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Primary Submission Category: Aging

An intersectional analysis of birth cohort trends in activity limitations among U.S. adults before midlife

Authors:  Natalie Rivadeneira, Natalicio Serrano, Joanna Maselko, Ganga Bey,

Presenting Author: Natalie Rivadeneira*

Studies of birth cohort trends for various health outcomes have demonstrated poorer health in more recent birth cohorts. Few studies have considered how race and gender intersect to shape lived experiences that can impact birth cohort differences. This study uses an intersectionality approach to evaluate birth cohort trends in activity limitations among adults aged 30-45. We estimated cohort effects for activity limitation prevalence using cross-sectional data from the National Health Interview Survey between 1973 and 2016. We conducted an Age-Period-Cohort (APC) analysis using the median polish approach to calculate the prevalence ratios (PR) estimating birth cohort effects. We then calculated stratified estimates for race and gender (i.e., Black and White men and women). The overall prevalence of activity limitations among individuals aged 30-45 was higher in more recent birth cohorts than the earliest cohorts identified in the study. The cohort effect was 1.86 (95% CI: 1.07–3.29) for the 1983-1986 birth cohort relative to referent 1943-1946 birth cohort. When stratified by race and gender, this cohort effect was only seen in White men. Conversely, the prevalence among White women in the same cohort was significantly lower compared to the referent cohort. For Black men, significant cohort effects were pronounced in individuals born between the late 1940s and mid-1950s. There were no significant cohort effects for Black women, however Black women had higher prevalence across time periods and age groups relative to White Women. Modeling race/ethnicity and gender separately obscures important differences in activity limitation trends across populations, undermining efforts to develop effective interventions for promoting equity in healthy aging. Findings highlight the importance of an intersectionality approach to understanding health inequities.