Racial and ethnic differences in obesity and overweight as predictors of the onset of functional impairment

OBJECTIVES

To examine racial and ethnic differences in the effects of body mass index (BMI) on the onset of functional impairment over 10 years of follow-up.

DESIGN

Longitudinal analyses of a cohort from a nationally representative survey of community-dwelling American adults.

SETTING

Six waves (1996-2006) of the Health and Retirement Study (HRS).

PARTICIPANTS

Two groups of HRS participants aged 50 and older without functional impairment at baseline (1996): 5,884 with no mobility difficulty and 8,484 with no activity of daily living (ADL) difficulty.

MEASUREMENTS

Mobility difficulty was a composite measure of difficulty walking several blocks, walking one block, climbing several flights of stairs, and climbing one flight of stairs. ADL difficulty was measured as difficulty in dressing, bathing or showering, eating, and getting in and out of bed without help. The association between baseline BMI and risk of developing functional impairment was estimated using generalized estimating equation models.

RESULTS

Overweight and obesity were significant predictors of functional impairment. Overweight and obese Hispanics were 41% and 91% more likely, respectively, to develop ADL disability than whites in the same BMI categories. Overweight and severely obese blacks were also more likely than their white counterparts to develop ADL disability. Risk of developing ADL difficulty was higher for Hispanics than for blacks in the obese category. No significant differences in onset of mobility difficulty were found between racial or ethnic groups within any BMI category.

CONCLUSION

Blacks and Hispanics were at higher risk than whites of ADL but not mobility impairment. In addition to weight control, prevention efforts should promote exercise to reduce functional impairment, especially for blacks and Hispanics, who are at higher risk.

Factors affecting reduction of gender differences in health care coverage for vocational rehabilitation clients with disabilities

BACKGROUND

Uninsured women with disabilities experience serious difficulties in accessing quality health care. Employment improves an individual's ability to access health insurance. The aim of Vocational Rehabilitation Services (VR) is to improve employment abilities for people with disabilities.

STUDY PURPOSE

To examine gender differences in health insurance coverage for people who access VR and the factors that influence health insurance coverage for people with disabilities.

METHODS

The study analyzed VR case management data from 617,149 cases that were closed by VR in 2006 in the United States. Chi-square and t-tests were used to examine gender differences and multivariate analysis was used to assess factors that influence health insurance coverage.

PRINCIPAL FINDINGS

The study found significant gender differences in access to VR employment-enhancing services and in insurance coverage. Women were more dependent on coverage from public sources.

CONCLUSION

VR can improve health insurance coverage but is more effective with men than with women.

Factors Affecting Vocational Rehabilitation Intervention Outcomes

Vocational rehabilitation (VR) services are designed to help individuals with disabilities achieve gainful employment. This study examines VR’s effectiveness in assisting minorities achieve gainful employment. The study uses case management data from 617,149 cases closed by VR in 2006 in all states. It examines differences in access, employment, and earnings for White and ethnic minority clients. Multivariate techniques are used to assess factors that influence competitive employment outcomes, hourly earnings, and hours worked. Findings show significant differences in employment and earnings outcomes for minority and majority clients, with minorities faring worse. VR intervention length and per capita expenditures for services significantly influence employment and earnings outcomes. VR is more effective with White than with minority clients. There is a need to implement policies or practices that ensure equity in access to services that might translate into more equitable employment and earnings outcomes.