Transitions among disability levels or death in African American and white older women.

BACKGROUND: This study examined the racial differences in probabilities of transitioning across three disability levels of walking (1/2) 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 (1/2) 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 (1/2) 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.