Racial, Ethnic, Nativity, and Educational Disparities in Cognitive Impairment and Activity Limitations in the United States, 1998-2016

Despite exten sive research on cog ni tive impair ment and lim i ta tions in basic activ i ties of daily liv ing, no study has inves ti gated the bur den of their co-occur rence (co-impair ment). Using the Health and Retirement Study data and inci dence-based mul ti state mod els, we study the pop u la tion bur den of co-impair ment using three key indi ca tors: mean age at onset, life time risk, and health expec tancy. We exam ine pat terns by gen der, race, eth nic ity, nativ ity, edu ca tion, and their inter ac tions for U.S. res i dents aged 50-100. Furthermore, we ana lyze what frac tions of racial, eth nic, and nativ-ity disparities in co-impair ment are attrib ut able to inequalities in edu ca tional attain-ment. Results reveal that an esti mated 56% of women and 41% of men aged 50 will expe ri ence co-impair ment in their remaining life expec tancy. Men expe ri ence an ear-lier onset of co-impair ment than women (74 vs. 77 years), and women live lon ger in co-impair ment than men (3.4 vs. 1.9 years). Individuals who are Black, Latinx, and lower educated, especially those experiencing intersecting disadvantages, have substan-tially higher life time risk of co-impair ment, ear lier co-impair ment onset, and lon ger life in co-impair ment than their coun ter parts. Up to 75% of racial, eth nic, and nativ ity dis-parity is attributable to inequality in educational attainment. This study provides novel insights into the bur den of co-impair ment and offers evi dence of dra matic disparities in the older U.S. pop u la tion.