The Journals of Gerontology Series A: Biological Sciences and Medical Sciences Advance Access originally published online on February 19, 2009
The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2009 64A(6):670-674; doi:10.1093/gerona/glp010
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Transitions Among Disability Levels or Death in African American and White Older Women
1 Department of Health Policy and Management
2 Hopkins Center for Health Disparities Solutions, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
3 Department of Medicine, Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
4 Center on Aging and Health, The Johns Hopkins University School of Medicine, Baltimore, Maryland
Address correspondence to Roland J. Thorpe, Jr., PhD, Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Suite 441, Baltimore, MD 21205. Email: rthorpe{at}jhsph.edu
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Abstract |
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Background: This study examined the racial differences in probabilities of transitioning across three disability levels of walking 
mile in a community-dwelling population of older women.
Methods: The sample comprised 436 community-dwelling older women who were among the two-third least disabled women in Baltimore, Maryland. The levels of disability status of walking mile included high functioning defined as reporting no difficulty, preclinical disability defined as reports of task modification but no reported difficulty, and disability defined as reported difficulty. First-order Markov transition models were specified to determine whether race influences the types of individual-level transitions between difficulty levels of walking mile.
Results: Among high-functioning women, African Americans were more likely to be disabled at the next round than their White counterparts. African American women who began with preclinical disability were more likely to die before the next round. After adjusting for age, education, and perceived income inadequacy, African American women tended to have an increased risk of becoming disabled if preclinically disabled than White women.
Conclusions: Prevention through identification of individuals at an early phase of decline appears to be key to addressing racial disparities in physical disability even in later life.
Keywords Racial disparities; Preclinical disability; Mobility disability; Walking
Received: November 30, 2007; Accepted: October 20, 2009