Sociocultural status and burden of disability in aging Mexican Americans

Based on U.S. Census reports (Hispanic Americans: Census Facts. 2011. Retrieved August 1, 2011, from http://www.infoplease.com/spot/hhmcensus1.html) the United States Hispanic population has more than doubled during the past two decades, from 22.4 million in 1990 to 48.4 million in 2009 (16% of the population). Hispanics are the fasting growing ethnic group in the United States and are expected to comprise over 15% of the older United States population in 2050 (U.S. Bureau of the Census). Mexican-origin Hispanics (Mexican Americans) comprise 66% of the Hispanic population, and older Mexican Americans have higher rates of dependency, i.e., needing assistance from others, in activities of daily living than do European Americans (Hazuda, H. P., & Espino, D. V. 1997. Aging, chronic disease, and physical disability in Hispanic elderly. In K.S. Markides & M. Mirnda (Eds.) Minorities, Aging, and Health (pp. 127-148). Thousand Oaks, CA: Sage; Shetterly, S. M., Baxter, J., Morgenstern, N. E., Grigsby, J., & Hamman, R. F. 1998. Higher instrumental activities of daily living disability in Hispanics compared with non-Hispanic Whites in rural Colorado: The San Luis Valley Health and Aging Study. American Journal of Epidemiology 147:1019-1027; Hamman, R. F., Mulgrew, C. L., Baxter, J., Shetterly, S. M., Swenson, C., & Morgenstern, N. E. 1999. Methods and prevalence of ADL limitations in Hispanic and non-Hispanic White subjects in rural Colorado: The San Luis Valley Health and Aging Study. Annals of Epidemiology 9:225-235). A key factor contributing to this higher rate of dependency in older Mexican Americans may be the high prevalence of diabetes, which is 1.5-2 times greater than that in older European Americans (Hazuda et al.) and has been identified as a major cause of disability and dependence (Gregg, E. W., Beckles, G. L., Williamson, D. F., Leveille, S. G., Langlois, J. A., Engelgau, M. M., and Narayan, K. M. V. 2000. Diabetes and physical disability among older U.S. adults. Diabetes Care 23:1272-1277). The generally lower socioeconomic status (SES) of older Mexican Americans relative to European Americans is also likely to play a role as there is evidence that both education and income are associated with an inverse gradient of disability in later life, at least up to age 85 (Minkler, M., Fuller-Thompson, E., & Guralnik, J. M. 2006. Gradient of disability across the socioeconomic spectrum in the United States. The New England Journal of Medicine 355:695-703). Little attention has been given to systematically examining the relative contribution of specific diseases and sociocultural status (SES and acculturation-assimilation) to disability within the context of a theoretical framework that accounts for the role of both types of factors in the development of disability.