The disability gap: Risk factors for life course disability trajectories for Black and White older adults

Jessica Ann Kelley-Moore, Purdue University

Abstract

Research has shown that Black older adults tend have higher disability. However, previous studies have disagreed about the magnitude of this disability gap and whether it diverges, converges, or remains constant over time. Most explanations have concentrated on differences in socioeconomic status but this has not explained the entire disparity. Seven waves of panel data from the North Carolina Established Populations for the Epidemiologic Study of the Elderly (1986–1992) are used to examine possible mechanisms of the racial health disparity. The baseline sample is 4,162 adults ages 65 and older and more than half of the sample are Black respondents (54%). The first project addresses whether the racial disability gap exists and what happens to that gap over time by estimating the trajectory of disability separately for Black and White older adults with latent growth curves. Black older adults have a higher level and slope of disability than White adults, but after controlling for covariates, the slopes are no longer significantly different. Incident morbidity accounts for the remaining racial disability gap. The second project focuses on intra-individual differences in disability reports across data collection modes. Separate predicted trajectories of disability using only face-to-face interviews and then only telephone interviews indicate that older adults are significantly more likely to report higher disability in-person. Using only face-to-face interviews, Black and White adults have a level and trajectory of disability that is not significantly different. Using only telephone interviews, there is a racial disability gap and it continues to diverge over time. Conclusions about whether a racial disability gap even exists are dependent on the mode of data collection. The final project extends the conceptual model of the disablement process to include feedback mechanisms between morbidity, depression, and disability. These cycles of health decline are tested with lagged effects of depression and morbidity on disability while simultaneously estimating the opposite causal effect of disability on depression and morbidity. Cycles of health decline are evident: higher levels of morbidity and depression cause each other over time. No race differences in the process of health decline are evident.

Degree

Ph.D.

Advisors

Ferraro, Purdue University.

Subject Area

Gerontology|Ethnic studies|Black studies|Public health

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