ATLANTA—African-Americans and Hispanics develop functional limitations faster and have a greater risk of developing limitations because of chronic conditions compared to whites, according to a study led by researchers at Georgia State University.
The study investigated whether the risk of becoming functionally limited – the condition of becoming unable to perform simple, physical tasks – is more accelerated in African-Americans and Hispanics compared to whites. It examined whether the link between chronic conditions and functional limitations varies by race/ethnicity and if socioeconomic status accounts for any racial differences in the association between chronic conditions and functional limitations. The findings are published in The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences.
“What we found is that at any given level of disease, African-Americans and Hispanics experienced greater risk of becoming functionally limited than whites,” said Dr. Ben Lennox Kail, lead author of the study and assistant professor of sociology at Georgia State. “To put that a different way, the consequences of disease are greater for African-Americans and Hispanics in terms of the risk of becoming functionally limited than they are for whites.”
The study found socioeconomic resources, such as education, income and insurance, did not account for racial/ethnic differences in the relationship between chronic diseases and functional limitations.
“We tested that and found socioeconomic status does not explain why African-Americans and Hispanics have a higher, accelerated risk of functional limitations given any level of chronic conditions compared to whites,” Kail said.
The researchers used data from the Health and Retirement Study, collected from 1994 to 2012, that involved 21,796 people between the ages of 51 and 61. Participants reported their difficulty with physical activities, including walking several blocks, sitting for two hours, pushing or pulling large objects, reaching or extending arms up, getting up from a chair, climbing several flights of stairs, climbing one flight of stairs and stooping, kneeling or crouching.
Participants also reported whether they have been diagnosed with a chronic condition, including high blood pressure, diabetes, lung disease, arthritis, stroke or heart disease, and answered questions about their race/ethnicity and socioeconomic status.
The researchers determined when functional limitations began for individuals, whether race/ethnicity played a role in the relationship between chronic conditions and functional limitations and whether socioeconomic resources were responsible for racial differences.
Understanding the process of disablement is important, Kail said, because disablement begins with an illness/disease, leads to impairments in basic physical activities, progresses into more severe disablement and can lead to death.
The researchers cite several possible reasons for the racial and ethnic differences found in this study. African-Americans and Hispanics have lower access to quality healthcare and receive poorer care when they do have access to care compared to whites. They are less likely to be screened for diseases, which decreases early detection, Kail said. In addition, based on other data, African-Americans and Hispanics experience, on average, considerable amounts of racial discrimination throughout their lives.
“The accumulation of a lifetime of discrimination produces negative physiological changes in the body,” Kail said. “What I speculate is that this discrimination is operating like another chronic disease. It’s stressful, and stress produces physiological changes in the body, so it amplifies chronic diseases when they occur.”
He notes the study did find that with no chronic conditions, African-Americans are actually at a lower risk of being functionally limited than whites are, but there are few people in this group because African-Americans are more likely to experience chronic disease, he said.
“Our expert opinion is that in order to reduce some of these gaps in disability and mortality, and particularly physical limitations as we find in our study, we need earlier interventions to help attenuate these racial disparities,” Kail said. “In particular, we need better access to care and quality of care for African-Americans and Hispanics to help reduce the likelihood of getting diseases and getting better treatment for diseases so they’re less likely to lead to physical limitations. But the bigger issue is we need to figure out ways to create a world where African-Americans and Hispanics don’t accrue this lifetime of chronic stress from an experience of a lifetime of discrimination.”
Co-authors of the study include Dr. Miles G. Taylor of Florida State University and Nick Rogers of Stony Brook University.
Assistant Professor, Department of Sociology
Affiliate Faculty Member, Gerontology Institute
Dr. Kail’s research focuses on the relationships between public and private benefits, work, unpaid work, and health throughout the life course. Recent publications have focused on the relationships between insurance benefits and postretirement employment, and the relationship between postretirement employment and unpaid productive activities after leaving full time work.