Methods and Prevalence of ADL Limitations in Hispanic and Non-Hispanic White Subjects in Rural Colorado: The San Luis Valley Health and Aging Study RICHARD F. HAMMAN, MD, DrPH, CHRISTINE L. MULGREW, PHD, MPH, JUDITH BAXTER, MA, SUSAN M. SHETTERLY, MS, CAROLYN SWENSON, MSN, FNP, AND NORA E. MORGENSTERN, MD PURPOSE: The Hispanic population in the United States is the fastest growing minority group, yet there is little understanding of the disability patterns that occur as this population ages. We conducted a cross-sectional study to define the prevalence of limitations of activities of daily living (ADL) and measures of observed function. METHODS: We censussed two rural counties in southern Colorado and selected a stratified sample of both Hispanic and non-Hispanic white (NHW) residents; 81.6% completed the protocol. RESULTS: Among the 1250 subjects aged 65 years and older, Hispanic elderly living in the community had greater ADL disability than NHW subjects, both for any difficulty (p = 0.006), and for needing assistance (p = 0.002). Hispanic persons were less likely to reside in nursing homes (3.4%) compared with NHW persons (9.3%). Hispanic elderly had excess prevalence of dependent ADL tasks (needs assistance or unable to do), (age, gender-adjusted odds ratio = 1.39, 95% CI = 1.01–1.92) in community dwelling and nursing home residents combined. There was no Hispanic excess of less severe difficulty compared with NHW persons, and there was a similar prevalence of limitation on observed functional tasks (timed walk, stooping, rising from a chair) in both groups. CONCLUSIONS: There was a modest Hispanic excess of reported dependent ADL limitation, and no excess of observed functional difficulties. Hispanics enter older age with much less income and education, yet they do not have a marked excess prevalence of limitations in activities of daily living when compared with NHW persons living in the same area. Ann Epidemiol 1999;9:225–235.  1999 Elsevier Science Inc. All rights reserved. KEY WORDS: Hispanic Americans, Activities of Daily Living, Disability, Prevalence, Ethnic Groups. The Hispanic population has been considered an “epide- INTRODUCTION miologic paradox” with socioeconomic conditions favoring The Hispanic population in the United States is the fastest selected higher disease rates, yet they have better patterns growing minority group (1), yet little attention has been of infant mortality, cardiovascular disease, and cancer of paid to understanding disability patterns as this population major sites than non-Hispanic whites (NHWs) (5, 6). Lim- ages (2). As persons age, the prevalence of functional dis- ited data are available on disability and functional limita- ability and dependence increases, requiring additional fam- tions among Hispanics. Data from the late 1970s suggests ily and health care support (3). Hispanic persons attain that Hispanic subjects have greater restricted activity days older ages with less formal education and lower income per person per year (46.5 vs. 38.7 for NHWs), and higher levels (4), and they often live in circumstances where the bed disability days (20.7 vs. 12.9) (6). Markides and col- health care system is poorly equipped to deal with chronic leagues have recently shown that many chronic conditions debilitating conditions. (stroke, arthritis, heart attack, hip fracture, etc.) are associ- ated with difficulties performing activities of daily living (ADL) in Hispanic elders (7), similar to majority popula- tions. However, they noted a greater impact from stroke From the Department of Preventive Medicine and Biometrics (R.F.H., C.L.M., J.B., S.M.S., C.S.) and the Department of Medicine, Center on and hip fracture on ADL limitations in their community Aging (N.E.M.), University of Colorado School of Medicine, Denver, dwelling Hispanic elders than was reported in the Framing- Colorado. ham Disability Study (8). Haan and Weldon recently com- Address reprint requests to: Richard F. Hamman, M.D., Dr.P.H., Depart- ment of Preventive Medicine and Biometrics, University of Colorado pleted a community-based survey of Hispanic and NHW School of Medicine, Box C245, 4200 East Ninth Avenue, Denver, Colo- subjects living in 14 census block groups in Sacramento, rado, 80262. Received June 27, 1997; Revised May 18, 1998; Accepted May 20, 1998. California (9). They found somewhat higher mean numbers  1999 Elsevier Science Inc. All rights reserved. 1047-2797/99/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S1047-2797(98)00036-2