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Inner City, Middle-Aged African Americans Have Excess Frank and Subclinical Disability

¹ School of Medicine, Saint Louis University, St. Louis, Missouri.
² Geriatric Research, Education, and Clinical Center, VAMC, St. Louis, Missouri.
³ College of Public Health, University of Iowa, Iowa City.
⁴ School of Public Health, Saint Louis University, St. Louis, Missouri.
⁵ Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.

Address correspondence to Douglas K. Miller, MD, Indiana University, Center for Aging Research, Regenstrief Institute, 1050 Wishard Blvd., RG-6, Indianapolis, IN 46202. E-mail: dokmille{at}iupui.edu

Background. Healthy People 2010 seeks to decrease or eliminate the health disparities experienced by disadvantaged minority groups.

Methods. African American Health (AAH) is a population-based panel study of community-dwelling African Americans born between 1936 and 1950 from two strata. The first encompasses a poor, inner city area, and the second involves a suburban population with higher socioeconomic status. The authors recruited 998 participants (76% recruitment). Frank disability was assessed for 25 tasks and defined as inability or difficulty performing that task. Subclinical disability was assessed for 12 tasks and defined as no difficulty but a change in either manner or frequency of task performance. Frank disability prevalences were compared with national data for community-dwelling non-Hispanic white persons (NHW) and African American persons in the same age range.

Results. Compared with the suburban sample, the inner city group had a higher prevalence of frank disability for all 25 tasks (p <.05 for 16) and subclinical disability for 11 of the12 tasks (p <.05 for 5). Both strata had more frank disability compared with the national NHW population. The inner city area had higher frank disability proportions than did the national African American sample, whereas the suburban group had similar disability levels.

Conclusions. The AAH inner city group experiences more frank disability than other populations of African Americans and NHWs. The increased prevalence of subclinical disability in the inner city group compared with the suburban group suggests that the disparity in frank disability will continue. These findings indicate that African Americans living in poor inner city areas in particular need intensive and targeted clinical and public health efforts.

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