Racial and ethnic differences in activities of daily living disability among the elderly: The case of Spanish speakers

Objective: To compare incident disability patterns across racial and ethnic groups. Design: Prospective cohort study with 6-year follow-up (1998-2004). Setting: National probability sample. Participants: A 1998 Health and Retirement Study sample of 12,288 non-Hispanic whites, 1952 African Americans, 575 Hispanics interviewed in Spanish (Hispanic-Spanish), and 518 Hispanics interviewed in English (Hispanic-English), older than 51 years, and free of disability at baseline. Interventions: Not applicable. Main Outcome Measure: Disability in activities of daily living (ADL) tasks (walking, dressing, transferring, bathing, toileting, feeding). Results: Hispanic-Spanish reported disproportionately lower rates of walking disability (standardized rates, 4.31% vs Hispanic-English [8.57%], black [7.54%], white [7.20%]) despite higher reported Hispanic-Spanish frequencies of lower-extremity dysfunction than other racial and ethnic groups. Across the 6 ADL tasks, the development of walking disability was most frequent among Hispanic-English subjects, African Americans, and whites. In contrast, Hispanic-Spanish subjects reported dressing as the most frequent ADL task disability, whereas walking ranked fourth. Conclusions: Aggregating all Hispanics, regardless of interview language, may be inappropriate. Future research on linguistic group differences in self-reported health outcomes is necessary to ensure that health status measures will be appropriate for use in diverse racial and ethnic groups.