Influence of Gender on the Association between Race and Disability: California Health Interview Survey

Purpose: Disability is common in older adults: 40% of those 65 years or older live with a disability in the US. Women typically have higher rates of disability than men in later life. Moreover, minority groups have also been shown to have a higher prevalence of disability than their White counterpart. However, there is very little research regarding the role of gender in the association of race with disability. We aimed to examine whether the association between race and disability differed by men and women.

Method: We conducted a cross-sectional analysis using data from the 2015-2016 California Health Interview Survey (CHIS) in adults aged 65 years or older (n=15,044). Due to the complex survey design in CHIS, we accounted for complex sampling weights in all analyses using SAS v9.4. Physical, mental, and emotional disabilities were recorded by participants, and disability was dichotomized as present or absent. Race was classified as Hispanic, Asian, Black, White, and Other. We generated sex- and race-specific descriptive statistics and used multivariable logistic regression to estimate sex-stratified associations between race and disability, adjusting for age, education, marital status, cigarette smoking, arthritis, hypertension, diabetes, mental distress, and walking for work or pleasure.

Results: The mean age was 71.5 years for men (range 65-85 years) and 72.2 years for women (range 65-85 years). Participants were predominantly female (59.4%). The majority of participants were White (71.0%) followed by Hispanic (11.4%), Asian (10.7%), Black (4.3%), and other race/ethnicity (2.5%). The prevalence of reported disability was higher among females than males (52% vs. 47%, P=0.0002). The prevalence of disability was highest for Hispanics (60%), followed by Other race/ethnicity (50%), White (48%), Black (48%), and Asian (43%) individuals. Among women, in fully adjusted models, Hispanic individuals were more likely to have reported a disability when compared with white women (OR=1.67, 95% CI= 1.07–2.60). Among males, Hispanic individuals were as likely to have reported a disability as White males (OR=1.03, 95% CI=0.68-1.56). The association between race/ethnicity and disability was not statistically significant for other race/ethnicities.

Conclusion: We observed that Hispanic women were more likely to report disability when compared with White women. Further research should be conducted to understand possible factors that contribute to the association between race and disability differently in women than men.