title: Physical disability trajectories in older Americans with and without diabetes: the role of age, gender, race or ethnicity, and education.
abstract: OBJECTIVE
  This research combined cross-sectional and longitudinal data to characterize age-related trajectories in physical disability for adults with and without diabetes in the United States and to investigate if those patterns differ by age, gender, race or ethnicity, and education.
  
  
  METHODS
  Data were examined on 20,433 adults aged 51 and older from the 1998 to 2006 Health and Retirement Study. Multilevel models and a cohort-sequential design were applied to quantitatively depict the age norm of physical disability after age 50.
  
  
  RESULTS
  Adults with diabetes not only experience greater levels of physical disability but also faster rates of deterioration over time. This pattern is net of attrition, time-invariant sociodemographic factors, and time-varying chronic disease conditions. Differences in physical disability between adults with and without diabetes were more pronounced in women, non-White, and those of lower education. The moderating effects of gender and education remained robust even after controlling for selected covariates in the model.
  
  
  CONCLUSIONS
  This study highlighted the consistently greater development of disability over time in adults with diabetes and particularly in those who are women, non-White, or adults of lower education. Future studies are recommended to examine the mechanisms underlying the differential effects of diabetes on physical disability by gender and education.
authors: Department of Biobehavioral Health, 315 HHD East, The Pennsylvania State University, University Park, PA 16802, USA. cuc197@psu.edu
authors: Ching-Ju
authors: CJ
authors: Chiu
authors: Linda A
authors: LA
authors: Wray
mesh_terms: D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000503:physiopathology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D044469:Racial Groups; D017678:Sex Distribution; D013997:Time Factors; D014481:United States