title: Inner city, middle-aged African Americans have excess frank and subclinical disability.
abstract: BACKGROUND
  Healthy People 2010 seeks to decrease or eliminate the health disparities experienced by disadvantaged minority groups.
  
  
  METHODS
  African American Health (AAH) is a population-based panel study of community-dwelling African Americans born between 1936 and 1950 from two strata. The first encompasses a poor, inner city area, and the second involves a suburban population with higher socioeconomic status. The authors recruited 998 participants (76% recruitment). Frank disability was assessed for 25 tasks and defined as inability or difficulty performing that task. Subclinical disability was assessed for 12 tasks and defined as no difficulty but a change in either manner or frequency of task performance. Frank disability prevalences were compared with national data for community-dwelling non-Hispanic white persons (NHW) and African American persons in the same age range.
  
  
  RESULTS
  Compared with the suburban sample, the inner city group had a higher prevalence of frank disability for all 25 tasks (p<.05 for 16) and subclinical disability for 11 of the 12 tasks (p<.05 for 5). Both strata had more frank disability compared with the national NHW population. The inner city area had higher frank disability proportions than did the national African American sample, whereas the suburban group had similar disability levels.
  
  
  CONCLUSIONS
  The AAH inner city group experiences more frank disability than other populations of African Americans and NHWs. The increased prevalence of subclinical disability in the inner city group compared with the suburban group suggests that the disparity in frank disability will continue. These findings indicate that African Americans living in poor inner city areas in particular need intensive and targeted clinical and public health efforts.
authors.affiliation: School of Medicine, Saint Louis University, St. Louis, Missouri, USA. dokmille@iupui.edu
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Miller
authors.forename: Fredric D
authors.initials: FD
authors.lastname: Wolinsky
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Malmstrom
authors.forename: Elena M
authors.initials: EM
authors.lastname: Andresen
authors.forename: J Philip
authors.initials: JP
authors.lastname: Miller
mesh_terms: D001741:Black or African American; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012923:Social Class; D014481:United States / Q000453:epidemiology; D014505:Urban Population