Song Jing, Chang Huan J, Tirodkar Manasi, Chang Rowland W, Manheim Larry M, Dunlop Dorothy D
Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
Arthritis Rheum. 2007 Aug 15;57(6):1058-66. doi: 10.1002/art.22906.
To investigate racial/ethnic differences in disability onset among older Americans with arthritis. Factors amenable to clinical and public health intervention that may explain racial/ethnic differences in incident disability were examined.
We analyzed longitudinal data (1998-2004) from a national representative sample of 5,818 non-Hispanic whites, 1,001 African Americans, 228 Hispanics interviewed in Spanish (Hispanic/Spanish), and 210 Hispanics interviewed in English (Hispanic/English), with arthritis and age >or=51 years who did not have baseline disability. Disability in activities of daily living (ADL) was identified from report of inability, avoidance, or needing assistance to perform >or=1 ADL task.
Over the period of 6 years, 28.0% of African Americans, 28.5% of Hispanic/Spanish, 19.1% of Hispanic/English, and 16.2% of whites developed disability. The demographic-adjusted disability hazard ratios (AHR) were significantly greater among African Americans (AHR 1.94, 95% confidence interval [95% CI] 1.51-2.38) and Hispanic/Spanish (AHR 2.03, 95% CI 1.35-2.71), but not significantly increased for Hispanic/English (AHR 1.41, 95% CI 0.82-2.00) compared with whites. Differences in health factors (comorbid conditions, functional limitations, and behaviors) explained over half the excess risk among African Americans and Hispanic/Spanish. Medical access factors (education, income, wealth, and health insurance) were substantial mediators of racial/ethnic differences in all minority groups.
Racial/ethnic differences in the development of disability among older adults with arthritis were largely attenuated by health and medical access factors. Lack of health insurance was particularly problematic. At the clinical level, treatment of comorbid conditions, functional limitations, and promotion of physical activity and weight maintenance should be a priority to prevent the development of disability, especially in minority populations.
调查患有关节炎的美国老年人在残疾发病方面的种族/民族差异。研究了可能解释残疾发生率种族/民族差异的、适合临床和公共卫生干预的因素。
我们分析了来自全国代表性样本的纵向数据（1998 - 2004年），该样本包括5818名非西班牙裔白人、1001名非裔美国人、228名接受西班牙语访谈的西班牙裔（西班牙裔/西班牙语）以及210名接受英语访谈的西班牙裔（西班牙裔/英语），他们患有关节炎且年龄≥51岁，无基线残疾。通过报告无法、避免或需要协助完成≥1项日常生活活动（ADL）任务来确定日常生活活动中的残疾情况。
在6年期间，28.0%的非裔美国人、28.5%的西班牙裔/西班牙语、19.1%的西班牙裔/英语以及16.2%的白人出现了残疾。经人口统计学调整后的残疾风险比（AHR）在非裔美国人（AHR 1.94，95%置信区间[95%CI] 1.51 - 2.38）和西班牙裔/西班牙语人群（AHR 2.03，95%CI 1.35 - 2.71）中显著更高，但与白人相比，西班牙裔/英语人群（AHR 1.41，95%CI 0.82 - 2.00）的残疾风险比没有显著增加。健康因素（合并症、功能限制和行为）的差异解释了非裔美国人和西班牙裔/西班牙语人群中超过一半的额外风险。医疗获取因素（教育、收入、财富和医疗保险）是所有少数群体中种族/民族差异的重要中介因素。
健康和医疗获取因素在很大程度上减弱了患有关节炎的老年人在残疾发展方面的种族/民族差异。缺乏医疗保险尤其成问题。在临床层面，治疗合并症、功能限制以及促进身体活动和维持体重应成为预防残疾发展的优先事项，特别是在少数族裔人群中。
