摘要：Objective. We sought to determine whether socioeconomic and racial/ethnic disparities in prevalence of disability over age 70 have widened or narrowed during the past 2 decades. Methods. We used data from the 1982–2002 National Health Interview Surveys, which are nationally representative cross-sectional surveys of the noninstitutionalized population of the United States. Participants included 172227 people aged 70 years and older. The primary outcome measure was the average annual percentage change in the prevalence of 2 self-reported disability measures: the need for help with activities of daily living (“ADL disability”) and need for help with either ADL or instrumental activities of daily living (“any disability”). Results. All groups experienced declines in the age- and gender-adjusted prevalence of any disability during the 1982 to 2002 period. However, the average annual percent declines were smaller for the least advantaged socioeconomic groups. Differences in trends across racial/ethnic groups were not statistically significant. ADL disability prevalence decreased for the more advantaged groups but increased among the lowest income and education groups. Non-Hispanic Whites and minorities experienced similar average annual percent declines in ADL disability. Conclusions. Racial/ethnic disparities in old-age disability have persisted over the last 20 years, whereas socioeconomic disparities have increased. Much attention and public debate have recently focused on disparities in health and medical care among racial and socioeconomic groups. 1 – 3 At older ages, minority and socioeconomically disadvantaged populations are up to 3 times as likely as other groups to experience disability and the physical, cognitive, and sensory limitations that underlie it. 4 – 6 In comparison with those without activity limitations, older people who report limitations—no matter their race or socioeconomic status—have 3 times the medical expenditures. 7 Additionally, half of all medical expenditures for people with disabilities are paid for by public health programs. 8 Recently, declines in disability have been documented among older Americans. 6 , 9 A systematic review of the literature identified average annual declines during the 1980s and 1990s of 0.4% to 2.7% in limitations with instrumental activities of daily living (IADLs), such as shopping, cleaning, and going places, but inconsistent trends in limitations in activities of daily living (ADLs), such as bathing, dressing, and walking. 10 More recently, an expert panel found that during the middle and late 1990s, the population aged 70 years and older experienced declines of 1.0% to 2.5% per year in ADL limitations. 11 Whether these recent improvements have been experienced broadly is still unclear. Although racial and socioeconomic disparities in late-life health have been widely documented, 12 few studies have examined disparities in disability trends. In their systematic review of the literature, Freedman et al. 10 found that most analyses of trends in disparities in late-life disability have been cursory and have rarely included formal statistical tests. With respect to racial disparities, findings have been mixed: 2 studies reported a widening of Black–White differences during the 1980s, 6 , 13 1 found a narrowing during the 1990s, 6 and a third suggested no change from 1982 through 1996. 14 Two studies that have examined educational disparities suggest that improvements may have been larger for those with more than a high school education. 14 , 15 To date, no evidence exists regarding trends in disparities with respect to other measures of socioeconomic status, notably income. Hence, it remains unclear which groups have gained the most in recent years and which have been left behind. A more thorough understanding of trends in racial/ethnic and socioeconomic disparities is critical not only for measuring progress in eliminating the gaps, but also for targeting interventions and planning for the likely future course of population-level disability.
