Department of Health Management and Policy, University of Michigan School of Public Health., Ann Arbor, MI 48109-2029, USA.
J Gerontol B Psychol Sci Soc Sci. 2010 Jul;65(4):470-81. doi: 10.1093/geronb/gbp114. Epub 2009 Dec 14.
Following a person-centered approach, this research aims to depict distinct courses of disability and to ascertain how the probabilities of experiencing these trajectories vary across Black, Hispanic, and White middle-aged and older Americans.
Data came from the 1995-2006 Health and Retirement Study, which involved a national sample of 18,486 Americans older than 50 years of age. Group-based semiparametric mixture models (Proc Traj) were used for data analysis.
Five trajectories were identified: (a) excellent functional health (61%), (b) good functional health with small increasing disability (25%), (c) accelerated increase in disability (7%), (d) high but stable disability (4%), and (e) persistent severe impairment (3%). However, when time-varying covariates (e.g., martial status and health conditions) were controlled, only 3 trajectories emerged: (a) healthy functioning (53%), moderate functional decrement (40%), and (c) large functional decrement (8%). Black and Hispanic Americans had significantly higher probabilities than White Americans in experiencing poor functional health trajectories, with Blacks at greater risks than Hispanics.
Parallel to the concepts of successful aging, usual aging, and pathological aging, there exist distinct courses of changing functional health over time. The mechanisms underlying changes in disability may vary between Black and Hispanic Americans.
本研究采用以人为中心的方法，旨在描绘不同的残疾轨迹，并确定黑种人、西班牙裔和白种人中的中老年人经历这些轨迹的概率有何不同。
数据来自于 1995 年至 2006 年的“健康与退休研究”，涉及了一个由 18486 名 50 岁以上的美国人组成的全国样本。使用基于群组的半参数混合模型（Proc Traj）进行数据分析。
确定了 5 种轨迹：（a）极好的功能健康（61%）；（b）功能健康良好但逐渐出现小的残疾（25%）；（c）残疾加速增加（7%）；（d）高但稳定的残疾（4%）；（e）持续严重受损（3%）。然而，当控制时变协变量（例如婚姻状况和健康状况）时，只有 3 种轨迹出现：（a）健康功能（53%）；（b）中度功能下降（40%）；（c）功能严重下降（8%）。与白种人相比，黑种人和西班牙裔美国人经历不良功能健康轨迹的可能性明显更高，而黑种人比西班牙裔人风险更高。
与成功老龄化、正常老龄化和病理老龄化的概念类似，随着时间的推移，功能健康的变化存在不同的轨迹。残疾变化的机制可能在黑人和西班牙裔美国人之间有所不同。
