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The Role of Race and Age in Those With Multiple Health Conditions

For older adults with multiple health conditions, race might not play as much of a role as once thought

Ana Quiñones, PhD
Photograph by Eric Karl

Ana Quiñones, PhD

Occupation
Gerontologist at Oregon Health and Science University

Focus
Epidemiology

American Diabetes Association Research Funding
Career Development

As people age, their health problems increase. Older adults with diabetes are often dealing with other chronic illnesses at the same time: 67 percent of Americans over 50 have more than one chronic disease, with type 2 diabetes being one of the most common.

The added load of juggling several different conditions makes it more difficult for people to keep their diabetes well managed. That, in turn, can exacerbate their other health issues—from arthritis and heart disease to high blood pressure and nerve damage (neuropathy). “In older adults, the most common condition is having more than one chronic condition,” says Ana Quiñones, PhD, a gerontologist at Oregon Health and Science University in Portland. “We’re finding older adults have a large range of conditions alongside their diabetes.”

When it comes to specific conditions, previous research has found a link with race. One recent study estimated that African Americans and Latinos develop type 2 diabetes six years earlier than their white counterparts, for example.And African Americans and Latinos tend to get sick younger—and die earlier. “Blacks exhibit earlier onset of chronic disease, in greater numbers than whites,” Quiñones says. “There are populations that are more vulnerable and see more disease burden earlier.”

She’s spent the past five years trying to find out if race and ethnicity also play a role in the combination of diseases older adults develop. When she began her project, she guessed that there would be racial and ethnic differences in the combination of health problems older adults deal with—and that people of different ethnicities would respond differently to certain treatments.

Her research project was supported by an American Diabetes Association career development grant, funding designed to give young scientists support to pursue promising leads and develop their ideas. Quiñones used it to look at broad trends in health, at the impact neighborhoods have on the health of older adults, and at the benefits of comprehensive care, a health care strategy that puts a nurse in charge of coordinating different parts of a patient’s health care team.

Older adults with diabetes and one or more chronic illnesses were at the center of her research. For example, she wondered if whites, African Americans, and Latinos would have different combinations of chronic diseases, and whether that might explain the differences in mortality among the groups.

As she crunched the numbers, Quiñones was surprised to see ethnicity and race didn’t play the role she expected. “We’re not finding much difference between ethnic groups,” Quiñones says. “The combinations look really similar.” Arthritis, hypertension, and diabetes characterize African Americans, Hispanics, and whites.

And across the board, mental health was a pivotal factor for adults over 50. Older people with depression alongside other conditions were much less likely to live independent lives. “People with depression, combined with other conditions, have much greater rates of disability than others,” says Quiñones, who hopes to focus future research on the role of depression and other conditions, including diabetes.

Her look at disease treatment, too, turned up more similarities than differences. “When it came to care management, we were also surprised,” Quiñones says. For instance, when she studied coordinated care—in which a nurse practitioner was in charge of managing different aspects of a patient’s medical care, including specialists treating various health conditions—she expected the concept to improve the health outcomes of older minority patients in particular. But when she and her team crunched the numbers, people from all ethnic groups benefited equally from help juggling different medical specialists. “We saw improvements for all patients, regardless of race,” Quiñones says.

Quiñones’ ADA-supported work has changed the way she sees the connections between race and diabetes. “When we broadened it out to older adults, it’s surprising how consistent the script has been in terms of what diseases we’re dealing with,” she says. Race and ethnicity don’t seem to matter when it comes to combinations of health conditions in older adults.

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