Comparison of Disability Rates Among Older Adults in Aggregated and Separate Asian American/Pacific Islander Subpopulations

摘要

Objectives. We assessed the prevalence and adjusted odds of 4 types of disability among 7 groups of older Asian American/Pacific Islander (AAPI) subpopulations, both separately and aggregated, compared with non-Hispanic Whites. Methods. Data were from the nationally representative 2006 American Community Survey, which included institutionalized and community-dwelling Hawaiian/Pacific Islander (n = 524), Vietnamese (n = 2357), Korean (n = 2082), Japanese (n = 3230), Filipino (n = 5109), Asian Indian (n = 2942), Chinese (n = 6034), and non-Hispanic White (n = 641 177) individuals aged 55 years and older. The weighted prevalence, population estimates, and odds ratios of 4 types of disability (functional limitations, limitations in activities of daily living, cognitive problems, and blindness or deafness) were reported for each group. Results. Disability rates in older adults varied more among AAPI subpopulations than between non-Hispanic Whites and the aggregated Asian group. Asian older adults had, on average, better disability outcomes than did non-Hispanic Whites. Conclusions. This study provides the strongest evidence to date that exclusion of institutionalized older adults minimizes disparities in disabilities between Asians and Whites. The aggregation of Asians into one group obscures substantial subgroup variability and fails to identify the most vulnerable groups (e.g., Hawaiian/Pacific Islanders and Vietnamese). In 2008, more than 1 in 3 immigrants arriving in the United States were born in Asia, and just under 1 in 5 were 50 years of age or older. 1 Whereas the elderly non-Hispanic White population in the United States is projected to increase by 73% between 2000 and 2025, the comparable Asian American/Pacific Islander (AAPI) population is projected to grow by 246%. 2 Despite the anticipated growth of Asian older adults in the United States, few studies have examined aging-related outcomes among specific AAPI subpopulations. 3 Instead, most research has used the common practice of aggregating all Asians in one category, which results in data that lack specificity and obscures important differences in morbidity and mortality rates among distinct subpopulations. To accommodate the imminent growth of the Asian older adult population in the United States, health policy and planning decisions need to be made now that address the full diversity of health needs spanning the various AAPI subpopulations. The AAPI population comprises an extremely diverse and heterogeneous group that includes Asian Indian, Chinese, Cambodian, Filipino, Hmong, Japanese, Korean, Laotian, Pakistani, Samoan and other Pacific Islander, Thai, and Vietnamese individuals. 4 US data sources including the US census, 4 and in turn, many researchers, use the designation Asian American/Pacific Islander to represent all Asian subpopulations within 1 category. This practice of combining data across multiple AAPI subpopulations creates a semblance of homogeneity across groups that is both inaccurate and misleading. 5 Although comparative studies of health outcomes among AAPI subpopulations are relatively atypical, existing research demonstrates important intergroup variability in rates of several diseases associated with aging. Both cancer incidence rates—including cancer of the lung, 6 breast, 7 – 9 and thyroid 10 —and cancer survival rates 11 have been shown to vary significantly across AAPI groups. Similarly, disparities in rates of hypertension and heart disease 12 – 15 and type 2 diabetes 16 – 18 have been documented across AAPI groups. With respect to diabetes, Hawaiian/Pacific Islanders 17 – 19 and Filipinos 20 have been shown to have elevated levels of type 2 diabetes compared with other AAPI subpopulations and Whites. Risk profiles for various diseases have also been shown to be distinct to particular AAPI subpopulations. 18 , 21 , 22 Hawaiian/Pacific Islanders, for example, are observed to have disproportionately high rates of obesity, which is thought to be a result of genetic factors. 19 In contrast, Filipinos have low rates of obesity despite high rates of type 2 diabetes, 20 which suggests that the degree to which various factors contribute to the development of diabetes varies by AAPI subtype. 18 The health outcomes of AAPI populations are also known to vary according to whether the individual was born in the United States. 22 In general, the newly immigrated are “healthier” than are the US-born. 23 This “healthy migrant effect” or “positive immigrant selectivity” suggests that those able to successfully migrate to the United States are healthier, more physically fit, and have greater drive than those who remain in their country of origin. 3 , 23 – 25 Migrant selectivity effects,