Abstract
Background As life expectancy increases, healthy ageing becomes more salient, and therefore it is important to understand how conditions such as disability may affect the later years of our extended lives. Ethnic differences in disability have been observed in some countries, however there is a lack of evidence from British ethnic groups. Methods Follow-up data over 20 years from 1789 White, Indian Asian and African Caribbean men and women were examined from a community-based study in West London. Disability was measured using the performance-based test of locomotor function and self-reported functional limitation, instrumental and basic activities of daily living (IADL/ADL) questionnaires. Logistic regression analyses examined ethnic group differences in disability, adjusting for socioeconomic, behavioural, adiposity and chronic disease risk factors. Results After full adjustment, Indian Asian people were significantly more likely to have developed all of the disability outcomes, compared with UK Whites (locomotor dysfunction: OR 2.20, 95% CI 1.56–3.11; functional limitation: OR 2.77, 2.01–3.81; IADL impairment: OR 3.12, 2.20–4.41; ADL impairment: OR 1.56, 1.11–2.24). Health behaviours, central adiposity, and chronic disease burden explained only a proportion of this excess risk. There were no ethnic group differences in locomotor dysfunction, functional limitation and IADL impairment between African Caribbean and White participants, however African Caribbean people showed a reduced risk of ADL impairment (OR 0.59, 0.38–0.93), after multivariate adjustment. Conclusion These findings demonstrate dramatic ethnic group differences in performance-based and self-reported disability between White, Indian Asian, and African Caribbean people in the UK. The excessive risk experienced by Indian Asian people was partly explained by health behaviours, adiposity, and chronic disease, however considerable inequalities remained. Other possible explanations for this vulnerability to disability among Indian Asian people will be discussed. Such inequalities are likely to have a detrimental impact on quality of life and morbidity in later years, and therefore, more research is urgently needed to understand these large ethnic inequalities in disability.