Office of Population Research, Princeton University, USA.
Office of Population Research, Woodrow Wilson School of Public and International Affairs, Princeton University, USA.
Soc Sci Med. 2020 Jun;255:112983. doi: 10.1016/j.socscimed.2020.112983. Epub 2020 Apr 18.
Measures of physical functioning are among the strongest predictors of mortality, but no previous study has assessed whether the predictive value of such measures varies by race/ethnicity, as has been done for the simple self-rated health question. The current study tests whether the relationship between two measures of physical functioning (the number of self-reported functional limitations and measured walking speed) and mortality is weaker (has a lower hazard ratio) for Latinos and blacks than for whites. Data were drawn from the 1998-2014 waves of the Health and Retirement Study, with mortality follow-up through 2016. We used Cox hazard models with household random effects to test for interactions between race/ethnicity and these measures of physical functioning and verified earlier findings for self-rated health. The number of self-reported functional limitations is significantly related to mortality for all racial/ethnic groups, but has a substantially lower hazard ratio for blacks and Latinos than for whites, as hypothesized. This hazard ratio remains lower for blacks and Latinos after adjustment for sociodemographic characteristics and health conditions. These findings suggest that the higher rates of functional limitations observed among Latinos and blacks compared with whites may reflect a history of strenuous physical work, inadequately controlled pain, lower leisure-time physical activity, or untreated/under-treated mobility problems that can lead to reduced physical performance without necessarily having a substantial effect on mortality risk. On the other hand, we do not detect significant racial/ethnic differences in the association between measured walking speed and subsequent mortality. This may be the result of the smaller sample size for the walking speed tests, the more nuanced nature of the continuous walking speed measure, or the fact that the walking speed test captures only a subset of the limitations included in the self-reports.
身体功能的测量指标是预测死亡率的最强指标之一,但之前没有研究评估过这些指标的预测价值是否因种族/族裔而异,就像简单的自我评估健康问题那样。本研究测试了两种身体功能测量指标(自我报告的功能限制数量和测量的步行速度)与死亡率之间的关系,对于拉丁裔和非裔美国人来说,其关联是否比白人更弱(风险比更低)。数据来自 1998-2014 年健康与退休研究的各轮调查,死亡率随访至 2016 年。我们使用带有家庭随机效应的 Cox 风险模型来检验种族/族裔与这些身体功能测量指标之间的交互作用,并验证了自我评估健康的早期发现。自我报告的功能限制数量与所有种族/族裔群体的死亡率显著相关,但与白人相比,黑人的风险比和拉丁裔的风险比明显更低,这与假设一致。在调整社会人口特征和健康状况后,黑人的风险比和拉丁裔的风险比仍然较低。这些发现表明,与白人相比,拉丁裔和黑人观察到的功能限制率较高,可能反映了他们曾从事过艰苦的体力劳动、疼痛控制不足、休闲时间体力活动较少、或未经治疗/治疗不足的行动问题,这些问题可能导致身体表现下降,而不一定对死亡率风险产生实质性影响。另一方面,我们没有检测到测量的步行速度与随后的死亡率之间存在显著的种族/族裔差异。这可能是由于步行速度测试的样本量较小、连续步行速度测量的性质更为复杂,或者步行速度测试仅捕捉到自我报告中包含的限制的一个子集。