia incidence stratified by ethnicity and nativity in a cohort of older Asian American individuals. JAMA Netw Open. 2023;6(3):e231661. https://doi.org/10.1001/jamanetworkopen.2023.1661.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Adjoian M, Dodds L, Rundek T, et al. Associations between cognitive functioning and mortality in a population-based sample of older united states adults: differences by sex and education. J Aging Health. 2022;34(6–8):905–15. https://doi.org/10.1177/08982643221076690.

    Article  Google Scholar 

  29. Meng X, D’Arcy C. Education and dementia in the context of the cognitive reserve hypothesis: a systematic review with meta-analyses and qualitative analyses. PLoS One. 2012;7(6):e38268. https://doi.org/10.1371/journal.pone.0038268.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Drouhot LG, Garip F. What’s behind a racial category? Uncovering heterogeneity among Asian Americans through a data-driven typology. Russell Sage Foundation J Soc Sci. 2021;7(2):22–5. https://doi.org/10.7758/RSF.2021.7.2.02.

    Article  Google Scholar 

  31. Budiman A, Ruiz N. Key facts about Asian origin groups in the U.S. Pew Research Center. https://www.pewresearch.org/fact-tank/2021/04/29/key-facts-about-asian-origin-groups-in-the-u-s/. Accessed 10 Mar 2023.

  32. The Rise of Asian Americans. Pew Research Center. https://www.pewresearch.org/social-trends/2012/06/19/the-rise-of-asian-americans/. Accessed  10 Mar 2023.

  33. Ponce NA, Hays RD, Cunningham WE. Linguistic disparities in health care access and health status among older adults. J Gen Intern Med. 2006;21(7):786–91. https://doi.org/10.1111/j.1525-1497.2006.00491.x.

    Article  PubMed  PubMed Central  Google Scholar 

  34. An N, Cochran SD, Mays VM, McCarthy WJ. Influence of American acculturation on cigarette smoking behaviors among Asian American subpopulations in California. Nicotine Tob Res. 2008;10(4):579–87. https://doi.org/10.1080/14622200801979126.

    Article  PubMed  Google Scholar 

  35. Kanaya AM, Hsing AW, Panapasa SV, et al. Knowledge gaps, challenges, and opportunities in health and prevention research for Asian Americans, native Hawaiians, and pacific islanders: a report from the 2021 national institutes of health workshop. Ann Intern Med. 2022;175(4):574–89. https://doi.org/10.7326/M21-3729.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Trinity College of Arts and Sciences, Duke University, NC, Durham, USA

    Katherine Wang

  2. Rory Meyers College of Nursing, New York University, 433 1St Ave, New York, NY, 10010, USA

    Zheng Zhu & Xiang Qi

  3. School of Nursing, Fudan University, Shanghai, China

    Zheng Zhu

Authors
  1. Katherine Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zheng Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiang Qi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design of the study: Katherine Wang, Zheng Zhu, and Xiang Qi.

Data analysis: Katherine Wang, Zheng Zhu, and Xiang Qi.

Interpretation of data and critical revision for intellectual content: Katherine Wang, Zheng Zhu, and Xiang Qi.

Writing the final manuscript, final approval of version to be published: Katherine Wang, Zheng Zhu, and Xiang Qi.

Katherine Wang had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors have approved the final manuscript.

Corresponding author

Correspondence to Xiang Qi.

Ethics declarations

Ethics Approval

The National Health and Nutrition Examination Survey (NHANES) protocol was approved by the Institutional Review Board (IRB) of the Centers for Disease Control and Prevention, and all patients provided written informed consent. This project is the result of a secondary analysis of NHANES and is exempt from local IRB approval.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, K., Zhu, Z. & Qi, X. Socioeconomic Status Disparities in Cognitive and Physical Functional Impairment among Older Adults: Comparison of Asians with other Major Racial/Ethnic Groups. J Urban Health 100, 839–851 (2023). https://doi.org/10.1007/s11524-023-00768-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11524-023-00768-1

Keywords

Search

Navigation