Older Asian Americans and Pacific Islanders with Activities of Daily Living (ADL) Limitations: Immigration and Other Factors Associated with Institutionalization
Abstract
:1. Introduction
- (1) The prevalence of institutionalization among those with ADL limitations will be significantly lower for each of the Asian groups in comparison to non-Hispanic whites and that significant difference will remain after accounting for differences in key risk factors.
- (2) Among Asians, those who speak English at home will be more likely to be institutionalized
- (3) There will be significant variation in the odds of institutionalization among the different Asian ethnicities, even after adjustments for key risk factors.
- (4) Non-citizens will be less likely to be institutionalized than citizens.
2. Methods
2.1. Data Source
2.2. Measures
2.3. Data Analysis
3. Results
Weighted estimates according to ethnicity | ||||||||
---|---|---|---|---|---|---|---|---|
Characteristic | Chinese | Pacific Islander | Vietnamese | Korean | Japanese | Filipino | Asian Indian | Non-Hispanic White |
N = 43,218 | N=5,966 | N = 22,460 | N = 14,148 | N = 17,258 | N = 32,102 | N = 18,671 | N = 4,915,191 | |
Institutionalization | ||||||||
Not Institutionalized | 37,500 | 5,286 | 21,220 | 11,489 | 14,431 | 29,159 | 17,799 | 3,743,339 |
(86.8%) | (88.6%) | (94.5%) | (81.2%) | (83.6%) | (90.8%) | (95.3%) | (76.2%) | |
Institutionalized | 5,718 | 680 | 680 | 1,240 | 2,659 | 2,827 | 872 | 1,171,852 |
(13.2%) | (11.4%) | (5.5%) | (18.8%) | (16.4%) | (9.2%) | (4.7%) | (23.8%) | |
Gender | ||||||||
Male | 16,780 | 2,764 | 9,991 | 4,740 | 6,256 | 10,636 | 6,733 | 1,712,285 |
(38.8%) | (46.3%) | (44.5%) | (33.5%) | (36.2%) | (33.1%) | (36.1%) | (34.8%) | |
Female | 26,438 | 3,202 | 12,469 | 9,408 | 11,002 | 21,466 | 11,938 | 3,202,906 |
(61.2%) | (53.7%) | (55.5%) | (66.5%) | (63.8%) | (66.9%) | (63.9%) | (65.2%) | |
Age | ||||||||
55–64 | 6,316 | 1,990 | 5,167 | 1,697 | 1,919 | 6,400 | 4,333 | 1,060,053 |
(14.6%) | (33.4%) | (23.0%) | (12.0%) | (11.1%) | (19.9%) | (23.2%) | (21.6%) | |
65–74 | 8,346 | 1,462 | 6,351 | 3,251 | 2,244 | 6,150 | 5,416 | 909,278 |
(19.3%) | (24.5%) | (28.3%) | (23.0%) | (13.0%) | (19.2%) | (29.0%) | (18.5%) | |
75–84 | 16,081 | 1,776 | 7,166 | 6,132 | 5,983 | 11,463 | 5,470 | 1,481,325 |
(37.2%) | (29.8%) | (31.9%) | (43.3%) | (34.7%) | (35.7%) | (29.3%) | (30.1%) | |
85+ | 12,475 | 738 | 3,776 | 3,068 | 7,112 | 8,089 | 3,452 | 1,464,535 |
(28.9%) | (12.4%) | (16.8%) | (21.7%) | (41.2%) | (25.2%) | (18.5%) | (29.8%) | |
Marital Status | ||||||||
Not Married | 23,476 | 3,524 | 10,774 | 8,611 | 9,561 | 16,598 | 8,655 | 3,086,557 |
(54.3%) | (59.1%) | (48.0%) | (60.9%) | (55.4%) | (51.7%) | (46.4%) | (62.8%) | |
Married | 19,742 | 2,442 | 11,686 | 5,537 | 7,697 | 15,504 | 10,016 | 1,828,634 |
(45.7%) | (40.9%) | (52.0%) | (39.1%) | (44.6%) | (48.3%) | (53.6%) | (37.2%) | |
Education (Highest completed) | ||||||||
Primary School | 19,642 | 2,353 | 9,404 | 3,773 | 2,782 | 8,834 | 7,895 | 854,930 |
(45.4%) | (39.4%) | (41.9%) | (26.7%) | (16.1%) | (27.5%) | (42.3%) | (17.4%) | |
High School—No Diploma | 4,191 | 857 | 4,295 | 2,076 | 2,737 | 3,043 | 2,201 | 771,061 |
(9.7%) | (14.4%) | (19.1%) | (14.7%) | (15.9%) | (9.5%) | (11.8%) | (15.7%) | |
High School Diploma | 13,508 | 2,580 | 6,941 | 5,551 | 8,639 | 12,377 | 4,658 | 2,661,023 |
(31.3%) | (43.2%) | (30.9%) | (39.2%) | (50.1%) | (38.6%) | (24.9%) | (54.1%) | |
Bachelors’ Degree | 3,670 | 76 | 1,322 | 1883 | 2,293 | 6,557 | 2,216 | 390,941 |
(8.5%) | (1.3%) | (5.9%) | (13.3%) | (13.3%) | (20.4%) | (11.9%) | (8.0%) | |
Graduate Degree | 2,207 | 100 | 498 | 865 | 807 | 1,291 | 1,701 | 237,236 |
(5.1%) | (1.7%) | (2.2%) | (6.1%) | (4.7%) | (4.0%) | (9.1%) | (4.8%) | |
Poverty Level 1 | ||||||||
Under poverty line | 7,498 | 996 | 4,910 | 3,052 | 1,444 | 3,511 | 2,590 | 610,078 |
(20.0%) | (18.8%) | (23.1%) | (26.6%) | (10.0%) | (12.0%) | (14.6%) | (16.3%) | |
100–199% | 10,218 | 975 | 4,465 | 3,700 | 2,539 | 6,236 | 2,984 | 1,057,774 |
(27.2%) | (18.4%) | (21.0%) | (32.2%) | (17.6%) | (21.4%) | (16.8%) | (28.3%) | |
200–299% | 4,993 | 1,298 | 4,343 | 1,319 | 2,301 | 2,944 | 2,606 | 713,717 |
(13.3%) | (24.6%) | (20.5%) | (11.5%) | (15.9%) | (10.1%) | (14.6%) | (19.1%) | |
300–399% | 4,410 | 291 | 2,210 | 637 | 2,491 | 4,882 | 2,976 | 462,692 |
(11.8%) | (5.5%) | (10.4%) | (5.5%) | (17.3%) | (16.7%) | (16.7%) | (12.4%) | |
400–499% | 2,870 | 623 | 1,762 | 479 | 904 | 3,559 | 2,210 | 297,961 |
(7.7%) | (11.8%) | (8.3%) | (4.2%) | (6.3%) | (12.2%) | (12.4%) | (8.0%) | |
500%+ | 7,511 | 1,103 | 3,530 | 2,302 | 4,752 | 8,027 | 4,433 | 601,117 |
(20.0%) | (20.9%) | (16.6%) | (20.0%) | (32.9%) | (27.5%) | (24.9%) | (16.1%) | |
Cognitive Problems | ||||||||
No Problems | 14,440 | 2,196 | 5,854 | 4,272 | 5,192 | 12,894 | 7,095 | 2,086,130 |
(33.4%) | (36.8%) | (26.1%) | (30.2%) | (30.1%) | (40.2%) | (38.0%) | (42.4%) | |
Some Cognitive Problems | 28,778 | 3,770 | 16,606 | 9,876 | 12,066 | 19,208 | 11,576 | 2,829,061 |
(66.6%) | (63.2%) | (73.9%) | (69.8%) | (69.9%) | (59.8%) | (62.0%) | (57.6%) | |
Citizenship | ||||||||
American by birth or naturalization | 35,177 | 5,023 | 16,954 | 10,272 | 16,428 | 26,096 | 10,455 | 4,856,583 |
(81.4%) | (84.2%) | (75.5%) | (72.6%) | (95.2%) | (81.3%) | (56.0%) | (98.8%) | |
Not a citizen | 8,041 | 943 | 5,506 | 3,876 | 830 | 6,006 | 8,216 | 58,608 |
(18.6%) | (15.8%) | (24.5%) | (27.4%) | (4.8%) | (18.7%) | (44.0%) | (1.2%) | |
Language spoken at home | ||||||||
Speaks English at home | 3,409 | 2,629 | 2,346 | 556 | 9,212 | 3,464 | 3,535 | 4,519,002 |
(7.9%) | (44.1%) | (10.4%) | (3.9%) | (53.4%) | (10.8%) | (18.9%) | (91.9%) | |
Doesn’t Speak English at home | 39,809 | 3,337 | 20,114 | 13,592 | 8,046 | 28,638 | 15,136 | 396,189 |
(92.1%) | (55.9%) | (89.6%) | (96.1%) | (46.6%) | (89.2%) | (81.1%) | (8.1%) |
Characteristic | Model 1 | Model 2 |
---|---|---|
OR (95% Confidence Interval) | OR (95% Confidence Interval) | |
Race | ||
Non-Hispanic White | 1.00 (Ref) | 1.00 (Ref) |
Chinese | 0.44 (0.34, 0.58) | 0.70 (0.53, 0.93) |
Hawaiian/ Pacific Islander | 0.55 (0.25, 1.19) | 0.55 (0.25, 1.21) |
Vietnamese | 0.22 (0.12, 0.37) | 0.31 (0.18, 0.55) |
Korean | 0.72 (0.48, 1.09) | 1.25 (0.82, 1.92) |
Japanese | 0.50 (0.34, 0.73) | 0.58 (0.39, 0.87) |
Filipino | 0.31 (0.21, 0.45) | 0.51 (0.35, 0.75) |
Asian Indian | 0.17 (0.09, 0.33) | 0.29 (0.15, 0.57) |
Gender | ||
Male | 1.00 (Ref) | 1.00 (Ref) |
Female | 1.33 (1.27, 1.39) | 1.08 (1.03, 1.13) |
Age | ||
55–64 | 1.00 (Ref) | 1.00 (Ref) |
65–74 | 2.19 (2.00, 2.39) | 2.31 (2.11, 2.53) |
75–84 | 4.34 (4.01, 4.69) | 4.01 (3.71, 4.35) |
85+ | 8.13 (7.53, 8.77) | 6.25 (5.78, 6.76) |
Marital Status | ||
Not married | --- | 1.00 (Ref) |
Married | --- | 0.43 (0.41, 0.46) |
Education (Highest completed) | ||
Graduate Degree | --- | 1.00 (Ref) |
Bachelors’ Degree | --- | 1.24 (1.09, 1.42) |
High School Diploma | --- | 1.36 (1.22, 1.53) |
High School—No Diploma | --- | 1.32 (1.17, 1.49) |
Primary School | --- | 1.46 (1.30, 1.64) |
Cognitive Problems | ||
No Problems | --- | 1.00 (Ref) |
Some Cognitive Problems | --- | 2.63 (2.51, 2.76) |
Citizenship | ||
Not a citizen | --- | 1.00 (Ref) |
American by birth or naturalization | --- | 2.20 (1.73, 2.80) |
Language spoken at home | ||
Doesn’t Speak English at home | --- | 1.00 (Ref) |
Speaks English at home | --- | 1.66 (1.53, 1.81) |
Characteristic | OR (95% Confidence Interval) |
---|---|
Chinese | 1.00 (Ref) |
Hawaiian/Pacific Islander | 0.69 (0.27, 1.80) |
Vietnamese | 0.37 (0.19, 0.74) |
Korean | 1.62 (0.93, 2.81) |
Japanese | 0.65 (0.36, 1.17) |
Filipino | 0.71 (0.43, 1.19) |
Asian Indian | 0.31 (0.14, 0.71) |
Male | 1.00 (Ref) |
Female | 0.83 (0.56, 1.24) |
55–64 | 1.00 (Ref) |
65–74 | 1.81 (0.79, 4.14) |
75–84 | 2.70 (1.27, 5.74) |
85+ | 5.18 (2.43, 11.06) |
Married | 1.00 (Ref) |
Not married | 1.72 (1.13, 2.60) |
Graduate Degree | 1.00 (Ref) |
Bachelors’ Degree | 1.00 (0.35, 2.86) |
High School Diploma | 1.30 (0.51, 3.32) |
High School—No Diploma | 2.11 (0.80, 5.60) |
Primary School | 0.87 (0.34, 2.25) |
No Cognitive Problems | 1.00 (Ref) |
Some Cognitive Problems | 3.80 (2.30, 6.28) |
Not a citizen | 1.00 (Ref) |
American by birth or naturalization | 1.07 (0.67, 1.73) |
Doesn’t Speak English at home | 1.00 (Ref) |
Speaks English at home | 2.26 (1.42, 3.61) |
4. Discussion and Conclusions
Acknowledgments
Conflict of Interest
References
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Share and Cite
Fuller-Thomson, E.; Chi, M. Older Asian Americans and Pacific Islanders with Activities of Daily Living (ADL) Limitations: Immigration and Other Factors Associated with Institutionalization. Int. J. Environ. Res. Public Health 2012, 9, 3264-3279. https://doi.org/10.3390/ijerph9093264
Fuller-Thomson E, Chi M. Older Asian Americans and Pacific Islanders with Activities of Daily Living (ADL) Limitations: Immigration and Other Factors Associated with Institutionalization. International Journal of Environmental Research and Public Health. 2012; 9(9):3264-3279. https://doi.org/10.3390/ijerph9093264
Chicago/Turabian StyleFuller-Thomson, Esme, and Monica Chi. 2012. "Older Asian Americans and Pacific Islanders with Activities of Daily Living (ADL) Limitations: Immigration and Other Factors Associated with Institutionalization" International Journal of Environmental Research and Public Health 9, no. 9: 3264-3279. https://doi.org/10.3390/ijerph9093264