Disparities In Disability Research Articles

Autism, ADHD, Sexual Compulsivity, and Problematic Pornography Use: A Sexual Psychosocial Communication Disparity in Disability

Autism, ADHD, Sexual Compulsivity, and Problematic Pornography Use: A Sexual Psychosocial Communication Disparity in Disability

Disparities in Stress Exposure and Later-Life Disability.

Drawing from cumulative inequality theory and the weathering hypothesis, this study examined the relationship between life-course stress exposure (measured cumulatively and by domains) and the onset of disability in later life among White, Black, U.S.-born Hispanic, and foreign-born Hispanic older adults. Cross-sectional and longitudinal models were estimated using nationally representative data from the Health and Retirement Study (N = 11,483). We used logistic regression models to examine associations between stress exposure and Wave 1 disability (i.e., occurrence), and Weibull-accelerated failure-time models to examine the relationship between stress exposure and age of onset of disability 12-14 years later (i.e., incidence). We tested for moderation between stress and disability by race, ethnicity, and Hispanic nativity. At Wave 1, higher odds of disability occurrence were associated with cumulative stress burden (CSB; odds ratio [OR] = 4.93, 95% confidence interval [CI]: 2.95-8.23). In a model specifying domains of stressors, disability occurrence was associated with childhood financial strain (OR = 1.22, CI: 1.01-1.46), lifetime traumatic events (OR = 1.92, CI: 1.41-2.62), neighborhood disadvantage (OR = 1.32, CI: 1.01-1.73), and major lifetime discrimination (OR = 1.64, CI: 1.12-2.41). Over time, earlier onset of disability was associated with CSB (β = -0.39), childhood traumatic events (β = -0.16), adult financial strain (β = -0.17), everyday discrimination (β = -0.15), and major lifetime discrimination (β = -0.13). The effect of childhood traumatic events on the transition to disability was stronger for U.S.-born Hispanic adults than White adults (occurring 33% earlier). To reduce racial, ethnic, and nativity disparities in disability, it is important to consider the historical and structural disadvantages associated with stress exposure across the life course. It is also important to acknowledge that nativity influences stratification processes associated with disparities in racial and ethnic health trajectories.

Disparities in Knee Pain and Disability Among Historically Underserved Individuals With Knee Osteoarthritis Participating in a Clinical Trial: An Exploratory Study

Disparities in Knee Pain and Disability Among Historically Underserved Individuals With Knee Osteoarthritis Participating in a Clinical Trial: An Exploratory Study

Frequency of Low Back Pain and its Effect on Function and HealthRelated Quality of Life across Three Levels of Lower Limb Amputation: A Cross-Sectional Study

Background: Amputation is a profoundly life-altering event that can have both physical and psychological impacts on individuals. Objective: This study aimed to investigate the frequency of low back pain and its effect on function and health-related quality of life in individuals with various levels of lower limb amputation. Methods: It was a cross-sectional study at the Pakistan Institute of Prosthetic and Orthotics Peshawar (PIPOS) from May to September 2020, 264 participants were purposively selected. Inclusion criteria: males and females aged 18-65 with unilateral transfemoral, knee disarticulation, or transtibial amputations. Exclusion criteria: hearing/speech impairments, hip pathology, or bilateral lower limb amputation. Data collected via selfadministered questionnaires, including the Roland Morris Disability Questionnaire (RMDQ) and the Short Form 36 Health Survey (SF-36). Data analyzed using SPSS v.25. Results: Of the 264 participants, 219 were males (83%), and 45 were females (17%). There was significant connection between before and after amputation back pain (P < 0.05). However, no notable link was observed between low back pain and the three amputation levels (P > 0.05). Moreover, there was no statistical disparity in disability based on the level of amputation (P > 0.05). Significantly, low back pain differed across all quality of life domains (P < 0.05), except for mental and physical health. In contrast, no statistical variation was noted in the quality of life among the three amputation levels (P > 0.05). Conclusion: This study underscores the prevalence of low back pain in lower limb amputees. However, we did not find a clear association between low back pain and specific amputation levels (unilateral transfemoral, knee disarticulation, or transtibial amputation). Additionally, low back pain appears to impact disability and select aspects of quality of life, such as physical function, social function, and general health in individuals with lower limb amputation.

Socio-Economic-Driven Disparities in Chronic Illness and Disability Among the South African Children: Exploring Variations Within the Urban and Rural Areas

ABSTRACT: Existing literature on health inequalities often overlooks the nuanced dynamics, particularly among vulnerable children with chronic diseases and disabilities and fails to consider regional disparities within countries like South Africa. This paper asserts the necessity for a more granular analysis in South Africa, recognizing the varied health outcomes for children across different economic segments and geographical settings. Specifically, the health trajectories for children differ markedly between rural formal areas, regions under traditional authorities, formal urban areas, and informal urban settlements. Addressing the generalizations common in prior research, this study takes a precise, regionally focused approach to socio-economic-driven disparities in chronic illness or disability. It distinguishes between rural formal areas, traditional authority areas, formal urban areas, and informal urban areas, unveiling the intricate layers of health disparities. Using data from the National Income Dynamics Study, concentration indices, and the Oaxaca-Blinder Decomposition method, the paper analyzed health inequality trends from 2008 to 2017. The results uncover significant inequalities, with alarming trends, particularly among children with chronic illnesses and disabilities in traditional authority regions and informal urban environments. The paper's evidence shows that rural formal areas have experienced a decline in health disparities as opposed to the deepening divide in traditional authority-led regions. The urban analysis reveals a split: while formal urban settings often favour the wealthier, informal urban areas indicate a shift towards lower socioeconomic brackets. The decomposition analysis highlights the evolving socioeconomic elements influencing each region over time. These insights emphasize the urgent necessity for geographically tailored policy interventions. By understanding the distinct socioeconomic landscapes across various regions, we can formulate policies that resonate with each area's specific realities and challenges. Such targeted strategies are essential in reducing health inequalities and enhancing the life quality of children with chronic health conditions and disabilities, playing a critical role in South Africa's journey toward comprehensive health equity.

Regional disparity in age-related disability: toward healthy aging in Indonesia

Purpose: Maintaining functional ability and minimizing age-related disability of older adults are required to promote healthy aging. A supportive physical and social environment, in addition to individual variables, has a role in reducing the risk of age-related disability. Infrastructure development differs between Java-Bali and outer Java-Bali regions. This study aims to determine the extent to which the disability of older adults in Java-Bali and outer Java-Bali regions. 
 Methods: This study is cross-sectional, using data from the 2020 National Socio-Economic Survey (SUSENAS) with 122.344 Indonesian older adults aged 60 and over. Disability is the outcome variable. The explanatory variable is regional disparity (Java-Bali and outer Java-Bali regions), which refers to where the older adults live. In addition, the control variables include age, sex, marital status, educational level, employment status, leisure activity, household wealth status, and self-rated health status (SRHS). A multivariate logistic regression statistical analysis is performed. 
 Results: The outer Java-Bali region has a slightly greater prevalence of older adults with age-related disability than the Java-Bali region, with 28.8 and 22.9 percent, respectively. However, older adults living in the outer Java-Bali region are 1.63 times more likely (OR 1.63; 95% CI (1.58-1.68)) to have disability than those living in the Java-Bali region. Other socio-demographic variables are significantly associated with age-related disability. 
 Conclusion: Living in the Java-Bali region increases the risk of age-related disability. Infrastructure development in the outer Java-Bali region needs to be improved so that older adults can experience healthy aging.

QUANTIFYING CONTRIBUTIONS OF WORK CHARACTERISTICS TO EDUCATIONAL DISPARITIES IN HEALTH-INDUCED WORK LIMITATIONS

Abstract While public policies are incentivizing longer working lives, poor health and inhospitable working conditions pose challenges to working longer, especially for Americans with low educational attainment. This analysis sought to quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in mid life and old age. Using the Health and Retirement Study (2006-2016), we showed that educational disparities in reporting “any impairment or health problem that limits the kind or amount of paid work” in ages 51-80 have been profound and persistent over time. Blinder-Oaxaca three-fold decomposition revealed that distributions of income and employer insurance made the largest contribution to explaining different rates of work limitations among respondents with versus without high school degrees, followed by work characteristics (physical job demands, insufficient hours) and health conditions (diabetes, lung disease). Comparing respondents with high school versus college degrees, distributions of health conditions mattered most (high blood pressure, lung disease, heart disease, stroke), followed by health behaviors (smoking, drinking). Health-induced work limitations are often used as a health outcome, but we found that work characteristics explained 57% of the disadvantage of those without a high school degree and 44% of the disadvantage of high school compared to college graduates. Therefore, improving work environments holds promise for reducing educational disparities in mid-to-late-life disability.

Socio-Demographic and Disability Disparities in Stroke by Citizenship Status: A Cross-Sectional Analysis.

This study aims to assess relationships between previous stroke diagnosis and demographic or disability status variables, stratified by U.S. citizenship status. The2019 and 2021 National Health Interview Survey data were analyzed for both descriptive statistics and logistic regression models. Age, sex, income level, race/ethnicity, health insurance status, and indicators of disability common after stroke were predictor variables of interest. For each disability predictor variable, higher odds of having stroke were seen regardless of citizenship status, except for the 'difficulty remembering' variable. For U.S. citizens, increasing age corresponded with higher odds of stroke diagnosis. For noncitizens, odds ratios decreased from 40.3 (95% CI 38.88-41.82) for the 40-65 age group to 29.6 (95% CI 28.38-30.77) in the 80 + group, when compared with the 18-39 age reference group. Female noncitizens had higher odds of stroke, while male citizens had higher odds. Non-Hispanic Black citizens had higher odds of stroke, while the other racial/ethnic groups had higher odds for noncitizens. The results indicated the existence of several socio-demographic disparities in stroke. Notably, noncitizens experienced stroke at a younger age and reported more severe disability outcomes after stroke diagnosis than citizens.

Bilingual randomized controlled trial design, of a telephone-based intervention to promote rehabilitation adherence; A study focus on recruitment of Hispanic children with traumatic brain injury

BackgroundWhile Hispanic children experience large long-term disparities in disability after traumatic Brain Injury (TBI), there is a gap in evidenced-based interventions to improve outcomes among this rapidly growing and at high-risk population. We developed and pilot tested a bilingual/bicultural intervention informed by Hispanic families consisting of Brain Injury Education and outpatient Navigation (1st BIEN). It integrates bilingual in-person education enriched by video content delivered through mobile phone devices, with outpatient navigation by bilingual and bicultural navigators during transitions of care and school return. MethodsRandomized controlled trial to test the efficacy of 1st BIEN to maintain long-term adherence to rehabilitation and determine its effect on children's functional outcomes. The primary outcome is treatment adherence at 6 months post-discharge at centralized acute facilities and community providers. Secondary outcomes are functional status of the child using PROMIS parental report measures and parental health literacy, self-efficacy, and mental health; measured at baseline (pre-injury and discharge) 3-,6- and 12- months post discharge. Children's academic performance is assessed using school records the year before and the year after injury. DiscussionOur study evaluates a novel, flexible and scalable approach using mobile phone devices to aid transitions of care, increase treatment adherence and improve TBI outcomes. It addresses the needs of an understudied population and builds upon their strengths. It is implemented by a bilingual and bicultural team with a deep understanding of the study population. It can serve as a model for TBI family centered interventions for at risk groups.Trial registration:ClinicalTrials.govNCT05261477. Registered on March 2, 2022.

Quantifying the Contribution of Work Characteristics to Educational Disparities in Health-Induced Work Limitations.

To quantify how poor health and inhospitable working conditions each contribute to educational disparities in work disability in midlife and old age. We used the Health and Retirement Study (2006-2016) to examine educational disparities in reporting "any impairment or health problem that limits the kind or amount of paid work" in ages 51-80. We found disparities to be profound and persistent over time. Blinder-Oaxaca threefold decomposition revealed that distributions of income and employer insurance made the largest contribution to explaining different rates of work limitations among respondents with versus without high school degrees, followed by work characteristics (physical job demands, insufficient hours) and health conditions (diabetes, lung disease). Comparing respondents with high school versus college degrees, distributions of health conditions mattered most (high blood pressure, lung disease, heart disease, stroke), followed by health behaviors (smoking, drinking). Health-induced work limitations are often used as a measure of health, but we found that work characteristics explained 57% of the disadvantage of those without a high school degree and 44% of the disadvantage of high school compared to college graduates. Work environments appear to play an important role in educational disparities in mid- to late-life disability.

Race/Ethnicity, Nativity, and Gender Disparities in Unmet Care Needs Among Older Adults in the United States.

Although disparities in disability and the unequal distribution of care resources are widely discussed in the literature, there has been less research on disparities in experiencing unmet care needs among older adults. This study aims to investigate how unmet care needs are unevenly distributed across social groups with various intersecting identities, such as race/ethnicity, nativity, and gender, although considering their care needs and care networks, drawing on the conceptual framework of the pathway to unmet needs. The data for this study came from the National Health and Aging Trends Study (2011-2018), and the study sample consisted of 7,061 Medicare beneficiaries who needed assistance with daily activities. Questions about unmet care needs were in the form of consequences related to difficulty or lack of help with daily activities. Mixed-effects negative binomial regression models were used to predict rates of unmet needs. Older adults of color, especially women, experienced higher rates of unmet care needs compared with their White and male counterparts. Although Black-White and gender differences in unmet needs were mostly explained by unequal exposures to care needs and differential care networks, Hispanic women and foreign-born Hispanic men were still at a disadvantage even after adjusting for these covariates. These results emphasize the importance of adopting an intersectional approach to enhance the quality of long-term services and support for older adults facing social disadvantages.

Abstract #1402660: Association of Social Vulnerability Index Themes and Pre-Diabetes in Chicago Neighborhoods

Pre-diabetes, defined as a glycosylated hemoglobin between 5.7% and 6.4%, is a common condition that is amenable to intervention to ameliorate progression to diabetes. The distribution of pre-diabetes at the census tract level in diverse urban communities and the neighborhood factors that may influence community pre-diabetes rates are not well understood. The social vulnerability index (SVI) was created by the Centers for Disease Control and Prevention to study how communities may be affected following natural disasters. SVI scores range from 0 to 1 with higher SVI scores representing increased social vulnerability. SVI is composed of four neighborhood level themes — socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. The objective of this proof-of-concept project was to determine the distribution of pre-diabetes in patients from census tracts served by a single academic health center and to understand how census tract SVI scores amongst the four SVI themes may be associated with pre-diabetes. For data available in 2018, pre-diabetes rates varied from 0.5% to 16.7% for 1,203 out of the 1,313 census tracts for which there were at least 25 adult patients seen at Rush University Medical Center. A linear regression model was used to assess the change in SVI theme score with the rate of pre-diabetes. Each 0.1 unit increase in SVI theme score for the socioeconomic status, household composition and disability, and minority status and language themes were associated with a 0.37% (SE = 0.027; p-value < 0.0001), 0.36% (SE = 0.027; p-value < 0.0001), and 0.14% (SE = 0.029; p-value = 0.0045) increase in the rate of pre-diabetes, respectively. However, the housing and transportation theme had a non-significant 0.08% decreased rate of pre-diabetes per 0.1-unit change (SE = 0.029, p-value = 0.07). While there was significant heterogeneity of SVI theme scores and pre-diabetes rates in census tracts served by a single, urban health center, this proof-of-concept work shows a potential relationship between SVI themes and pre-diabetes rates at the census-tract level. If confirmed in future studies, SVI could be a tool for future targeted neighborhood-specific interventions to reduce the health impact of pre-diabetes, such as providing more resources to address disparities in socioeconomic status, household composition and disability, and minority status and language domains.

Examining racial and ethnic differences in disability among older adults: A polysocial score approach

ObjectivesRacial and ethnic disparities in disability in activities of daily living (ADL) continue to be a public concern. We evaluated whether the polysocial score approach could provide a more comprehensive method for modifying racial and ethnic differences in such disability. Study designCohort study. Main outcome measuresWe included 5833 participants from the Health and Retirement Study, who were aged 65 years or more and were initially free of ADL disability. We considered six ADLs: bathing, eating, using the toilet, dressing, walking across a room, and getting in/out of bed. We included 20 social factors spanning economic stability, neighborhood and physical environment, education, community and social context, and health system. We used forward stepwise logistic regression to derive a polysocial score for ADL disability. We created a polysocial score using 12 social factors and categorized the score as low (0–19), intermediate (20–30), and high (31+). We used multivariable logistic regression to estimate the incident risk of ADL disability and examine additive interactions between race/ethnicity and polysocial score. ResultsA higher polysocial score is associated with a lower incidence of ADL disability among older adults in the United States. We found additive interactions between race/ethnicity and polysocial score categories. In the low polysocial score category, White and Black/Hispanic participants had a 18.5 % and 24.4 % risk of ADL disability, respectively. Among White participants, the risk of ADL disability decreased to 14.1 % and 12.1 % in the intermediate and high polysocial score categories, respectively; among Black/Hispanic participants, those in the intermediate and high categories had a 11.9 % and 8.7 % risk of ADL disability, respectively. ConclusionsThe polysocial score approach provides a new opportunity for explaining racial/ethnic disparities in functional capacity among older adults.

Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults With Cognitive Impairment Living Alone, 2000-2018.

Informal care is the primary source of support for older adults with cognitive impairment, yet is less available to those who live alone. We examined trends in the prevalence of physical disability and social support among older adults with cognitive impairment living alone in the United States. We analyzed 10 waves of data from the U.S. Health and Retirement Survey spanning 2000-2018. Eligible people were those aged ≥65, having cognitive impairment, and living alone. Physical disability and social support were measured via basic and instrumental activities of daily living (BADLs, IADLs). We estimated linear temporal trends for binary/integer outcomes via logistic/Poisson regression, respectively. A total of 20 070 participants were included. Among those reporting BADL/IADL disability, the proportion unsupported for BADLs decreased significantly over time (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.97-0.99), and the proportion unsupported for IADLs increased (OR = 1.02, CI 1.01-1.04). Among those receiving IADL support, the number of unmet IADL support needs increased significantly over time (relative risk [RR] 1.04, CI 1.03-1.05). No gender disparities were found for these trends. Over time, Black respondents had a relatively increasing trend of being BADL-unsupported (OR = 1.03, CI 1.0-1.05) and Hispanic and Black respondents had a relatively increasing trend in the number of unmet BADL needs (RR = 1.02, CI 1.00-1.03; RR = 1.01, CI 1.00-1.02, respectively), compared to the corresponding trends in White respondents. Among lone-dwelling U.S. older adults with cognitive impairment, fewer people received IADL support over time, and the extent of unmet IADL support needs increased. Racial/ethnic disparities were seen both in the prevalence of reported BADL/IADL disability and unmet BADL/IADL support needs; some but not all were compatible with a reduction in disparity over time. This evidence could prompt interventions to reduce disparities and unmet support needs.

Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults with Cognitive Impairment Living Alone, 2000–2018

Trends in Gender and Racial/Ethnic Disparities in Physical Disability and Social Support Among U.S. Older Adults with Cognitive Impairment Living Alone, 2000–2018

Collagen-bound fibrin sealant (TachoSil®) for dural closure in cranial surgery: single-centre comparative cohort study and systematic review of the literature

Cerebrospinal fluid (CSF) leakage is a well-known complication of craniotomies and there are several dural closure techniques. One commonly used commercial product as adjunct for dural closure is the collagen-bound fibrin sealant TachoSil®. We analysed whether the addition of TachoSil has beneficial effects on postoperative complications and outcomes. Our prospective, institutional database was retrospectively queried, and 662 patients undergoing craniotomy were included. Three hundred fifty-two were treated with dural suture alone, and in 310, TachoSil was added after primary suture. Our primary endpoint was the rate of postoperative complications associated with CSF leakage. Secondary endpoints included functional, disability and neurological outcome. Systematic review according to PRISMA guidelines was performed to identify studies comparing primary dural closure with and without additional sealants. Postoperative complications associated with CSF leakage occurred in 24 (7.74%) and 28 (7.95%) procedures with or without TachoSil, respectively (p = 0.960). Multivariate analysis confirmed no significant differences in complication rate between the two groups (aOR 0.97, 95% CI 0.53–1.80, p = 0.930). There were no significant disparities in postoperative functional, disability or neurological scores. The systematic review identified 661 and included 8 studies in the qualitative synthesis. None showed a significant superiority of additional sealants over standard technique regarding complications, rates of revision surgery or outcome. According to our findings, we summarize that routinary use of TachoSil and similar products as adjuncts to primary dural sutures after intracranial surgical procedures is safe but without clear advantage in complication avoidance or outcome. Future studies should investigate whether their use is beneficial in high-risk settings.

Changes and Trend Disparities in Life Expectancy and Health-Adjusted Life Expectancy Attributed to Disability and Mortality From 1990 to 2019 in China.

ObjectiveThis study aims to investigate sex, age, and cause-specific contributions to changes and trend disparities in life expectancy (LE) and health-adjusted life expectancy (HALE) attributed to disability and mortality from 1990 to 2019 in China, which provides insight into policy-making, health systems planning, and resource allocation.MethodsContributions of disability and mortality to changes and trend disparities in LE and HALE were estimated with standard abridged life table, Sullivan's method, and decomposition method, using retrospective demographic analysis based on mortality and years lived with disability (YLD) rates extracted from Global Burden of Disease Study 2019 (GBD 2019).ResultsFrom 1990 to 2019, LE and HALE increased by 10.49 and 8.71 years for both sexes, mainly due to noncommunicable diseases (NCDs) (5.83 years, 55.58% for LE and 6.28 years, 72.10% for HALE). However, HIV/AIDS and sexually transmitted infections had negative effects on changes in LE (−0.03 years, −0.29%) and HALE (−0.05 years, −0.57%). Lung cancer and ischemic heart disease caused the biggest reduction in LE (−0.14 years, −1.33%) and HALE (−0.42 years, −4.82%). Also, cardiovascular diseases (−0.08 years, −0.92%), neurological disorders (−0.08 years, −0.92%), diabetes and kidney diseases (−0.06 years, −0.69%), and transport injuries (−0.06 years, −0.69%) had main negative disability effects in HALE. Moreover, life expectancy lived with disability (LED) increased by 1.78 years, mainly attributed to respiratory infections and tuberculosis (1.04 years, 58.43%) and maternal and neonatal disorders (0.78 years, 43.82%).ConclusionThe LE and HALE in China have grown rapidly over the past few decades, mainly attributed to NCDs. It is necessary to further reduce the negative mortality effect of HIV/AIDS, lung cancer, colon and rectum cancer, pancreatic cancer, and ischemic heart disease and the negative disability effect of stroke, diabetes mellitus, and road injuries. In addition, the signs of disparities in mortality and disability of different sexes and ages call for targeted and precise interventions for key groups such as males and the elderly. According to the decomposition results, we may better determine the key objects of health policies that take into account substantial cause-specific variations to facilitate the realization of “healthy China 2030” plan.

Association of Socioeconomic Status and Infarct Volume With Functional Outcome in Patients With Ischemic Stroke

Long-term disability after stroke is associated with socioeconomic status (SES). However, the reasons for such disparities in outcomes remain unclear. To assess whether lower SES is associated with larger admission infarct volume and whether initial infarct volume accounts for the association between SES and long-term disability. This cohort study was conducted in a prospective, consecutive population (n = 1256) presenting with acute ischemic stroke who underwent magnetic resonance imaging (MRI) within 24 hours of admission. Patients were recruited in Massachusetts General Hospital, Boston, from May 31, 2009, to December 31, 2011. Data were analyzed from May 1, 2019, until June 30, 2020. Initial stroke severity (within 24 hours of presentation) was determined using clinical (National Institutes of Health Stroke Scale [NIHSS]) and imaging (infarct volume by diffusion-weighted MRI) measures. Stroke etiologic subtypes were determined using the Causative Classification of Ischemic Stroke algorithm. Long-term stroke disability was measured using the modified Rankin Scale. Socioeconomic status was estimated using zip code-derived median household income and census block group-derived area deprivation index (ADI). Regression and mediation analyses were performed. A total of 1098 patients had imaging and SES data available (mean [SD] age, 68.1 [15.7] years; 607 men [55.3%]). Income was inversely associated with initial infarct volume (standardized β, -0.074 [95% CI, -0.127 to -0.020]; P = .007), initial NIHSS (standardized β, -0.113 [95% CI, -0.171 to -0.054]; P < .001), and long-term disability (standardized β, -0.092 [95% CI, -0.149 to -0.035]; P = .001), which remained significant after multivariable adjustments. Initial stroke severity accounted for 64% of the association between SES and long-term disability (standardized β, -0.063 [95% CI, -0.095 to -0.029]; P < .05). Findings were similar when SES was alternatively assessed using ADI. The findings of this cohort study suggest that lower SES is associated with larger infarct volumes on presentation. These SES-associated differences in initial stroke severity accounted for most of the subsequent disparities in long-term disability in this study. These findings shift the culpability for SES-associated disparities in poststroke disability from poststroke factors to those that precede presentation.

Functional Disability Among Middle-Aged and Older Adults in China: The Intersecting Roles of Ethnicity, Social Class, and Urban/Rural Residency.

This study explores how ethnicity, family income, and education level differentiate patterns of functional limitations among urban and rural Chinese (aged 45 ≥ years). Based on the 2018 China Family Panel Studies (CFPS) (n = 16,589), this nationwide study employed binary/multinomial logistic regression analyses, stratified by urban/rural residency, to estimate the likelihood of instrumental activities of daily living (IADLs) disability (0/1-2/≥3 limitations) by social determinants of health (SDoH). The estimated overall prevalence of IADLs disability was 14.3%. The multivariable analyses did not find significant ethnic disparity in IADLs disability in urban China, while in rural China, ethnic minorities were 44% more likely to have IADLs disability than Han Chinese. Among rural residents, Mongolians, Tibetans, and Yi minority more than tripled the odds of having ≥3 limitations than Han Chinese; and the intersections of ethnicity and social class were associated with functional limitations. Long-term care and anti-poverty programs should target minority aging populations in rural China.

Trends in activities of daily living disability among Chinese older adults from 1998 to 2018: an age-period-cohort analysis.

This study aims to investigate the age, period, and cohort effects on trends in activities of daily living (ADL) disability among Chinese older adults; and to explore these three temporal effects on gender and residence disparities in disability. We utilized multiple cross-sectional waves of the Chinese Longitudinal Healthy Longevity Survey data (1998-2018), including 89,511 participants aged above 65years old. Our measurement of disability is the number of ADL items (dressing, bathing, indoor transferring, toileting, eating, and continence) participants can't perform independently. Hierarchical age-period-cohort cross-classified random effects models were conducted to investigate age, period and cohort trends in ADL disability. Results showed that ADL disability increased with age at an increasing rate. A V-shaped cohort trend and a fluctuated period trend were identified. Females and urban residents were associated with more ADL limitations. When age increased, the gender and residence gaps in disability further increased. The cohort-based gender and residence inequalities in ADL limitations converged with successive cohorts. The period-based residence gap in ADL limitations diverged throughout the 20-year period, while the corresponding period-based change in gender disparity was not significant. These findings suggested that age, period, and cohort had different and independent effects on ADL disability among Chinese older adults. The age effect on trends in ADL is stronger compared to period and cohort effects. The gender and residence disparities in disability increased with age and decreased with successive cohorts. These patterns might help inform healthcare planning and the priorities for medical resource allocation accordingly.