Black-White Racial Disparities in Disabilities Among Older Americans Between 2008 and 2017: Improvements in Cognitive Disabilities but no Progress in Activities of Daily Living or Functional Limitations.

The objectives of this study were to examine the prevalence of race-based disparities in cognitive problems, functional limitations (FLs), and activity of daily living (ADL) limitations between US Black and White older adults in 2008 and 2017, to explore how age, sex, income, and education attenuate these racial disparities, and to determine if Black-White health disparities are narrowing. Secondary analysis of the nationally representative American Community Surveys including 423,066 respondents aged ≥65 (388,602 White, 34,464 Black) in 2008 and 536,984 (488,483 White, 48,501 Black) in 2017. Findings indicate that Black-White racial disparities were apparent for all three outcomes in 2008 and 2017. Approximately half of the racial disparities was attenuated when adjustments were made for education and income. Racial disparities in cognition declined between 2008 and 2017 (p < .001) but persisted unabated in FLs and ADL limitations. Further exploration on the mechanisms of racial disparities is warranted.

The prevalence and management of diabetes among Vietnamese Americans: A population-based survey of an understudied ethnic group.

OBJECTIVES: Although obesity remains relatively rare among Vietnamese Americans, the prevalence of diabetes has increased in this population. This study aims to: 1. Estimate the prevalence of diabetes among non-obese Vietnamese American adults compared to non-obese non-Hispanic whites (NHW). 2. Identify factors associated with diabetes among non-obese Vietnamese Americans. 3. Examine whether Vietnamese Americans and NHW with diabetes are equally as likely to receive optimal frequency of diabetes care (i.e., hemoglobin A1C monitoring, foot care, eye care). METHODS: We conducted a secondary analysis of non-obese adult Vietnamese Americans using pooled data from the 2007, 2009, 2011 and 2013-2016 waves of the California Health Interview Survey (CHIS). RESULTS: Only 9% of Vietnamese Americans with diabetes are obese. Non-obese Vietnamese Americans have 60% higher adjusted odds of diabetes compared to non-obese NHW. Among non-obese Vietnamese Americans, those who were older, ever smokers and born outside US had a higher prevalence of diabetes. We found both Vietnamese Americans and NHW with diabetes received similar levels of care. DISCUSSION: Non-obese Vietnamese Americans have much higher odds of diabetes than NHW. Health professionals can effectively minimize disparities between Vietnamese Americans and NHW with diabetes through appropriate monitoring of foot care, eye care and A1C levels.

Attention-Deficit/Hyperactivity Disorder and Alcohol and Other Substance Use Disorders in Young Adulthood: Findings from a Canadian Nationally Representative Survey.

AIM: (a) To document the prevalence and odds of (i) alcohol use disorders, (ii) cannabis use disorders, (iii) other drug use disorders and (iv) any substance use disorder (SUD), among young adults with and without ADHD, and (b) to investigate the degree to which the association between ADHD and SUDs is attenuated by socio-demographics, early adversities and mental health. METHOD: Secondary analysis of the nationally representative Canadian Community Health Survey-Mental Health (CCHS-MH). The sample included 6872 respondents aged 20-39, of whom 270 had ADHD. The survey response rate was 68.9%. MEASUREMENTS: Substance Use Disorder: World Health Organization's Composite International Diagnostic Interview criteria, SUDs, were derived from lifetime algorithms for alcohol, cannabis and other substance abuse or dependence. ADHD was based on self-report of a health professional's diagnosis. FINDINGS: One in three young adults with ADHD had a lifetime alcohol use disorder (36%) compared to 19% of those without ADHD (P < 0.001). After adjusting for all control variables, those with ADHD had higher odds of developing alcohol use disorders (OR = 1.38, 95% CI: 1.05, 1.81), cannabis use disorders (OR = 1.46, 95% CI: 1.06, 2.00), other drug use disorders (OR = 2.07, 95% CI: 1.46, 2.95) and any SUD (OR = 1.69, 95% CI: 1.28, 2.23). History of depression and anxiety led to the largest attenuation of the ADHD-SUD relationship, followed by childhood adversities and socioeconomic status. CONCLUSIONS: Young adults with ADHD have a high prevalence of alcohol and other SUDs. Targeted outreach and interventions for this extremely vulnerable population are warranted.

Temporal Trends over a Decade in Serious Vision Impairment in a Large, Nationally Representative Population-based Sample of Older Americans: Gender, Cohort and Racial/Ethnic Differences.

PURPOSE: The objectives of this study are:1)To identify temporal trends in the age-sex-race/ethnicity adjusted prevalence of vision impairment among Americans aged 65+ from 2008-2017; To determine if these temporal trends in vision impairment differ by 2)gender and age cohort, and 3)race/ethnicity, and; 4)To investigate if improvements in cohort educational attainment partially attenuate these trends. METHODS: Secondary analysis of 10 years of annual nationally-representative data from the American Community Survey with 5.4 million community-dwelling and institutionalized older adults aged 65+. The question on vision impairment was "Is this person blind or does he/she have serious difficulty seeing even when wearing glasses?". RESULTS: The prevalence of serious vision impairment in the US population aged 65+ declined from 8.3% to 6.6% between 2008 and 2017. There would have been an additional 848,000 older Americans with serious vision impairment in 2017 if rates had remained at the 2008 level. After age, sex and race/ethnicity were controlled, women had a 2.1% per year decline in the odds of vision impairment (OR = 0.979; CI = 0.977, 0.980), which represents a 21% decline over the decade, and men had a 9% decline over the decade (OR = 0.991; CI = 0.989, 0.993). Adjusting for education attenuated the decade decline among women, reducing it to 13%, and completely attenuated the decline among men. Most of the decline was among those aged 75+. Racial/ethnic disparities narrowed over the decade. CONCLUSION: Between 2008 and 2017, the prevalence of serious vision impairment among older Americans declined significantly, with steeper declines among African Americans and Hispanic Americans than among non-Hispanic White Americans.

Physical Health of Older Canadians: Do Intersections Between Immigrant and Refugee Status, Racialized Status, and Socioeconomic Position Matter?

It is unclear whether racial or nativity health disparities exist among older Canadians and what social and economic disadvantages may contribute to these differences. Secondary analysis of data collected from respondents aged 55 and older in the Canadian General Social Survey 27 was performed. The outcome variable was self-reported physical health. Compared to racialized immigrants, white immigrant and Canadian-born respondents had approximately 35% higher odds of good health. Among racialized older adults, the odds of good health were better if they were younger than 75, more affluent, better educated, had a confidant, had not experienced discrimination in the past five years, and were more acculturated. Racialized immigrants are at a health disadvantage compared to white groups in Canada; however, greater acculturation, social support, and lower experiences of discrimination contribute to better health among racialized older adults.

Suicide Attempts among Those with Migraine: Findings from a Nationally Representative Canadian Study.

The objectives of this study were to identify the gender-specific prevalence of suicide attempts among those with migraine and to examine what factors are associated with suicide attempts among migraineurs. This study was a nationally representative analysis of the 2012 Canadian Community Health Survey - Mental Health (CCHS-MH) with 21,744 respondents, of whom 2,223 had migraine. Bivariate and logistic regression analyses were conducted. Those with migraine had a much higher prevalence of ever attempting suicide than those without migraine (men: 7.5% vs 1.9%; women; 9.3% vs 2.7%, p < .001). Among migraineurs, the odds of suicide attempts were higher among poorer respondents, those in chronic pain and those with a history of childhood adversities, substance dependence and/or mental illness. Targeted outreach is needed to reduce suicidality in this vulnerable population.

Factors Associated with Recovery in Aboriginal People in Canada Who Had Previously Been Suicidal.

To explore factors associated with recovery from suicidal ideation among Aboriginal peoples living off reserve in Canada. Recovery is defined as being free of serious suicidal thoughts for the past year. Data for this study came from the 2012 Aboriginal Peoples Survey, a nationally representative sample of Aboriginal peoples in Canada who are living off-reserve. The sample consisted of those who had seriously considered suicide at some point in their life (n = 2,680). Those who had been suicidal in the past year were compared to those who were no longer suicidal using Pearson chi-square and logistic regression analyses. Several factors were associated with recovery among Aboriginal peoples living off-reserve in Canada who had previously been suicidal. Recovery was higher among women, individuals who were older, and those who were food secure, spoke an Aboriginal language, had a high school degree, had a confidant, and had no previous diagnosis of mood disorders or learning disability. Several sociodemographic factors appear to influence recovery from suicidality among Aboriginal peoples. Intervention approaches to promote recovery from suicidal ideation would benefit from targeted outreach, a strength-based, culturally-specific approach using traditional practices, and encouraging involvement of various community members to foster resilience and formation of relationships.

Diabetes Care of Non-obese Korean Americans: Considerable Room for Improvement.

BACKGROUND: Family doctors are increasingly managing the diabetes care of Korean-Americans. Little is known about the prevalence of diabetes among non-obese Korean-Americans, or the extent to which they receive timely and appropriate diabetes care. The purpose of this investigation is to: (1) identify the prevalence of diabetes and to determine the adjusted odds of diabetes among non-obese Korean-Americans compared to non-Hispanic White (NHW) Americans, (2) examine the factors associated with having diabetes in a large sample of non-obese KoreanAmericans, and (3) determine the prevalence and adjusted odds of optimal frequency of eye care, foot care and A1C blood glucose level monitoring among non-obese Korean-Americans with diabetes in comparison to NHWs with diabetes. METHODS: Secondary analysis of population-based data from the combined 2007, 2009, and 2011 adult California Health Interview Survey. The sample included 74,361 respondents with body mass index (BMI) <30 kg/m2 (referred to as 'non-obese BMI'), of whom 2,289 were Korean-Americans and 72,072 were NHWs, and 4,576 had diabetes. RESULTS: The prevalence and adjusted odds of diabetes among non-obese Korean-Americans are significantly higher than among their NHW peers. More than 90% of Korean-Americans with diabetes were non-obese. NHWs had substantially higher odds of having optimal frequency of eye care, foot care and A1C glucose level monitoring, even after adjusting for insulin dependence, sex, age, education, income, and BMI. CONCLUSION: Non-obese Korean-Americans are at higher risk for diabetes and are much less likely to receive optimal diabetes care in comparison to NHWs. Targeted outreach is necessary.

Latino Solo Grandparents Raising Grandchildren: Health Risks and Behaviors.

INTRODUCTION: The purpose of this descriptive report is to provide the first representative information on the sociodemographic profile and the prevalence of mental and physical health conditions of two "at-risk" groups of Latino caregivers: solo grandparent caregivers and single parents. METHODS: The 2012 Behavior Risk Factor Surveillance System was used to compare five dimensions of health on a sample of Latino solo grandparents and Latino single parents, raising their grandchildren/children alone. Bivariate and logistic regression comparative analyses were conducted on study measures. RESULTS: Latino solo grandparents have a high prevalence of chronic health conditions, including arthritis (51%), depression (40%), diabetes (34%), and asthma (34%). Latino single parents have lower but troubling health risks, including depression (22%), diabetes (14%), and asthma (14%). Differences between the two groups were largely due to the grandparents older age. DISCUSSION: Latino solo grandparents have a high prevalence of several chronic medical conditions. The prevalence of disorders is much lower for Latino single parents, although they too have disturbing health risks. CONCLUSION: Latino solo grandparents perform their parenting role under intense physical and emotional strain. Health professionals can be instrumental in facilitating interventions that affect the well-being of this expanding family group.

Examining Child Welfare Decisions and Services for Asian-Canadian Versus White-Canadian Children and Families in the Child Welfare System.

Using administrative child welfare data from the Ontario Child Abuse and Neglect Data System (OCANDS), this study compared the profiles of Asian-Canadian and White-Canadian children and families that experienced a case closure after an investigation instead of being transferred to ongoing child protection services (CPS). Child protection investigations involving Asian-Canadian and White-Canadian children and families that were transferred to ongoing CPS presented a different profile of case characteristics and caregiver and child clinical needs. Asian-Canadian children and families received ongoing CPS for over a month longer than White-Canadian children and families and were less likely (odds ratio [ OR] = 0.39) to be reinvestigated for any form of maltreatment-related concerns within 1 year after case closure. It appears that child protection investigations involving Asian-Canadian children and families are less likely to be closed prematurely than White-Canadian children and families, and the child protection system may be meeting the needs of Asian-Canadian communities. Alternatively, it is possible there is unaccounted biases that may be reflective of systemic problem of discriminative practices in the child protection system. Further research is needed to explore this phenomenon.

African-American Solo Grandparents Raising Grandchildren: A Representative Profile of Their Health Status.

The objective of this study is to document the health profile of 252 African-American grandparents raising their grandchildren solo, compared with 1552 African-American single parents. The 2012 Behavior Risk Factor Surveillance System is used to compare the specific physical and mental health profiles of these two family groups. The findings suggest solo grandparents have prevalence of many health conditions, including arthritis (50.3 %), diabetes (20.1 %), heart attack (16.6 %) and coronary heart disease (16.6 %). Logistic regression analyses suggest that solo grandparents have much higher odds of several chronic health disorders in comparison with single parents, but this difference is largely explained by age. Although solo grandparents have good access to health care insurance and primary care providers, a substantial percentage (44 %) rate their health as fair or poor. Practice interventions to address African American solo grandparents' health needs are discussed.

Older Asian Americans and Pacific Islanders with Activities of Daily Living (ADL) limitations: immigration and other factors associated with institutionalization.

This study determined the national prevalence and profile of Asian Americans with Activities of Daily Living (ADL) limitations and identified factors associated with institutionalization. Data were obtained from 2006 American Community Survey, which replaced the long-form of the US Census. The data are nationally representative of both institutionalized and community-dwelling older adults. Respondents were Vietnamese (n = 203), Korean (n = 131), Japanese (n = 193), Filipino (n = 309), Asian Indian (n = 169), Chinese (n = 404), Hawaiian/Pacific Islander (n = 54), and non-Hispanic whites (n = 55,040) aged 55 and over who all had ADL limitations. The prevalence of institutionalized among those with ADL limitations varies substantially from 4.7% of Asian Indians to 18.8% of Korean Americans with ADL limitations. Every AAPI group had a lower prevalence of institutionalization than disabled Non-Hispanic whites older adults (23.8%) (p < 0.001). After adjustment for socio-demographic characteristics, Asian Indians, Vietnamese, Japanese, Filipino, and Chinese had significantly lower odds of institutionalization than non-Hispanic whites (OR = 0.29, 0.31, 0.58, 0.51, 0.70, respectively). When the sample was restricted to AAPIs, the odds of institutionalization were higher among those who were older, unmarried, cognitively impaired and those who spoke English at home. This variation suggests that aggregating data across the AAPI groups obscures meaningful differences among these subpopulations and substantial inter-group differences may have important implications in the long-term care setting.

Evidence supporting an independent association between childhood physical abuse and lifetime suicidal ideation.

A regionally representative Canadian sample was used to investigate the gender-specific relationship between childhood physical abuse and lifetime suicidal ideation. The prevalence of suicidal ideation was about five times higher in abused men and women compared with their nonabused counterparts. After controlling for five clusters of potentially confounding factors (adverse childhood conditions, socioeconomic factors, health behaviors, psychosocial stressors/chronic illnesses, and mental health), childhood physical abuse was significantly associated with suicidal ideation (OR(adjusted) women = 4.48, 95% CI = 3.32-6.04; men = 3.57, 95% CI = 2.08-6.14). These findings suggest childhood physical abuse is independently associated with suicidal ideation and highlight the importance of providing preventative treatment to childhood abuse survivors.

Black-white differences in self-reported disability outcomes in the U.S.: early childhood to older adulthood.

OBJECTIVE: We examined black-white differences in activities of daily living (ADLs), functional limitations (FLs), vision/hearing/sensory impairment, and memory/learning problems in a large, nationally representative sample of community-dwelling and institutionalized people across the lifespan. METHODS: Data are from the 2006 American Community Survey (n=2,288,800). We included data on non-Hispanic black respondents (125,985 males and 145,780 females) and non-Hispanic white respondents (977,792 males and 1,039,243 females) ≥5 years of age. We used logistic regression to examine the black-white odds for each disability outcome. The overall response rate was 97.5%. RESULTS: For FLs, ADL limitations, and memory/learning problems, black people experienced higher odds of disability across the adult lifespan compared with white people. Black-white differences narrowed in older age. For vision/hearing problems, a black-white crossover was found in older age (≥85 years), where odds of vision/hearing problems were lower among black people than among white people. For all disability outcomes, black-white differences peaked in midlife (50-69 years of age), with black people having approximately 1.5 to two times the odds of disabilities as their white peers. CONCLUSIONS: The study findings suggest the need to address black-white disparities across a range of disability outcomes throughout the lifespan. Future work identifying the factors accounting for this pattern of disparities will help inform the development of appropriate prevention strategies.

Health decline among recent immigrants to Canada: findings from a nationally-representative longitudinal survey.

OBJECTIVE: The healthy immigrant effect suggests new immigrants to Canada enjoy better health, on average, than those born in Canada, yet cross-sectional data suggest that immigrants who have been in Canada for decades have comparable health to their native-born peers. We analyzed prospective cohort data to identify the factors associated with health decline among new immigrants. METHODS: The Longitudinal Survey of Immigrants to Canada was conducted by Statistics Canada and Citizenship and Immigration Canada between April 2001 and November 2005. A probability sample of 7,716 recent immigrants from abroad was interviewed three times: at six months, two years and four years after arrival in Canada. Logistic regression was used to model predictors of a two-step decline in self-reported health (e.g., from excellent to good or from very good to fair). RESULTS: Among recent immigrants, 15% reported a two-step decline in health in the first four years after arrival in Canada. In comparison, only 6% of non-immigrants from a similar age cohort reported a two-step decline in health during the same time period. The characteristics associated with an increased likelihood of health decline among recent immigrants include initial health status, age, gender, marital status, language skills and place/region of birth. Experience of discrimination was also associated with health decline. One in four immigrants who experienced a health decline reported problems accessing Canadian health services. CONCLUSIONS: The process of immigration is associated with health decline for some recent immigrants. These findings support Health Canada's identification of immigration as a determinant of health. Strategies need to be developed to improve access to health care among new immigrants.

Suicidal ideation among individuals whose parents have divorced: findings from a representative Canadian community survey.

This study used a large, nationally representative sample to examine the gender-specific association between parental divorce and the cumulative lifetime incidence of suicidal ideation. Known risk factors for suicidal ideation, such as childhood stressors, socioeconomic factors, adult health behaviors and stressors, marital status, and any history of mood and/or anxiety disorders were controlled. Gender-specific analyses revealed that for men, the parental divorce-suicidal ideation relationship remained statistically significant even when the above-listed cluster of risk factors were included in the analyses (odds ratio (OR)=2.36, 95% confidence interval (CI)=1.56, 3.58). For women, the association between parental divorce and suicidal ideation was reduced to non-significance when other adverse childhood experiences were included in the analyses (full adjustment OR=1.04, 95% CI=0.72, 1.50). These findings indicate a need for screening of suicidal ideation among individuals, particularly men and those with mood and/or anxiety disorders, who have experienced parental divorce. Future research should focus on the mechanisms linking parental divorce and suicidal ideation.

Comparison of disability rates among older adults in aggregated and separate Asian American/Pacific Islander subpopulations.

OBJECTIVES: We assessed the prevalence and adjusted odds of 4 types of disability among 7 groups of older Asian American/Pacific Islander (AAPI) subpopulations, both separately and aggregated, compared with non-Hispanic Whites. METHODS: Data were from the nationally representative 2006 American Community Survey, which included institutionalized and community-dwelling Hawaiian/Pacific Islander (n = 524), Vietnamese (n = 2357), Korean (n = 2082), Japanese (n = 3230), Filipino (n = 5109), Asian Indian (n = 2942), Chinese (n = 6034), and non-Hispanic White (n = 641 177) individuals aged 55 years and older. The weighted prevalence, population estimates, and odds ratios of 4 types of disability (functional limitations, limitations in activities of daily living, cognitive problems, and blindness or deafness) were reported for each group. RESULTS: Disability rates in older adults varied more among AAPI subpopulations than between non-Hispanic Whites and the aggregated Asian group. Asian older adults had, on average, better disability outcomes than did non-Hispanic Whites. CONCLUSIONS: This study provides the strongest evidence to date that exclusion of institutionalized older adults minimizes disparities in disabilities between Asians and Whites. The aggregation of Asians into one group obscures substantial subgroup variability and fails to identify the most vulnerable groups (e.g., Hawaiian/Pacific Islanders and Vietnamese).

Black-White disparities in disability among older Americans: further untangling the role of race and socioeconomic status.

OBJECTIVE: To explore the impact of adjusting for income and education on disparities in functional limitations and limitations in activities of daily living (ADLs) between Black and White older Americans. METHOD: Data from the 2003 American Community Survey were used to examine the associations of education and income, stratified by race and gender, with functional limitations and ADLs, in a sample of 16,870 non-Hispanic Blacks and 186,086 non-Hispanic Whites aged 55 to 74. Sequential logistic regressions were used to examine the relative contribution of income and education to racial disparities. RESULTS: Ninety percent of the Black-White difference in disability rates for men and 75% of the difference for women aged 55 to 64 were explained by income and education. DISCUSSION: The greatly elevated risk of disability among Blacks aged 55 to 74 is largely explained by differences in socioeconomic status. Reductions in Black-White health disparities require a better understanding of the mechanisms whereby lower income and education are associated with functional outcomes in older persons.

Making a link between childhood physical abuse and cancer: results from a regional representative survey.

BACKGROUND: Abuse in childhood is associated with many negative adult health outcomes. Only 1 study to date has found an association between childhood abuse and cancer. By using a regionally representative community sample, this preliminary study sought to investigate the association between childhood physical abuse and cancer while controlling for 3 clusters of risk factors: childhood stressors, adult health behaviors, and adult socioeconomic status. METHODS: Regional data from the Canadian provinces of Manitoba and Saskatchewan were selected from the 2005 Canadian Community Health Survey. Of the 13,092 respondents, 7.4% (n = 1025) reported that they had been physically abused as a child by someone close to them, and 5.7% (95% confidence interval [CI], 4.9-6.6) reported that they had been diagnosed with cancer by a health professional. The regional level response rate was 84%. RESULTS: Childhood physical abuse was associated with 49% higher odds (95% CI, 1.10-2.01) of cancer when adjusting for age, sex, and race only. The odds ratio decreased only slightly to 47% higher odds (95% CI, 1.05-1.99) when the model was adjusted for all 3 clusters of risk factors. CONCLUSIONS: A significant and highly stable association between childhood physical abuse and cancer was found even when adjusting for 3 clusters of risk factors. Further research focusing on the potential mechanisms linking childhood abuse and cancer is needed.

The association between depression and epilepsy in a nationally representative sample.

PURPOSE: To determine the: (1) national prevalence of epilepsy and depression; (2) prevalence of depression among those with epilepsy; (3) odds ratio of depression among those with epilepsy compared to those without, controlling for demographic characteristics; (4) demographic correlates of depression among those with epilepsy and those without; and, (5) health services utilization of those with epilepsy and depression. METHODS: The full sample of the nationally representative 2000/2001 Canadian Community Health Survey (n = 130,880) was used to determine prevalence of epilepsy and depression. A subsample of 781 individuals reporting an epilepsy diagnosis and with complete depression data was used to determine prevalence and correlates of depression, and health service utilization patterns. Correlates of depression among those without epilepsy (n = 126,104) were also determined. Chi-square analyses, t-tests, prevalence ratios, and a logistic regression were conducted. RESULTS: Thirteen percent of those with epilepsy were depressed, in comparison to 7% of those without (p < 0.001). Epilepsy was associated with 43% higher odds of depression when adjusting for demographic factors. The odds of depression among individuals with epilepsy were higher for females, visible minorities, older individuals, and individuals experiencing food insecurity. Visible minority and older age appear to be unique risk factors for depression in those with epilepsy as compared to those without. Thirty-eight percent of depressed respondents with epilepsy had no consultations with a mental health professional in the previous year. DISCUSSION: Medical professionals need to regularly assess levels of depression in their patients with epilepsy. This research helps guide which risk groups should be targeted.